Diagnostic guidelines a barrier to prompt relief for some back pain

Strict adherence to long-held guidelines for diagnosing the cause of arthritis-related back pain may be creating more problems than it is solving, according to researchers with Johns Hopkins University.

The researchers noted in their study – to be published in the August issue of Anesthesiology – that delays in pain relief, excessive testing and wasteful spending of as much as $10,000 per patient are among the issues created by full reliance on the guidelines.

The study goes on to assert that a more efficient course of action would be moving straight to radiofrequency denervation treatment in cases of back pain with suspected arthritis at its root – as opposed to the use of temporary diagnostic nerve blocks to prove an arthritis connection.

“The whole way we’re doing this is wrong,” stated Steven P. Cohen, MD, study leader, in a release. “If we just do the radiofrequency procedure first, we’re going to help more people and we’re going to save a lot of money.”

Study parameters and findings

The investigators randomized 151 back pain patients at several hospitals into three groups. Group 0 received radiofrequency denervation based on clinical findings without nerve blocks, group 1 underwent the radiofrequency treatment only after a positive response to a single diagnostic block and group 2 only got the treatment if they had positive responses to 3 diagnostic blocks.

According to the study results, one-third of the patients in group 0 experienced significant pain relief lasting at least 3 months – while 16% of group 1 and 22% of group 2 showed improvement. The costs per successful treatment in groups 0, 1 and 2 were $6,286, $17,142 and $15,241, respectively.

Group 0 patients, Cohen noted in the release, were treated immediately, visited a clinic just once and lost no extra days of work to undergo repeated diagnostic tests.

Still a use for nerve blocks

The researchers stressed that among patients who had radiofrequency treatment, success rates were higher in those who had the diagnostic blocks first – as they were more likely to have arthritis. Regardless, Cohen stated in the release, those patients “endured long delays and multiple procedures before finally getting lasting pain relief, and some may not have gotten needed radiofrequency treatment because of the false-negative results associated with diagnostic blocks.”

The release went on to say that diagnostic nerve blocks are still called for in some cases – such as determining whether surgery is the right option for relieving certain kinds of back pain in patients without a clear-cut anatomical problem to avoid surgical intervention.

Reference:
Cohen SP, Williams KA, Kurihara, C, et al. Multicenter, randomized, comparative cost-effectiveness study comparing 0, 1, and 2 diagnostic medial branch (facet joint nerve) block treatment paradigms before lumbar facet radiofrequency denervation. Anesthesiology. doi: 10.1097/ALN.0b013e3181e33ae5

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