Abstract
Introduction: Intradiscal electrothermal therapy (IDET) is a controversial, new treatment for low back pain, whose efficacy has not been tested in randomized trials. The present study was undertaken to compare the efficacy of IDET with that of a placebo treatment.
Methods: Patients were recruited by referral and by advertising in the media. Of 4,530 individuals who enquired, 1,360 were prepared to submit to randomization. Of these, 260 were found potentially eligible after clinical examination, and 64 became eligible after discography. All had discogenic low back pain lasting longer than 6 months, with no comorbidity. Thirty-seven were allocated to IDET, and 27 to sham therapy. Both groups were satisfactorily matched for demographic and clinical features. IDET was performed using a standard protocol, in which the posterior annulus of the painful disc was heated to 90°C. Sham therapy consisted of introducing a needle onto the disc and exposing the patient to the same visual and auditory environment as for a real procedure. Follow-up at 6 months was achieved in over 85% of patients. Pain and disability were assessed using a visual analog scale for pain, the SF-36, the Oswestry disability scale, and the Back Depression Inventory.
Results: Patients in both groups exhibited improvements, but improvements in pain, disability, and depression, were significantly greater in the group treated with IDET. Pain scores improved by 24 points in the IDET group compared with 11 in the sham group. Oswestry scores improved by 11 in the IDET group, but only by 4 in the sham group. More patients deteriorated when subjected to sham treatment, whereas eight patients (25%) achieved greater than 75% relief of pain following IDET. Only one patient did so after sham treatment. The number needed to treat, to achieve 75% relief of pain, was 5. No patient suffered any adverse effects.
Discussion: IDET fails to provide relief in some 50% of patients. Consequently, its efficacy is difficult to demonstrate statistically. Nevertheless, IDET provides satisfying relief in a substantial proportion of patients. Non-specific factors account for a large proportion of the apparent efficacy of IDET, but its efficacy cannot be attributed wholly to a placebo effect. The efficacy of IDET may be related critically to patient selection and the technique used. Improvements in either of these areas may improve the effect-size of IDET. Meanwhile, IDET is a low risk procedure that constitutes a legitimate option for patients with discogenic low back pain whose only alternative is fusion.
The abstracts were prepared by Dr Robert Moore. Correspondence should be addressed to him at Spine Society of Australia, c/o the Adelaide Centre for Spinal Research, Institute of Medical and Veterinary Science, PO Box 14, Rundle Mall, Adelaide SA 500, Australia.
