New study raises doubts on common back pain management

Experts theorize that the current protocol of emphasis on diagnostic nerve blocks prior to radio frequency (RF) denervation to determine the cause of ailment is resulting in excessive tests, delays in pain relief, and steep costs, almost to the tune of $10,000 dollars per patient.

Study leader Steven P. Cohen, M.D., an associate professor of anaesthesiology and critical care medicine at the Johns Hopkins University School of Medicine stated, "The whole way we're doing this is wrong. If we just do the radio frequency procedure first, we're going to help more people and we're going to save a lot of money."

He added, "When you do two blocks, you may be wrongly weeding out many people who would actually benefit from radio-frequency denervation."

Details of the study
In a bid to assess whether radiofrequency denervation is as safe as giving a diagnostic block, the scientists conducted a randomized, multicenter study from January 2007 to April 2009.

As a part of the study, they enrolled 151 patients and divided them into three groups.

The first group was treated with RF denervation without nerve blocks, the second underwent RF denervation after a positive diagnose through one nerve block, while the last group went in for RF denervation treatment only after positive response to two nerve blocks.

Observations by the researchers
The researchers noted that 33 percent of the participants in the first group exhibited high success rate with pain relief lasting for nearly three months.

In contrast, only 16 percent of the patients in the second group and 22 percent of the third group patients experienced similar relief in the same time period.

In other words, the success rates were 33, 39, and 64 percent in three groups respectively.

In addition, the cost of treatment in the first group was $6,286, considerably less than the $17,142 and $15,241 incurred by the other two groups.

Moreover, it was perceived that patients who underwent nerve blocks endured multiple procedures and a long delay before finding some kind of relief in pain.

Also, there was the possibility that some might have missed out on radiofrequency denervation because of false-negative results.

Cohen concluded, "Based on this simple model of cost-effectiveness proceeding straight toradiofrequency denervation without any diagnostic blocks is associated with both the lowest cost per successful procedure and the highest number of total successful procedures."

The new study is published in the August issue of the journal Anaesthesiology.