Intradiscal electrothermal treatment for chronic discogenic low back pain: a prospective outcome study of 39 patients with the Oswestry disability index at 18 month follow-up

Objective: To compare the effectiveness of an integrated rehabilitation programme with an existing rehabilitation programme in patients with chronic low back pain. Design: A single-centre, pragmatic, two-arm parallel, randomized controlled trial (1:1 ratio). Setting: A rheumatology inpatient rehabilitation centre in Denmark. Subjects: A total of 165 adults (aged ⩾ 18 years) with chronic low back pain. Interventions: An integrated rehabilitation programme comprising an alternation of three weeks of inpatient stay and 12 weeks of home-based activities was compared with an existing rehabilitation programme of four weeks of inpatient stay. Main measures: Patient-reported outcomes were collected at baseline and at the 26-week follow-up. The primary outcome was back-specific disability (Oswestry Disability Index). Secondary outcomes included pain intensity (Numerical Rating Scale), pain self-efficacy (Pain Self-Efficacy Questionnaire), health-related quality of life (EuroQol-5 Domain 5-level (EQ-5D)), and depression (Major Depression Inventory). A complete case analysis was performed. Results: A total of 303 patients were assessed for eligibility of whom 165 (mean age: 50 years (SD 13) and mean Oswestry Disability Index score 42 (SD 11)) were randomized (83 to existing rehabilitation programme and 82 to integrated rehabilitation programme). Overall, 139 patients provided the 26-week follow-up data. Baseline demographic and clinical characteristics were comparable between programmes. The between-group difference in the Oswestry Disability Index score when adjusting for the corresponding baseline score was −0.28 (95% confidence interval (CI): −4.02, 3.45) which was neither statistically nor clinically significant. No significant differences were found in the secondary outcomes. Conclusion: An integrated rehabilitation programme was no more effective than an existing rehabilitation programme at the 26-week follow-up.

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Effect of Intradiscal Electrothermal Treatment with a Short Heating Catheter and Fibrin on Discogenic Low Back Pain

American Journal of Physical Medicine & Rehabilitation ◽

10.1097/01.phm.0000167619.84014.fb ◽

2005 ◽

Vol 84 (7) ◽

pp. 560-561 ◽

Cited By ~ 3

Author(s):

Richard Derby ◽

Byung-Jo Kim

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Low Back ◽

Discogenic Low Back Pain ◽

Electrothermal Treatment ◽

Short Heating

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Intradiscal Injection of Autologous Platelet-Rich Plasma Releasate to Treat Discogenic Low Back Pain: A Preliminary Clinical Trial

Asian Spine Journal ◽

10.4184/asj.2017.11.3.380 ◽

2017 ◽

Vol 11 (3) ◽

pp. 380-389 ◽

Cited By ~ 38

Author(s):

Koji Akeda ◽

Kohshi Ohishi ◽

Koichi Masuda ◽

Won C. Bae ◽

Norihiko Takegami ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Platelet Rich Plasma ◽

Low Back ◽

Discogenic Low Back Pain ◽

Intradiscal Injection ◽

Autologous Platelet Rich Plasma ◽

The Mean ◽

Autologous Platelet

<sec><title>Study Design</title>Preliminary clinical trial.</sec><sec><title>Purpose</title>To determine the safety and initial efficacy of intradiscal injection of autologous platelet-rich plasma (PRP) releasate in patients with discogenic low back pain.</sec><sec><title>Overview of Literature</title>PRP, which is comprised of autologous growth factors and cytokines, has been widely used in the clinical setting for tissue regeneration and repair. PRP has been shown <italic>in vitro</italic> and <italic>in vivo</italic> to potentially stimulate intervertebral disc matrix metabolism.</sec><sec><title>Methods</title>Inclusion criteria for this study included chronic low back pain without leg pain for more than 3 months; one or more lumbar discs (L3/L4 to L5/S1) with evidence of degeneration, as indicated via magnetic resonance imaging (MRI); and at least one symptomatic disc, confirmed using standardized provocative discography. PRP releasate, isolated from clotted PRP, was injected into the center of the nucleus pulposus. Outcome measures included the use of a visual analog scale (VAS) and the Roland-Morris Disability Questionnaire (RDQ), as well as X-ray and MRI (T2-quantification).</sec><sec><title>Results</title>Data were analyzed from 14 patients (8 men and 6 women; mean age, 33.8 years). The average follow-up period was 10 months. Following treatment, no patient experienced adverse events or significant narrowing of disc height. The mean pain scores before treatment (VAS, 7.5±1.3; RDQ, 12.6±4.1) were significantly decreased at one month, and this was generally sustained throughout the observation period (6 months after treatment: VAS, 3.2±2.4, RDQ; 3.6±4.5 and 12 months: VAS, 2.9±2.8; RDQ, 2.8±3.9; <italic>p</italic><0.01, respectively). The mean T2 values did not significantly change after treatment.</sec><sec><title>Conclusions</title>We demonstrated that intradiscal injection of autologous PRP releasate in patients with low back pain was safe, with no adverse events observed during follow-up. Future randomized controlled clinical studies should be performed to systematically evaluate the effects of this therapy.</sec>

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A Double-blind, Placebo-controlled, Dose–Response Pilot Study Evaluating Intradiscal Etanercept in Patients with Chronic Discogenic Low Back Pain or Lumbosacral Radiculopathy

Anesthesiology ◽

10.1097/01.anes.0000267518.20363.0d ◽

2007 ◽

Vol 107 (1) ◽

pp. 99-105 ◽

Cited By ~ 56

Author(s):

Steven P. Cohen ◽

Daniel Wenzell ◽

Robert W. Hurley ◽

Connie Kurihara ◽

Chester C. Buckenmaier ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Low Back ◽

Double Blind ◽

Pain Scores ◽

Discogenic Low Back Pain ◽

Leukocyte Counts ◽

Factor Α ◽

Necrosis Factor

Abstract Background: In recent years, convincing evidence has emerged implicating tumor necrosis factor α as a causative factor in radiculopathy and discogenic back pain. But although preliminary open-label studies demonstrated promising results for the treatment of low back pain with tumor necrosis factor-α inhibitors, early optimism has been tainted by a controlled study showing no significant benefit in sciatica. To determine whether outcomes might be improved by a more direct route of administration, the authors evaluated escalating doses of intradiscal etanercept in 36 patients with chronic lumbosacral radiculopathy or discogenic low back pain. Methods: A double-blind, placebo-controlled pilot study was conducted whereby six patients received 0.1, 0.25, 0.5, 0.75, 1.0, or 1.5 mg etanercept intradiscally in each pain-generating disc. In each escalating dose group of six patients, one received placebo. A neurologic examination and postprocedure leukocyte counts were performed in all patients at 1-month follow-up visits. In patients who experienced significant improvement in pain scores and function, follow-up visits were conducted 3 and 6 months after the procedure. Results: At 1-month follow-up, no differences were found for pain scores or disability scores between or within groups for any dose range or subgroup of patients. Only eight patients remained in the study after 1 month and elected to forego further treatment. No complications were reported, and no differences were noted between preprocedure and postprocedure leukocyte counts. Conclusions: Although no serious side effects were observed in this small study, a single low dose of intradiscal etanercept does not seem to be an effective treatment for chronic radicular or discogenic low back pain.

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Prospective Clinical Study on Natural History of Discogenic Low Back Pain at 4 Years of Follow-up

January 2018 - Pain Physician ◽

10.36076/ppj.2012/15/525 ◽

2012 ◽

Vol 6;15 (6;12) ◽

pp. 525-532

Author(s):

Baogan Peng

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Clinical Study ◽

Natural History ◽

Prospective Clinical Study ◽

Low Back ◽

Discogenic Low Back Pain ◽

History Of ◽

Pain Symptoms

Background: To accurately assess the effect of any therapy for treating discogenic low back pain, the natural history of such pain should be known beforehand. However, until now, no pathological characteristic could be used to predict the disease course of low back pain. Objective: To better instruct the clinical treatment of discogenic low back pain, a prospective clinical study was performed to observe the natural history of the disease. Study Design: A prospective clinical study during a 4-year follow-up period. Setting: The study was performed at a spinal center in China. Methods: A total of 279 patients with chronic low back pain were included from June 2006 through October 2007. Using discography, 156 patients (56%) were diagnosed to have discogenic back pain. A 101-point numerical rating scale (NRS) was used to assess the back pain symptoms and the Oswestry Disability Index (ODI) was used to assess lumbar function. Results: Of the 156 patients, 131 (84%) completed the study at 4-year follow-up. At the end of follow-up, 17 patients (13.0%) had their low back pain symptoms alleviated and lumbar function improved; 10 patients (7.6%) were slightly improved; 16 patients (12.2%) had their symptoms aggravated; and 88 patients (67.2%) experienced the same pain and disability as before. Although the average NRS and ODI scores obtained during the 4-year follow-up study gradually decreased, statistical significances were found in such changes (P < 0.05,and P < 0.05, respectively); however, the improvement rates of both pain (7.6%) and disability (5.2%) were very low. Limitations: The shortcoming of this study is its relatively small sample size. Conclusion: The present study indicated that the natural history of discogenic low back pain was chronic but persistent, and that the pain and disability in most patients did not improve over time. Key words: Discogenic low back pain, chronic low back pain, lumbar discography, painful disc, black disc, disc degeneration, internal disc disruption, natural history, prognosis.

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