Pulsed Radiofrequency For Acute Back Pain and Sciatica

MedicalResearch.com Interview with:

Probe being applied to nerve root. Credit: Radiological Society of North America

Probe being applied to nerve root.
Credit: Radiological Society of North America

Alessandro Napoli MD PhD
Department of Radiological, Oncological and Pathological Sciences
Sapienza University of Rome 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Disc Herniation in the lumbar region can create intense pain in the lower back and along the leg as a result of nerve compression. People suffering disc herniation may either experience a spontaneous relief from the pain or requiring further medical actions in order to improve quality of life and going back to work and daily activities. When the pain is not responding to usual conservative care (both physical and pharmacological therapy) surgery is often considered a valid option.However, most of the people (despite the intense pain) would possibly avoid surgery. For this reason, Interventional percutaneous therapies such as intraforaminal injection of steroid have become more popular. Pulsed radiofrequency is a percutaneous therapy that may have the potential to rapidly relief the pain in a long lasting way by means of single 10 minutes procedure. We decided to undertook a randomized clinical trial to test the clinical benefit of pulsed radiofrequency therapy using intraforaminal injection as a control group. in both groups percutaneous approach was guided under precise guidance of CT images.

Pulsed radiofrequency group patients experience a faster and more durable pain control during the 1 year period follow up. Incidence of retreatment or cross-over was significantly higher in the injection only group.

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Sciatica: Biomarker Demonstrates Inflammation, Not Just Compression of Nerve Roots

MedicalResearch.com Interview with:

“osteopathic treatment for sciatica” by betterhealthosteopathy is licensed under PDM 3.0Daniel Albrecht, PhD
Research Fellow in Radiology, Harvard Medical School
Research Fellow, Massachusetts General Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: A great deal of preclinical work in animal models of pain has established that activation of peripheral immune cells or, in the central nervous system (brain and spinal cord), immune cells called “glia” (microglia and astrocytes) play a key role in the establishment and/or maintenance of persistent pain. For instance, if you pharmacologically block activation of these cells in the nervous system, you are able to reduce/inhibit/prevent pain behaviors, e.g. in animals who have received a nerve injury.

This observation is very exciting, because it suggests that blocking neuroinflammation may be a viable way of treating pain. However, the evidence linking human chronic pain with neuroinflammation has so far been limited.

In this study we show, for the first time, that patients with chronic sciatica (that is, back pain that shoots down the leg) demonstrate elevations in the levels of a protein called the translocator protein (TSPO) in the spinal cord and in the nerve roots.

Because TSPO is a marker of neuroinflammation, our results suggest that sciatica is associated with neuroinflammation.

While on average patients do show elevations in the levels of the TSPO, we also saw significant variability across individuals. Importantly, patients that show stronger elevations (in the nerve roots) were those who benefit the most from receiving a local anti-inflammatory treatment (epidural spinal injection). This makes sense: patients whose nerve roots are inflamed benefit from an anti-inflammatory treatment. Those whose nerve roots aren’t inflamed, don’t receive the same benefit. In the latter case, the source of the inflammation and pain may not be the nerve roots, but may be the spinal cord, or, as we showed in a previous paper (Loggia et al., Brain 2015), the brain.  Continue reading

Pain From Sciatica Not Helped By Oral Steroids

Harley Goldberg, DO Physical Medicine and Rehabilitation Kaiser PermanenteMedicalResearch.com Interview with:
Harley Goldberg, DO
Physical Medicine and Rehabilitation
Kaiser Permanente

Medical Research: What is the background for this study? What are the main findings?

Dr. Goldberg: This is the first large-scale randomized, double-blind, placebo-controlled clinical trial of oral steroids for acute radiculopathy, commonly called sciatica, associated with a herniated lumbar disk.

Lumbar radiculopathy (or pain down the leg in a lumbar nerve root distribution) is a common source of pain and disability for many adults. It is thought that inflammation from a disk herniation is responsible for many of the symptoms, so giving a powerful anti-inflammatory, such as steroid medication, might help relieve sciatica symptoms quickly. Prior research has shown that lumbar diskectomy does not affect the one year outcome for most patients, and epidural steroid injections do not have strong support by clinical trials. If the use of epidural steroids injections is based on application of steroid anti-inflammatory to the affected nerve root(s), perhaps an oral steroid can have affect. Although oral steroids are used by many physicians and have been included in some clinical guidelines, no large-scale clinical trials of oral steroids for sciatica have been conducted before.

Our study found that among patients with acute radiculopathy associated with a herniated lumbar disk, a short course of oral steroids resulted in only modest improvement in function and no significant improvement in pain.
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Chiropractic Spinal Manipulation Therapy May Be Helpful For Uncomplicated Sciatica

Gert Bronfort, DC, PhD Professor, Integrative Health and Wellbeing Research Program Center for Spirituality & Healing University of MinnesotaMedicalResearch.com Interview with:
Gert Bronfort, DC, PhD
Professor, Integrative Health and Wellbeing Research Program
Center for Spirituality & Healing
University of Minnesota

Medical Research: What are the main findings of the study?
Were any of the findings unexpected?

Dr. Bronfort: Our study found that spinal manipulative therapy  SMT coupled with home exercise and advice (HEA) appears to be helpful compared to home exercise and advice alone (especially in the short term) for patients with sub-acute and chronic back-related leg pain (BRLP). BRLP was defined as radiating pain originating from the lumbar spine, which travels into the proximal or distal lower extremity, with or without neurological signs. Patients with progressive neurological deficits, cauda equina syndrome, spinal fracture, and other potentially serious causes of BRLP (and often candidates for surgery) were EXCLUDED.

There were a few things we did find to be quite interesting. First, it is notable that the spinal manipulative therapy & home exercise and advice group experienced less self-reported medication use after one year than the  home exercise and advice alone group (SMT&HEA was 2.6 times more likely to experience fewer medication days than HEA alone at 1 year). Given the growing concerns of overuse of pain medications (and the potential for adverse events and addiction), this is a finding that has important public health consequence.

Another interesting and important finding is that the adverse events observed in this study were only mild to moderate and self-limiting. No serious adverse events occurred that were related to the study interventions. Mild to moderate adverse events (e.g. temporary aggravation of pain, muscle soreness, etc.) were reported by 30% of the patients in the SMT&HEA group, and 42% in the HEA group. This is important as few studies have systematically recorded the side effects and adverse events related to SMT&HEA and HEA alone; this is one of the first, larger clinical trials to do so. These findings are especially notable because SMT is often not recommended for patients with leg symptoms because of safety concerns (which might be related to the previous absence of robust scientific data to support its use).

Finally, while an advantage of SMT& HEA versus HEA was found (especially in the short term), we do find the findings of the HEA alone group to also be of interest. Almost half of the HEA patients experienced a 50% reduction in leg pain symptoms in both the short (at 12 weeks) and long term (at 52 weeks). That’s an important improvement and warrants future investigation. Self-management strategies (like home exercise) that emphasize the importance of movement and fitness, restoration of normal activities, and allow patients to care for themselves embrace important principles for promoting overall health and wellbeing that could have a big impact if routinely put into practice.
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