What Is Good For the Shoulder May Work For the Back
Chronic low back pain from disc problems is hard to treat. Many doctors say that treatment without surgery is the rule for most of these patients. Short periods of rest, medications, and physical therapy are generally best. Treatment is sometimes difficult because the cause and source of the pain is often hard to find.
Doctors know that in the normal disc, there are no nerve endings in the center of the disc. Some sensation is present in the outer third of the disc. However, this is thought to change when damage to the disc occurs from aging or injury. Nerves grow inward within the disc. Scientists call this neoneuralization, a process that can cause true disc pain.
A new treatment is being studied for this problem. It is called intradiscal electrothermal therapy (IDET). IDET was first used to shrink and tighten loose tissue around the shoulder. In the year 2000, doctors suggested using IDET for chronic disc pain.
A thin, rigid tube called a catheter is inserted into the disc. A form of imaging called fluoroscopy is used to guide the catheter to the right spot. Heat is delivered to the disc for four to six minutes. This shrinks the fibers in the disc and destroys any nerve tissues that have formed. The patient usually doesn't get pain relief until six weeks later, but it appears to work for 60 to 80 percent of all patients.
IDET isn't for everyone. Doctors may suggest it as an option for patients with chronic low back pain caused by wearing away of the disc. The disc space must be large enough for the catheter to fit. IDET isn't for pregnant women or patients with other back problems. Patients with other serious health issues aren't good candidates either.
F. Todd Wetzel, MD, and Thomas A. McNally, MD. Treatment of Chronic Discogenic Low Back Pain With Intradiskal Electrothermal Therapy. In Journal of the American Academy of Orthopaedic Surgeons. January/February 2003. Vol. 11. No. 1. Pp. 6-11.