Shrinkage- At least it's not harmful

Intradiscal electrothermal therapy (IDET) is increasingly being used in the management of chronic spinal pain, to the tune of about 40K procedures a year in North America. IDET is performed under video fluoroscopy and involves placing a catheter needle in the “symptomatic” disc and heated to 90 C. The thermal energy has been shown to coagulate neural tissue, shrink collagen fibrils and thereby potentially reduce both the nociceptive and mechanical components of discogenic pain. However, the recent high quality double blind RCT by Freeman and colleagues (Download IDET_Placebo_RCT_Spine_2005.pdf) demonstrated no benefit of IDET over placebo. It was interesting that these individuals had relatively high disability scores and yet less than 30% had received physical therapy prior to enrolling in the trial (see Table 3). There were no reported complications from the procedure so despite being ineffective it appears that IDET is a relatively safe procedure.

Tim

Comments

[Jason Silvernail]

Good post, Tim.

Everytime I read something like this (expensive surgical or pharm procedure not helpful, most patients in study not offered PT), which is happening more and more often (remember the recent UK trial on lumbar fusion, for example) I just have to laugh.
With all the talk of concern over direct access and reimbursement issues in our profession, it seems obvious that there are simply OCEANS of patients who could benefit from our services who are either unaware of them or who are not offered them by existing providers in the medical system.

As more people slowly become aware of these issues, public demand for access can only increase. It is as John C likes to say, the best days of our profession are ahead of us.
J

[Michael DuPriest]

Money. Stockholders. Pressure on upper management to perform, i.e. increase the value of stock. Greed. The American value system of the more you have the happier you'll be.

Physical therapy and chiropractic are intensly service oriented. Then orient your practice per evidence toward a more manual therapy and exercise orientation; Purchase your equipment, which tends to be quite durable. So, what can I sell you? Well, not much.

Then the American public deluded by the media believing a quick fix exists and then we come along and say, "Well if we can address your fear-avoidance (which they frequently deny and say they have a high pain threshold) and perform exercise (even though it might hurt some)then you have a good chance of seeing some improvement. Now lets go sell this to the public.

We have some very good and valuable information. The conundrum is making it palatable to the public.

Mike

[John Ware]

You think IDET's expensive? Have any of you experienced the latest wave of disc replacement recipients, yet? Just for kicks I'm going to punch it into PubMed and see how many RCTs show up.

[Alexander Freeman]

A very friendly site. Have a nice day! Memorizing Girl becomes Greedy Girl in final: http://www.canoe.ca/ , Central is feature of Beautiful Corner Table can Forecast Cosmos , when Chair Hedge Round Compute when Pair Roll Gnome Double