An Interventional Pain and Sports Medicine Practice

An Interventional Pain & Sports
Medicine Practice

Internal Disc Disruption | Barr Center | Virginia Beach, VA

Internal disc disruption is best understood in the lumbar spine, because it is more common in occurrence and the anatomy is easier to understand. It can cause episodes of severe low back pain with muscle spasms. Discogenic pain symptoms are usually exacerbated by sitting for long periods, bending and lifting.  In rare instances the symptoms may become constant. We call this discogenic pain. This is in contrast to when a lumbar herniated disc presses against a nerve root causing sciatic pain, numbness, and/or weakness in your leg. Internal disc disruption is sometimes referred to as a leaky disc phenomenon. This means that pain can occur from “leaking” of nuclear disc material through an annular tear as opposed to an actual herniation of the disc.  This can lead to irritation of a variety of pain sensitive structures in the spine.

Provocative Discography

It is a diagnostic test to assess if small tears within the disc that can cause discogenic back pain. Contrast dye is injected into the disc nucleus(the gel-like substance in the center of the disc). This is the only diagnostic test that provides both anatomical and functional information about a diseased disc causing discogenic pain, and can identify problems that may not be seen on MRI or CT. Discography is also helpful in specifically localizing the disc level that needs to be treated.

Discogenic PainWho can benefit from discography?

Discography is considered an invasive diagnostic test and is performed only when the information is needed for surgical or other intradiscal intervention decision-making. More conservative treatments such as physical therapy andtherapeutic spinal injections are typically prescribed before considering provocative discography.

How is the procedure done?

This procedure is done with the patient lying on his or her stomach. Typically, a mild sedative is given through an IV. The patient remains awake but sedated during the procedure. The skin and soft tissues are anesthetized.

Under fluoroscopic (X-ray) guidance, Dr. Barr will insert a needle into the disc. Contrast dye is injected and an X-ray (discogram) is taken, which may show tears in the outer portion of the disc (annulus).

During the disc injection portion of the procedure, the patient will be asked if the increased pressure in the disc causes discomfort. Specifically, the patient will be asked to describe any discomfort with particular attention to the reproduction of the patient’s “typical back pain” in quality and location. Those disc injections which reproduce the patient’s “typical back pain” and have evidence of tears within the annulus (outer portion of the disc) are considered positive and likely are the etiology of the patient’s back pain.

Pain medication is usually given during and after the procedure. The procedure takes approximately 45-60 minutes.

Is the procedure painful?

Because there is typically some discomfort during the procedure, a mild sedative and pain medication are usually given by IV. Most patients tolerate the procedure quite well. They are usually sore for a few days to two weeks after the procedure, and pain medication may be needed for a few days afterward. Ice may be applied to the region as needed.

What should I do after the procedure?

  • Take it easy for the next few days.
  • Most patients take off work the next day.
  • Your physician will let you know of any activity restrictions.

Are there any contraindications to provocation discography?

Contraindications to discography include the following:

  • Patients with a bleeding disorder or on blood thinners
  • Pregnancy
  • Any systemic infection or local skin infection over the puncture site

Are there any risks to the procedure?

Some discomfort is to be expected, but it should be temporary.

Other side effects of the procedure are extremely rare and include:

  • Worsening of symptoms
  • Infection
  • Bleeding
  • Discitis—a serious but extremely rare infection of the disc itself (antibiotics are given via IV or in the disc to help prevent this)
  • Nerve or spinal cord injury

Can the Barr Center Help You with Back Pain Relief?

Call us at 757-578-2260 or email us at Info@BarrCenter.com to get started on relieving your back pain.

Learn More

Other pain management conditions we treat are: Neck PainShoulder PainHip Pain and Knee Pain.  We often use Regenerative Medicineand Physical Therapy in our treatments.

INNOVATIVE PAIN & REGENERATIVE THERAPIES
INNOVATIVE PAIN & REGENERATIVE THERAPIES
Expert care for spine, joint, nerve, sports injuries, and chronic pain.

Find Relief From the Conditions Holding You Back

Dr. Lisa Barr is a leading pain management physician in Virginia Beach with over 35 years of experience diagnosing and treating spine, joint, nerve, and musculoskeletal pain. As a Board Certified PM&R specialist, she focuses on whole-body, non-surgical solutions that uncover the true root cause of pain. She is also the international bestselling author of Outsmart Your Pain and one of the region’s most experienced experts in regenerative medicine, PRP, and advanced biologic therapies.

Spinal Conditions
  • Neck Pain
  • Mid Back Pain
  • Low Back Pain
  • Pelvic Pain
  • SacroiIiac Joint Pain
  • Hypermobility
  • Myofascial Pain
    • Trigger Point
      injections
    • What is Sarapin?
  • Fibromyalgia
  • EOS/Hypermobility
    Syndrome
  • Autoimmunity
    • LDN (Low dose
      Natrexone)
    • Testing
  • Prolotherapy
  • Neuroprolotherapy
  • Neural Therapy
  • Cold Laser
  • Entrapment Neuropathy
    • Carpal Tunnel Syndrome
    • Radial & Ulnar Nerve Entrapment
    • Lower Extremity Entrapment
    • Occipital Neuritis
  • Scar Tissue
  • Peripheral Neuropathy
    • Fatty Acid Testing & Specialized Therapies
    • Cold Laser
    • Nutritional Support
  • Neck Pain
  • Mid Back Pain
  • Low Back Pain
  • Pelvic Pain
  • SacroiIiac Joint Pain
  • Hypermobility
  • Inner Arsenal
  • Vagus Nerve Support
  • Power over Pain Mindset
  • Breathing Practices
Resources

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OVERVIEW

The Barr Center for Innovative Pain and Regenerative Therapies, led by Dr. Lisa Barr, is dedicated to helping people in pain. With over forty years of experience, Dr. Barr and her staff offer a range of evaluation and treatment options, including osteopathic assessment, trigger point injections, prolotherapy, and regenerative therapies. They prioritize a caring atmosphere and involve patients in their own care, ensuring they understand the recommended treatments. If necessary, they collaborate with other professionals to provide a comprehensive approach. Dr. Barr’s expertise has been recognized with the Top Doc award for thirty years.

FAQ

Pain Management and Treatment

The Barr Center for Innovative Pain & Regenerative Therapies is located at:

933 First Colonial Road, Suite 200
Virginia Beach, VA 23454

Phone: 757-578-2260
Email: info@BarrCenter.com

Monday–Thursday: 8:30 am–5:00 pm

Friday: Closed (note: physician on call)

Not always. Some insurance plans—especially HMOs—require a referral before seeing a specialist. To confirm what your specific plan requires, call your insurance provider or contact our office at 757-578-2260.

We accept most major insurance plans (except Medicaid). If your plan requires a referral or pre-authorization to see a specialist, you will need one for your first visit. After your initial consultation, our office obtains any future pre-authorizations, sometimes with assistance from your referring provider. Visit our Patient Resources page for details.

Yes. We offer telemedicine visits for certain appointment types, including follow-up visits and treatment discussions. Some procedures require in-office evaluation, and our team will help determine whether a virtual visit is appropriate.

Conditions and Treatment Questions

Led by pain management specialist Lisa Barr, M.D., the Barr Center provides comprehensive musculoskeletal and pain treatments including:

• Acupuncture
• Mind-body medicine and lifestyle optimization
• Interventional spinal procedures
• Sports medicine
• Physical therapy
• Regenerative medicine (PRP, prolotherapy)

We treat a wide range of pain and musculoskeletal conditions, including:

• Neck, shoulder, hip, back, and knee pain
• Sports injuries and repetitive strain conditions
• Posture, sleep, and movement-related pain
• Car accident injuries, including whiplash

Our approach provides proven alternatives to surgery and long-term medications through targeted injections, hands-on physical therapy, acupuncture, lifestyle guidance, and regenerative medicine.

If your pain is persistent, recurring, or limiting daily activities, it is time for an evaluation. We assess how your joints move, how your muscles function, and whether lifestyle factors are contributing to your symptoms.

We offer a comprehensive, root-cause approach to pain in a boutique practice setting.

Our team is highly specialized, and we combine interventional pain medicine, regenerative therapies, physical therapy, and whole-person care—all under one roof.

Our team includes board-certified physicians, licensed physical therapists, regenerative medicine specialists, acupuncture providers, and experienced clinical support staff with focused expertise in musculoskeletal medicine and pain management.

Preparing for your First Appointment

To help make your first visit efficient, please bring:

• Photo ID
• Insurance card
• Referral (if required by your insurance)
• Completed new-patient paperwork
• Co-pay, if applicable

If you have MRIs, CT scans, X-rays, or lab results, please have your referring provider fax them to our office. You may also download our Medical Records Request Form to expedite the process.

Experiencing Pain? Reach Out For Medication-Free Treatment