Patients who benefited from intradiscal biacuplasty to treat discogenic low-back pain maintained initial gains in pain relief and physical function when rechecked at one year, a new study showed. Furthermore, patients who were in the sham treatment group and were later offered intradiscal biacuplasty achieved the same positive results as patients in the original treatment arm, researchers reported in a scientific poster at the 30th Annual Meeting of the American Academy of Pain Medicine.
Interest in the use of intradiscal biacuplasty is growing in connection with the need for less invasive treatment options to treat discogenic low-back pain, study authors say. The treatment involves placing two cooled radiofrequency electrodes in affected discs to ablate the nerve fibres of the intervertebral disc cover, thus interrupting the generation of pain sensations.
Appropriate candidate selection is considered key to a good patient outcome in intradiscal biacuplasty.
“This minimally invasive procedure should be limited to younger patients with discogenic pain arising only from one or two lumbar discs and without other sources of lower back pain,” says lead study author Leonardo Kapural, of the Carolinas Pain Institute and Center for Clinical Research in Winston, Salem, North Carolina, USA. Kapural led a collaborative research team from the North Carolina facility and the Cleveland Clinic in Cleveland, Ohio, USA.
The current study is a follow-up to a six-month, double-blind, sham, randomised study (Kapural L et al, Pain Med 2013; 14(3):362-73). After unblinding, investigators continued to follow 22 out of 27 subjects in the original active treatment group for 12 months. Patients reported outcomes on physical function, pain and disability via the SF-36 health survey, the 11-point pain numerical rating scale and the Oswestry low-back pain disability questionnaire.
Clinically significant improvements reported at six months in the original treatment arm were maintained at nine and 12 months for physical function (∆ = 22) and pain (∆=-2.9).
Moreover, crossover patients who had been randomised to sham therapy during the initial study reported improvements after intradiscal biacuplasty that did not differ statistically from those of patients originally randomised to intradiscal biacuplasty treatment. Of 30 patients in the original sham group, 24 chose to crossover to intradiscal biacuplasty treatment, and 20 completed follow up.
Discogenic pain, which occurs when the intervertebral discs degenerate or wear out, is the most common cause of chronic low-back pain. The majority of sufferers have multilevel disease and would not be candidates for intradiscal biacuplasty, Kapural emphasises. Current surgical treatment options are limited to fusion and disc arthroplasty and have been suggested to yield very low success rates, he says.