A study published in Spine examines nonoperative treatment for discogenic low back pain.
The authors examined 11 randomized controlled trials investigated traction therapy, injections and ablative techniques. The researchers found:
1. Five of the trials investigating methylene blue injection, steroid injection, ramus communications ablation, intradiscal electrothermal therapy and biaculpasty favored intervention over sham therapy. However, the study on methylene blue injections has not been replicated in other trials.
2. The criteria used in the studies on ramus communicans ablation and intradiscal biaculpasty and a stratified analysis of randomized control trial results on intradiscal electrothermal therapy cast doubt on whether conclusions in these trials can be applied to the general discogenic back pain population.
3. Few high-quality studies evaluating nonoperative treatment to reduce low back pain and although several studies have favored intervention over sham therapy in the conclusion, long term benefits remain unclear.
4. Newer modalities such as biaculpasty have some promise, but the article's authors recommend more inclusive studies be performed.
5. An article published earlier this year by the American Academy of Pain Medicine reported patients treated with intradiscal biaculpasty for discogenic low back pain showed initial pain relief and physical function gains after one year. The study also reported patients who were in the "sham" treatment group were later offered IDB and achieved similar positive results to those initially treated with IBD, according to a Science Daily report.
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