Discogram question/concern...

[longroadahead]

I believe my next step in the ADR process is the discogram... Have read on this forum that there is usually more pain after the discogram than before and was a cause of concern for me.

Think I am a borderline case for ADR as my pain is not disabling but don't want it to be worst as I consider my options.

So I think I should have the discogram but can I expect pain to be worst after the discogram?

[Harrison]

It's always a concern, which is normal indeed! Please see this FAQ if you've not already -- there are many topics herein:

Discograms – what should I expect?

Mine was not bad at all, and actually inflated my disc for 3-4 days, which took pressure off the nerves. Of course, the headache I got was the worst ever...

[CharlesinCharge]

I had some moderate pain after my discograms (I had two of them), but do not really understand why people talk about them like they are medieval torture?! Yes, it does hurt when they pressurize a degenerated disc, that is the point of the test. But it was only for about 30 seconds to a minute, it was not like they were waterboarding me. They inject some anesthetic afterwards and you are sore (I iced my back for a few days), but it was no big deal.

In my opinion, you will NEVER know exactly how bad your disc is until you have a discogram. There is some debate in the spine community about the test, but it is still the best diagnostic tool they have to determine if a disc is a pain generator.

[steelskyway]

Hi Longroad!

Welcome! My first one in Feb 08 was not awful. The three days following the procedure I had more pain but just took it easy. A continuous ice pack is great. I did not have one for my first one.
I had another disco in April 09 the interesting thing is that since no pain was provoked I was pretty much asymptomatic the next day. I did have a continuous ice pack for the second one.

The apprehension is what gets to me about the "unknown". It is like "The Fog". Prepare for the worst and expect the best is always a way to help you through the ordeal.

Paul

[kimmers]

Did I get your attention, Longroadahead?

I'm just kidding. I have had two discograms thus far. One too many in my opinion. Had one 10-07 and another one, 4-16-09.

The first one (done by another doc), I was given Versed and it didn't quite work as when they said they were waking me up, I told them I was already awake.
So I did feel the anesthetic injected to numb my back, but did not feel the needles go into the discs (because they anesthetize down to the disc). They did three discs, L3/4 to L5/S1. They blindly pressurized the discs, but the first one was L3/4, which produced no pain. Then L4/5, which was an "ow, ow" and after I said the first ow, he put more pressure and that was an ow and ow and "8-9/10" and then he put Lidocaine into the disc and that felt good. It wore off and he injected it again. Then L5/S1, which was also an ow but not as bad. Lidocaine in that disc, too. Went off to another place to have a quick CT and then home to ice and more pain pills. This was thought to be a positive disc as L4/5 was actually extravated, or touching the nerve root.

Had a lot of pain afterwards and for about 10 days after that. I felt that the L4/5 disc got worse after that. My L5/S1 was thought to be painful because of referred pain, and now I don't know if that was true.
Had surgery in March 2008 on L4/5.

The disco last month, totally different. Different doc. They gave me Propofol (Diprovan), which is let me tell you, a great drug. It is conscious sedation and I was out. It was weird because I don't think i was totally awake and they already had the needles in my back in two of my discs and it went fast. I wasn't even aware they were pressurizing the discs. They just told me they were beginning. So apparently, no pain, at L3/4. Next, with L5/S1, I felt pain in my right leg, and lifted that leg off the table a bit and then the pain went to my back and they asked me how it was, and i told them "moderate". Then that was it. They told me it was over.
I know better to lift my leg off the table (I am a nurse) with six-inch needles sticking in my back, but I did, which i think meant I was not completely awake. And instead of saying, i felt 7-8/10 pain, i said it was moderate.
So my pain doc, thought my discogram was negative. He had to use a lot of pressure to cause pain at L5/S1. CT afterwards didn't show much.

However, in my "room" in the surgery center, where the disco was done, I had a lot of back pain. The anesethesiologist told me that she injected Toradol in my IV right before they pressurized the discs. I took 10 mg Percocet after the procedure. I might have gotten some more Toradol through the IV. I clarified to them what I meant by "moderate" pain. Waited about 30 minutes and then off to CT downstairs.
Home to ice pad.

Strangely, three days after the disco, I was icing my back, laying on the couch with my legs up on a pillow, and I got this all-of-a-sudden pain in my right thigh. I could not sleep, I took all the meds i could take that I had on hand and iced my back. Monday morning, I called my pain doc's office and told them about this excruciating pain and that I had quadrupled my pain meds. The pain would not go away and also moved to the outer edge of my right knee and inner part of my calf. It stayed that way for more than a week. For several days, I had a hard time putting pressure on that leg. It faded some, but a week-and-a-half after the disco, I had a facet block and it was still hurting.
I saw the pain doc in the office, on 4-24 and told him everything, but he considered my disco negative. My blood pressure was 154/117 (very high) that visit. I think he didn't see that.

The facet block on 4-30 was negative. And I didn't know what to think because I believed my thigh/knee/calf pain was from the discogram, irritating the L5/S1 disc.

Fast forward, to two weeks ago, appt with neurosurgeon. He was going over everything with me and he said, "I see your discogram was negative". And I told him about all the pain I had been having and how the discogram really felt and how I couldn't sit much, etc... It was more involved but the end-point, is that I am having surgery next month.

So discograms can vary. I think before the first one, I was more scared about it than anything and although it was painful, I did not consider it the most painful thing I have gone through. I had heard it was more painful than childbirth. I had unitended natural childbirth with my fourth child and it was not that painful by a mile. The pain in both actual discos lasted a very short time. They can inject Lidocaine into the disc to ease the pain.
I think I have a high pain tolerance so maybe some of these other people don't? I suppose if you had a doc that kept pressurizing when you are already at a high pain, then it could be more painful for sure.
It is done under fluorosope so the doc can see what your discs look like with the dye in them. I have heard if the disc is sequestered, leaking out beyond the disc, the test can hurt more. My disc in 2007 was obviously bad and the pain was just like the pain I had been feeling but just more intense. It was a tolerable test.

A lot of people do have some increase of pain afterwards. I think putting dye into a disc to pressurize the disc does irritate a "painful" disc.

SO long story, but this is my experience with doing the disco.

[Harrison]

But is this a good time to bring up the new article I posted about the 10 year study on discograms!? It may be insensitive to bring it up here, but I am just doing my job of bringing as much (confusing) information to the patient's table.

Discography may quicken disc degeneration

That said, if your disc is fried and dessicated, I might worry less about the consequences. Meaning, if it is to be replaced and surgery is likely, that "best practice" is smart. However, if the disc health is less obvious (good height, not dark on imaging, no obvious herniation), then this new long-term study is compelling and merits more consideration by doctors, patients and clinicians.

Scary thought: this study (and ones like it) becomes an excuse to NOT cover discographies patients with insurance...

[kimmers]

Harrison,

Interesting article.
It makes sense if you muck around with a disc, it might increase deterioration.
I have thought after my first disco, i felt worse and my back deteriorated.
After the recent disco, i have had some problems so I wonder if the study is relevant.
However, in my case, I think my discs were already DDD or DOA (Dead On Arrival).

Oh yes, another excuse for the insurance companies. Afterall, they do have our best interests at heart, don't they?

Kimmers

[longroadahead]

If I do go ahead with the discogram I will only want the disc tested that the surgeon wants to replace.

Thanks for this information...

[steelskyway]

Very interesting article. As I said previously the injection of the normal discs and the one suspected of being a pain generator and was not are all normal now. I remember the bad one with the dye going everywhere outside of the space. Probably helped to accelerate degeneration.

Hey Long! I beleive you need some sort of control disc for comparison.

Paul

[Maddie]

When I asked my doctors for a discogram I was told that they don't do them anymore, that they rely solely on MRIs for diagnosis. Not even facet blocks. And that was from several doctors, so I don't know what to think after reading the notes above.

I just assumed, like so many other things, that we are so very far behind here, and the gov't insurance doesn't want to spend any more money than necessary, so stopped funding them...but who knows.