Doctors Are Slow to Diagnose Arthritis of the Back
While people with crippled fingers or knees usually have no problem getting doctors to diagnose them with arthritis, sufferers of arthritic back pain typically must wait much longer for their problem to be defined and treated. And at least one doctor is claiming that this delay is costing the healthcare system too much money and resulting in needless pain and suffering for patients.
The issue is that back pain can be difficult to pinpoint as arthritis, although the disease does account for a significant percentage of back pain. Typically, doctors have followed the protocol of administering injectible nerve blocks into a patient's back to ensure that the pain is, in fact, being generated by an arthritic joint. But a team at Johns Hopkins University School of Medicine aims to encourage doctors to move straight to a procedure called radiofrequency denervation that uses heat to cut pain-causing nerves. Led by Steven Cohen, MD, an associate professor of anesthesiology and critical care medicine, the team has published a study showing the benefits of radiofrequency denervation compared with nerve blocks in cases where symptoms strongly suggest arthritis.
In this study, 151 subjects with back pain were divided into three treatment groups. The first group received radiofrequency denervation right away without nerve blocks, the second group received radiofrequency denervation only if they responded positively to a nerve block, and the third group received radiofrequency denervation only if they had a positive response to two nerve blocks.
The results? Fully a third of patients in the first group had significant pain relief that lasted at least three months. Only 16 percent of the second group and 22 percent of the third group could claim the same. According to Dr. Cohen, the problem with nerve blocks is that they aren't always accurate in diagnosing arthritis. And they prolong the misery for true arthritis sufferers who would benefit from immediate radiofrequency denervation, a procedure that carries no more risk than nerve blocks and which, in fact, may offer some extra protection because of its use of heat.
If you're bothered by recurring back pain that's suggestive of arthritis, speak to your doctor about moving quickly to radiofrquency denervation for treatment and bypassing time-consuming and costly nerve blocks altogether.
Source: Cohen, SP, 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 113.2 (2010): 395-405. Print.
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