For people with long-lasting low back pain, one of the hardest questions is which disc is actually causing the pain. Dr. Grunch is the first surgeon in Georgia to offer Nociscan to her patients. It is a newer test that helps answer that question with an MRI instead of needles.
Nociscan is a specialized MRI test for the lower back. During a lumbar MRI, an extra scanning sequence called MR spectroscopy measures the chemistry inside each disc being studied. Software then analyzes those chemical signals, which have been linked to painful discs, and reports which discs are likely to be a source of pain and which are not.
Unlike a discogram, there are no needles, no dye and no radiation.
Learn more about the technology from its maker, Aclarion, at aclarion.com.
An MRI is a wonderful picture of your anatomy. It shows the shape of a disc, how hydrated it is, whether it is bulging and whether a nerve is being squeezed. What it cannot do is tell whether a particular disc is painful.
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.
In other words, a disc can look worn out and feel perfectly fine. When several discs look worn out on an MRI, finding the one that is actually causing the pain is a real challenge. Treat too few levels, and the true source of pain may be left behind. Treat too many, and discs that were never the problem may be treated.
Nociscan helps Dr. Grunch:
It is used for patients with chronic low back pain from degenerative disc disease who are being considered for surgery. The results are always combined with your symptoms, exam and other imaging.
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 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:
Another study compared Nociscan with provocation discography head-to-head in 20 patients (55 discs). The scan 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 study of 14 patients (44 discs) also found that Nociscan data separated discs that were painful on discography from those that were not, while noting the limits of such a small group [5].
A signal is not a guarantee for any one person. Percentages describe groups. They cannot tell you what will happen in your back, and no test can. What a good test can do is help you and your surgeon make a more informed plan.
Promising does not mean proven. Here are the gaps:
Nociscan is designed for the lumbar spine (lower back). A conversation about it makes the most sense for someone who:
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 Dr. Grunch, and sometimes the answer will be “not necessary.”
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. These are not situations for a wait-and-see approach. Call 911 or go to the nearest emergency room.
The test feels exactly like a regular lumbar MRI. You lie still on your back while the machine takes pictures. The spectroscopy portion adds some extra time to the scan, so plan for the visit to take longer than a standard MRI.
You can drive and go back to normal activities right away. The data are analyzed and a report is sent to Dr. Grunch, which can take several days. She will go over the results with you along with your MRI pictures and your overall treatment plan.
Nociscan is as safe as a regular MRI. It uses no radiation, no dye and no needles. The only safety concerns are the same as any MRI: metal and certain implants.
Nociscan is a noninvasive MRI-based test for the lower back. It measures the chemistry inside each disc and helps show which discs are likely causing pain.
Yes. Dr. Grunch is the first surgeon in Georgia to offer Nociscan to her patients.
A discogram places needles into the discs and injects dye to see which disc reproduces your pain. Nociscan gathers similar information from an MRI, with no needles, dye or radiation.
No. It is not perfect and can miss a disc that other testing calls painful. It is one piece of information that Dr. Grunch weighs along with your symptoms, exam and imaging.
The research so far is encouraging but still building. A randomized trial called CLARITY is underway to test whether using Nociscan improves surgical outcomes.
U.S. private insurers have not yet established standard coverage for this newer test. Our office can help you check your coverage before the scan.
Nociscan is designed for the lumbar spine (lower back).
If Dr. Grunch has ordered a Nociscan for you and you have questions, call 470-293-9800 or contact us. You can also ask general questions any time through our “Ask Us Anything” chat. For questions about scheduling, cost or arrival time for the test itself, call the imaging center where it is booked.
Related: All imaging and diagnostic tests · Discogenic back pain · Discogram
This information is for educational purposes only and is not medical advice. It does not replace individualized care from a licensed physician. Please talk to your provider about your symptoms and follow the instructions from your imaging center.
