I'm having low back pain that isn't easy to diagnose. The doctor thinks it's a disc problem but the MRI and CT scan were "normal." The next test is a provocative discography. I'd really like to avoid more expensive tests. Is there anything else that might help?

There is a series of noninvasive tests called the McKenzie assessment that can be done by a physical therapist trained in this technique. There are eight basic movements the therapist will guide you through to find out what makes the pain better or worse. Making the pain better is called centralization.

A recent study showed that centralization of pain can predict when a discography would be positive. In other words, the McKenzie assessment can predict pain originating from a problem disc. The therapist can then give you a treatment program specifically for your type of disc pain.

This same study showed that the test results aren't accurate with patients who are extremely distressed or severely disabled. Discography may be the only option for these patients. You can always try the McKenzie program and see if it works. If you don't get better, your doctor may consider the discography as the next step.