RESULTS The results of this review confirm and help quantify the significant differences that existed in the terminology and all the areas of diagnosis and treatment of presumed discogenic pain .
Our findings show that suspected discogenic pain , despite its extensive affirmation in the literature and enormous re sources regularly devoted to it , currently lacks clear diagnostic criteria and uniform treatment or terminology
BACKGROUND CONTEXT Pain innate to intervertebral disc , often referred to as discogenic pain , is suspected by some authors to be the major source of chronic low back and neck pain .
Current management of suspected discogenic pain lacks st and ardized diagnosis , treatment , and terminology .
PURPOSE In an attempt to determine whether patterns existed that may facilitate st and ardization of care , we sought to analyze the terminologies used and the various modes of diagnosis and treatment of suspected discogenic pain .
A Randomized, Double-Blind, Controlled Trial: Intradiscal Electrothermal Therapy Versus Placebo for the Treatment of Chronic Discogenic Low Back Pain
Study Design . A prospect i ve , r and omized , double-blind , placebo-controlled trial of intradiscal electrothermal therapy ( IDET ) for the treatment of chronic discogenic low back pain ( CDLBP ) . Objectives . To test the safety and efficacy of IDET compared with a sham treatment ( placebo ) . Summary of Background Data . In North America alone , more than 40,000 intradiscal catheters have been used to treat CDLBP . The evidence for efficacy of IDET is weak coming from retrospective and prospect i ve cohort studies providing only Class II and Class III evidence . There is one study published with Class I evidence . This demonstrates statistically significant improvements following IDET ; however , the clinical significance of these improvements is question able . Methods . Patients with CDLBP who failed to improve following conservative therapy were considered for this study . Inclusion criteria included the presence of one- or two-level symptomatic disc degeneration with posterior or posterolateral anular tears as determined by provocative computed tomography ( CT ) discography . Patients were excluded if there was greater than 50 % loss of disc height or previous spinal surgery . Fifty-seven patients were r and omized with a 2:1 ratio : 38 to IDET and 19 to sham procedure ( placebo ) . In all cases , the IDET catheter was positioned to cover at least 75 % of the annular tear as defined by the CT discography . An independent technician connected the catheter to the generator and then either delivered electrothermal energy ( active group ) or did not ( sham group ) . Surgeon , patient , and independent outcome assessor were all blinded to the treatment . All patients followed a st and ard postprocedural rehabilitation program . Independent statistical analysis was performed . Outcome Measures . Low Back Outcome Score ( LBOS ) , Oswestry Disability Index ( ODI ) , Short Form 36 question naire ( SF-36 ) , Zung Depression Index ( ZDI ) , and Modified Somatic Perceptions Question naire ( MSPQ ) were measured at baseline and 6 months . Successful outcome was defined as : no neurologic deficit , improvement in LBOS of greater then 7 points , and improvement in SF-36 subsets ( physical function and bodily pain ) of greater than 1 st and ard deviation . Results . Baseline demographic data , initial LBOS , ODI , SF-36 , ZDI , and MSPQ were similar for both groups . No neurologic deficits occurred . No subject in either arm showed improvement of greater than 7 points in LBOS or greater than 1 st and ard deviation in the specified domains of the SF-36 . Mean ODI was 41.42 at baseline and 39.77 at 6 months for the IDET group , compared with 40.74 at baseline and 41.58 at 6 months for the placebo group . There was no significant change in ZDI or MSPQ scores for either group . Conclusions . The IDET procedure appeared safe with no permanent complications . No subject in either arm met criteria for successful outcome . Further detailed analyses showed no significant change in outcome measures in either group at 6 months . This study demonstrates no significant benefit from IDET over placebo
RESULTS The results of this review confirm and help quantify the significant differences that existed in the terminology and all the areas of diagnosis and treatment of presumed discogenic pain .
Our findings show that suspected discogenic pain , despite its extensive affirmation in the literature and enormous re sources regularly devoted to it , currently lacks clear diagnostic criteria and uniform treatment or terminology
BACKGROUND CONTEXT Pain innate to intervertebral disc , often referred to as discogenic pain , is suspected by some authors to be the major source of chronic low back and neck pain .
Current management of suspected discogenic pain lacks st and ardized diagnosis , treatment , and terminology .
PURPOSE In an attempt to determine whether patterns existed that may facilitate st and ardization of care , we sought to analyze the terminologies used and the various modes of diagnosis and treatment of suspected discogenic pain .