Intervertebral disc-related disease is a leading cause of back pain in the elderly population. Despite the widespread use of magnetic resonance imaging, many abnormal discs detected are often not the cause of the patients’ symptoms. Provocative discography is a technique which allows both anatomical and functional assessment of the intervertebral disc following contrast agent injection into the nucleus pulposus under imaging guidance. With standardized protocols, strict diagnostic criteria, and improved imaging techniques, provocative discography has been found to be a valuable diagnostic test in the evaluation of discogenic pain. Percutaneous imaging-guided intra-discal therapy is a useful technique for the treatment of symptomatic disc herniations, providing an intermediate step between traditional conservative therapy and surgical treatment. Both procedures are valuable in the holistic management of back pain when performed according to standard guidelines.