Arthritis is a common cause of back pain, though difficult to precisely diagnose, experts say, because of the poor correlation between a finding of arthritis on an X-ray or MRI and the degree of a patient's back pain. That has routinely led to a series of temporary diagnostic nerve blocks to prove the arthritis connection before doctors will recommend radiofrequency denervation, a relatively safe, noninvasive procedure that interrupts nerve-pain signals from arthritic joints.
The new study, published in the August issue of the journal Anesthesiology, says the wiser course is to skip the diagnostic nerve blocks altogether and move straight to treatment when arthritis is the suspected cause of back pain.
"The whole way we're doing this is wrong," says study leader Steven P. Cohen, M.D., an associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. "If we just do the radiofrequency procedure first, we're going to help more people and we're going to save a lot of money."
In Cohen's study, 151 patients at several hospitals whose back pain fit the criteria for arthritic back pain were randomized to one of three groups: Group 0 received radiofrequency denervation based on clinical findings without nerve blocks; group 1 underwent the radiofrequency treatment only after a positive response to a single diagnostic block; and group 2 only got the treatment if they had positive responses to two diagnostic blocks.
One-third of the patients in group 0 experienced significant pain relief lasting at least three months, while just 16 percent of group 1 and 22 percent of group 2 improved. Those in group 0 were treated immediately, visited a clinic just once and lost no extra days of work to undergo repeated diagnostic tests, Cohen says. The costs per successful treatment in groups 0, 1 and 2 were $6,286, $17,142 and $15,241, respectively.
Notably, among those who had radiofrequency treatment, success rates were higher in those who had the diagnostic blocks first because they were more likely to actually have arthritis. Still, Cohen says, those patients endured long delays and multiple procedures before finally getting lasting pain relief, and some may have not gotten needed radiofrequency treatment because of the false-negative results associated with diagnostic blocks.
"Our goal is to get people feeling better," he says. "When you do two blocks, you may be wrongly weeding out many people who would actually benefit from radiofrequency denervation."
Cohen notes that radiofrequency denervation is as safe as giving a diagnostic block and need only be done once for relief of symptoms. "The proof is in the treatment," he says. Radiofrequency denervation is unlikely to help patients whose back pain is not caused by arthritis. However, the procedure is not considered dangerous for those without arthritis.
Radiofrequency denervation is the second most common procedure in pain clinics across the United States. The relief can last many months and sometimes years, but often must be repeated when pain returns.
Cohen, who is also a colonel in the U.S. Army Reserves and director of chronic pain research at Walter Reed Army Medical Center, says the idea to do without diagnostic blocks came from his experience treating active-duty soldiers who complain of debilitating back pain. Deployed military doctors are under time pressure because soldiers who can't be sent back to their posts quickly are likely to be evacuated out of the war zone with the likelihood that they will not return.
In the civilian world, he says, patients also should be treated as quickly and safely as possible. Going straight to treatment typically means that those patients can also return to work and their normal lives in a shorter period of time.
Until recently, the big debate in the pain management community was whether to do one or two diagnostic blocks before the radiofrequency nerve-burning procedure. The rationale behind using two blocks is that some people without arthritic back pain can get pain relief from a single block, which is called a "false-positive" test. But Cohen and colleagues believe that making diagnostic accuracy a higher priority than pain relief may be misguided.
"If you ask patients what their main goal of treatment is, the answer is typically that they want to be able to pick up their grandkids or play golf,'" he says. "It's not, 'I want to know if it's my arthritic joints or my discs.'"
Cohen cautions that diagnostic nerve blocks are called for in some cases. For example, they should be used to determine whether surgery is the right option for relieving certain kinds of back pain in people without a clear-cut anatomical problem in order to avoid an unnecessary, risky operation.
The research was supported by a grant from the John P. Murtha Neuroscience and Pain Institute, the U.S. Army and the Army Regional Anesthesia and Pain Medicine Institute.
Kayode A. Williams, M.D., M.B.A., of Johns Hopkins, Connie Kurihara, R.N., of Walter Reed, and Scott Strassels, Pharm.D., Ph.D., of the University of Texas, also participated in the study.
For more information: http://www.hopkinsmedicine.org/pain/blaustein_pain_center/physicians/cohen.html
Stephanie Desmon | EurekAlert!
Resolving the mystery of preeclampsia
21.10.2016 | Universitätsklinikum Magdeburg
New potential cancer treatment using microwaves to target deep tumors
12.10.2016 | University of Texas at Arlington
Researchers from the Institute for Quantum Computing (IQC) at the University of Waterloo led the development of a new extensible wiring technique capable of controlling superconducting quantum bits, representing a significant step towards to the realization of a scalable quantum computer.
"The quantum socket is a wiring method that uses three-dimensional wires based on spring-loaded pins to address individual qubits," said Jeremy Béjanin, a PhD...
In a paper in Scientific Reports, a research team at Worcester Polytechnic Institute describes a novel light-activated phenomenon that could become the basis for applications as diverse as microscopic robotic grippers and more efficient solar cells.
A research team at Worcester Polytechnic Institute (WPI) has developed a revolutionary, light-activated semiconductor nanocomposite material that can be used...
By forcefully embedding two silicon atoms in a diamond matrix, Sandia researchers have demonstrated for the first time on a single chip all the components needed to create a quantum bridge to link quantum computers together.
"People have already built small quantum computers," says Sandia researcher Ryan Camacho. "Maybe the first useful one won't be a single giant quantum computer...
COMPAMED has become the leading international marketplace for suppliers of medical manufacturing. The trade fair, which takes place every November and is co-located to MEDICA in Dusseldorf, has been steadily growing over the past years and shows that medical technology remains a rapidly growing market.
In 2016, the joint pavilion by the IVAM Microtechnology Network, the Product Market “High-tech for Medical Devices”, will be located in Hall 8a again and will...
'Ferroelectric' materials can switch between different states of electrical polarization in response to an external electric field. This flexibility means they show promise for many applications, for example in electronic devices and computer memory. Current ferroelectric materials are highly valued for their thermal and chemical stability and rapid electro-mechanical responses, but creating a material that is scalable down to the tiny sizes needed for technologies like silicon-based semiconductors (Si-based CMOS) has proven challenging.
Now, Hiroshi Funakubo and co-workers at the Tokyo Institute of Technology, in collaboration with researchers across Japan, have conducted experiments to...
14.10.2016 | Event News
14.10.2016 | Event News
12.10.2016 | Event News
21.10.2016 | Health and Medicine
21.10.2016 | Information Technology
21.10.2016 | Materials Sciences