Which Disc Is Actually Causing My Back Pain?

This article originally appeared in The Neurotransmitter, Dr. Grunch’s weekly newsletter.

Picture someone who has had low back pain for two years. They’ve done physical therapy. They’ve tried injections. Finally, they get an MRI, and the report reads like a list of suspects: a bulge at L3-4, degeneration at L4-5, a tear at L5-S1.

Three levels. Three possible culprits. And one question that sounds simple but is surprisingly hard to answer: which disc is actually causing the pain?

That question is one I think about with patients every week, because the answer shapes everything that comes next. Today I want to tell you about a tool that is trying to help answer it. It’s called Nociscan, and I’m proud to be the first surgeon in Georgia to offer it to my patients. I also want to be straight with you about what it can do, what it can’t, and what the science still has to prove.

Why an MRI Can’t Always Answer the Question

An MRI is a wonderful picture of your anatomy. It shows the shape of a disc, how hydrated it is, whether it’s bulging, whether a nerve is being squeezed. What it can’t do is tell us whether a particular disc is painful.

Here’s why that is important. A large systematic review pooled data from 33 studies and more than 3,000 people who had no back pain at all. Disc degeneration showed up on imaging in 37% of the 20-year-olds and 96% of the 80-year-olds. Disc bulges were found in 30% of the 20-year-olds and 84% of the 80-year-olds [1]. The authors concluded that many of these findings are likely part of normal aging and unrelated to pain [1].

In other words, a disc can look worn out and feel perfectly fine. And when someone has several worn-out discs on the MRI, picking out the one that’s actually generating the pain is a real challenge.

Doctors call pain that originates in the disc itself discogenic pain (dis-koh-JEN-ik, meaning “born in the disc”). It typically shows up as a deep ache in the low back, often worse with sitting or bending, and it can be stubborn. If you’re thinking about a procedure or surgery for it, knowing which levels are involved is one of the most important pieces of the puzzle.

Think about what’s at stake. Treat too few levels, and the real source of pain may be left behind. Treat too many, and you may be operating on discs that were never the problem. Neither is a result any patient or surgeon wants, which is why a more reliable way to tell the discs apart is such an appealing goal.

The Old Way: Poking the Disc to Ask It

For decades, the main tool for sorting painful discs from quiet ones has been provocation discography. A needle is placed into the center of a disc under X-ray guidance, fluid is injected to raise the pressure, and the patient is asked whether it reproduces their familiar pain.

It’s clever, and it’s been useful. But it has real downsides. It’s invasive. It can be uncomfortable, sometimes quite a bit. And it depends on how a patient perceives and reports pain in the moment, which is hard to standardize. Many patients, understandably, would rather not have needles placed into several discs just to gather information.

So researchers have spent years asking a better question: could we find a painful disc without a needle at all?

What Is MR Spectroscopy?

Think of a regular MRI as a photograph of a house. You can see the walls, the roof, the windows. Now imagine that, during the very same visit, you could also get a report on what’s happening inside the walls: the wiring, the plumbing, any signs of trouble you can’t see from the outside.

That’s the idea behind magnetic resonance spectroscopy, or MRS. It uses the same MRI scanner, but instead of making a picture, it measures chemical signals coming from tissue.

Nociscan is a software platform built around that idea. The scan data from the MRI machine is sent to the cloud for each lumbar disc being evaluated. There, specialized processing extracts and quantifies chemical markers that studies have linked with disc pain [2]. The result is a disc-by-disc report that helps your surgeon see which discs look chemically more likely to be painful and which look less so [2].

The manufacturer is clear that it’s meant to be used alongside other diagnostic tools, not instead of them [2]. I agree with that completely. It’s one more piece of information, to be weighed along with your story, your exam, and your imaging.

One thing I like about this approach is that it’s noninvasive. There’s no needle in the disc. The goal is to get the information the old way tried to get, a sense of which discs are likely pain generators, without asking the patient to go through a painful provocation test.

What the Research Shows So Far

The study that put Nociscan on the map followed 78 patients with chronic discogenic low back pain who went on to have lumbar surgery after a standard workup. Researchers later looked at what happened when the surgery matched the discs Nociscan flagged as painful, compared with surgery that included discs Nociscan flagged as not painful [3].

Success was measured with the Oswestry Disability Index, a standard questionnaire about how much back pain interferes with daily life. The results favored the “matched” group at every checkpoint [3]:

• At 6 months, the success rate was 88% for the matched group vs. 62% for the unmatched group.
• At 12 months, it was 91% vs. 56%.
• At 24 months, the matched group’s success rate was still 85%.

Another study compared Nociscan with provocation discography head-to-head in 20 patients (55 discs). The MRS results agreed with discography in 70% to 87% of discs, depending on how strict the definition of agreement was. When the two tests disagreed, the most common type of disagreement (10 of 17 cases) was an “under-call” by the scan [4].

A smaller prospective study in 14 patients (44 discs) also found that the Nociscan data separated discs that were painful on discography from those that weren’t. The authors concluded that this has the potential to improve surgical outcomes, while noting the limits of such a small group [5].

How should you read numbers like these? Here’s how I think about them. The idea behind the scan is simple: if we treat the disc that’s truly generating pain, a patient should do better than if we treat a disc that was only an innocent bystander. The 78-patient study fits that idea nicely, because the patients whose treatment lined up with the scan did better. That’s a meaningful signal, and it’s why this technology has drawn so much interest among spine surgeons.

But a signal isn’t a guarantee for any one person. Percentages describe groups. They can’t tell you what will happen in your back, and no test can. What a good test can do is shift the odds in your favor and help you and your surgeon make a more informed plan.

What We Don’t Know Yet

I never want my readers to hear “promising” and walk away thinking “proven.” So let’s talk about the gaps.

The best data so far is from one site and 78 patients. Patients in that study weren’t randomly assigned to matched or unmatched surgery. They simply had the surgery they and their surgeons chose, and the researchers looked back at how it lined up with the scan [3]. That shows an association. It doesn’t prove the scan caused the better results.

Much of the published work involves the company that makes the technology.

That confirmation is underway. A prospective, randomized trial called CLARITY is designed to test whether using Nociscan improves surgical outcomes for chronic low back pain [6]. I’ll be watching those results closely, and I’ll tell you what they show when they’re in.

It isn’t perfect. As the discography comparison showed, the scan sometimes misses a disc that other testing calls painful [4]. That’s another reason it’s one input among many.

Insurance coverage in the U.S. is still developing. Several large private insurers in the U.K. have agreed to cover Nociscan, but U.S. private insurers have not yet established standard coverage for it [7]. The company has launched a program aimed at securing U.S. coverage [2]. If you’re curious about coverage for your situation, our team can walk you through where things stand.

Who Might Be a Candidate?

Nociscan is designed for the lumbar spine, the low back. A conversation about it makes the most sense for someone who:

• Has had chronic low back pain, often deep and aching, that hasn’t resolved with conservative care like physical therapy or injections
• Has an MRI showing degenerative changes at more than one level, so it’s not obvious which disc is the source
• Is considering interventional or surgical treatment and wants as much clarity as possible before deciding

It may add less when the source of pain is already clear from your symptoms, exam, and imaging, for example, a single disc pressing on a nerve and causing matching leg symptoms. Whether the scan is right for you is a decision for you and your surgeon, and sometimes the answer will be “not necessary.”

One more thing, and it’s important. Chronic back pain is different from an emergency. Seek care right away if back pain comes with new leg weakness, numbness in the groin or inner thighs (”saddle” numbness), new trouble controlling your bladder or bowels, fever, a recent significant injury, or a history of cancer. Those are not situations for a wait-and-see approach.

Questions to Ask Your Doctor

Whether or not Nociscan is on your radar, these questions can help you get more from any conversation about chronic back pain:

• Which discs or levels do you think are involved, and how sure are you?
• What else besides my MRI is pointing to that level?
• Have I truly exhausted the non-surgical options that make sense for me?
• Would additional testing change what we recommend? If so, how?
• What are the realistic goals of treatment for me, and what are the risks?
• Is a test like this covered by my insurance, and what would I owe if it isn’t?

Key Takeaways

• An MRI shows what a disc looks like, not whether it hurts. Disc wear-and-tear is very common in people with no pain at all [1].
• Nociscan uses MR spectroscopy to measure chemical markers in lumbar discs and help identify which ones are more likely to be painful [2].
• In one study of 78 patients, surgery at the discs Nociscan flagged was linked to higher success rates at 6, 12, and 24 months [3].
• The evidence is encouraging but still building. A randomized trial is underway, the scan isn’t perfect, and U.S. insurance coverage is still developing [4][6][7].
• It’s one tool alongside your story, your exam, and your imaging, never a replacement for them.

A Final Thought

Chronic pain is exhausting, and not knowing where it’s coming from can feel like being lost without a map. I became a surgeon to give people clarity and then compassionate, honest care built around them, not just their scans. Bringing Nociscan to Georgia is one more way to do that. It won’t be the right answer for everyone, and it isn’t a magic bullet. But more information, used wisely, can lead to better decisions.

References

1. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. https://doi.org/10.3174/ajnr.A4173

2. Aclarion, Inc. Aclarion publishes CEO shareholder letter highlighting progress for first half of 2026. 2026. https://www.barchart.com/story/news/3521929/aclarion-publishes-ceo-shareholder-letter-highlighting-progress-for-first-half-of-2026

3. Gornet MF, Eastlack RK, Peacock J, et al. Magnetic resonance spectroscopy (MRS) identification of chemically painful lumbar discs leads to improved 6-, 12-, and 24-month outcomes for discogenic low back pain surgeries. Eur Spine J. 2023. PMID:37014434. https://doi.org/10.1007/s00586-023-07665-w

4. MR spectroscopy in the diagnosis of lumbar discogenic pain. Eur Spine J. 2026. https://doi.org/10.1007/s00586-026-10319-2

5. Establishing a gold standard for noninvasive identification of painful lumbar discs: prospective comparison of magnetic resonance spectroscopy vs low-pressure provocation discography. Int J Spine Surg. 2024;18(1):91. https://www.ijssurgery.com/content/18/1/91

6. Aclarion, Inc. Aclarion adds UHealth, University of Miami Miller School of Medicine as CLARITY trial site. GlobeNewswire. June 10, 2025. https://www.santelog.com/node/95011

7. Aclarion, Inc. Aclarion provides corporate update highlighting scan volume growth and key milestones. 2025. https://www.santelog.com/actualites-sante-nasdaq/aclarion-provides-corporate-update-highlighting-scan-volume-growth-and-key

Disclaimer: This article is for educational purposes only and is not medical advice. It does not replace individualized care from a licensed physician. If you have symptoms or questions about your own health, please consult your healthcare provider. If you think you are having a medical emergency, call 911.

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