Quantitative discometry: Low-dose concordant pain onset identifies sensitized annular nociceptors under pressure–volume–controlled provocation

These findings support a reproducible low-dose, high-intensity concordant pain phenotype in structurally abnormal discs, most consistent with chemically and mechanically sensitized nociceptors in the annulus and at the annulus-endplate junction. Other discs-whether morphologically normal or with more prominent vertebrogenic features-remain load-tolerant under bounded pressurization, suggesting different dominant generators. In this framework, pressure-controlled discography functions less as a binary test and more as a quantitative phenotyping tool that uses combined pressure and work thresholds to distinguish annular-/junctional-dominant low-dose responses from higher-dose, load-tolerant patterns, and may help refine patient selection for disc-directed versus vertebrogenic-targeted interventions in future prospective studies.