Discography has been proven to be highly sensitive in isolating discogenic pain. However, specificity is low, and about one-third of false-positive findings have been reported. It has been shown that not only morphologic changes like internal disc disruption, disc degeneration, or annular rupture influence the patient’s report on pain, but also abnormal psychometric results. Improvement of specificity can only be achieved by selecting patients carefully, defining strict criteria for positive findings in discography and using optimal imaging for the procedure in order not to mask the procedure’s results by accidentally touching a nerve root or using too much local anesthesia. Discography remains the only diagnostic test with the potential to unequivocally identify disc pain and its origin.