Nerve Zap Might Ease Pain of Herniated Disk

Nerve Zap Might Ease Pain of Herniated Disk

TUESDAY, Nov. 27, 2018 (HealthDay News) –What if a simple zap to the spine could relieve the debilitating lower back and leg pain brought on by a herniated disk?

Such is the promise of “pulse radiofrequency” therapy (pRF), which sends inflammation-reducing pulses of energy to nerve roots in the spine, a new study claims.

The therapy is not new, having first received U.S. Food and Drug Administration approval in the 1980s.

But recent advances in CT scan technology now enable clinicians to deploy those energy pulses with much more accuracy, experts said. And the new research suggests the treatment could prove a boon to back pain patients for whom standard therapies have failed to do the trick.

“I was amazed with the results of pRF,” said study author Dr. Alessandro Napoli. “Especially having read, as a radiologist, numerous lumbar MRI scans of patients with recurrent hernia after surgery.”

And as a patient himself, Napoli added that “from personal experience I can tell you that the treatment is not painful, and the results are appreciated within days after a single treatment lasting 10 minutes.”

Napoli is a professor of interventional radiology at Sapienza University of Rome in Italy.

He and his colleagues plan to report their findings Tuesday at the Radiological Society of North America annual meeting, in Chicago. Such research is considered preliminary until published in a peer-reviewed journal.

Lower disk herniation results when the insulating disks that sit between spinal vertebrae tear open, allowing jelly-like material to protrude and exert pressure on surrounding nerve roots. Beyond lower back pain, the condition often triggers sciatica, a pain that radiates down a patient’s leg.

Standard therapies include over-the-counter pain meds, corticosteroid spinal injections, and/or invasive spine surgery that sometimes involves disk removal and vertebrae fusion.

The problem, said Napoli, is that such options entail risks without assured relief.

“Steroid injections are effective only in portion of the patients, and generally require more sessions,” he noted. And though surgery safety has “largely improved,” Napoli pointed to the risk for bleeding and infection, the need for a minimum two- to three-day hospital stay, the high cost, and the fact that some patients ultimately realize little benefit.

By contrast, pRF is scalpel-free, delivering radio signals directly to affected nerves via a CT scan-guided electrode. The process, said Napoli, requires no hospital stay, is noninvasive, far cheaper and less risky.

“The rationale for using pRF on disk herniation is that we eliminate the inflammation process of the compromised nerve root,” he explained. “Without inflammation the pain fades, and the body starts a self-healing process that allows for complete resolution of the disk herniation in a large proportion of patients.”

For the study, the Italian investigators compared 128 lumbar herniation patients who underwent a single 10-minute round of CT-guided pRF with 120 patients who received one to three rounds of steroid injections.

All the patients had already undergone standard interventions, with poor results.

By the one-year mark following either treatment, a full “perceived” recovery was reported by 95 percent of the pRF patients, compared with just 61 percent of the steroid injection patients.

Dr. Daniel Park, director of minimally invasive orthopedic spine surgery at William Beaumont Hospital in Royal Oak, Mich., offered some caution on the findings.

He noted that because “the majority of people with back pain improve with time and exercise alone,” it remains an open question as to whether the pRF procedure really cured the condition.

Still, Park noted that diagnostic uncertainty can undermine the ability of surgery to get at the true source of a patient’s pain, given that “the problem with low back pain is that there are many causes of it, and physicians have trouble identifying the cause of pain.”

Nevertheless, he remains unsure if pRF is truly ready for prime time.

“Best case, I think [pRF] could be an option for people if they [have already] failed therapy and medication,” said Park. “It may be a similar option for people if they do not or cannot have steroid injections, but they need more treatment. I think this is experimental, and should not be first-line.”

More information

The American Academy of Orthopaedic Surgeons offers more information on herniated disks.

SOURCES: Alessandro Napoli, M.D., Ph.D., interventional radiologist and professor, interventional radiology, department of radiological, oncological and pathological science, Sapienza University of Rome, Italy; Daniel Park, M.D., orthopedic spine surgeon, associate professor, orthopedic spine surgery, and director, Minimally Invasive Orthopedic Spine Surgery, William Beaumont Hospital, Royal Oak, Mich.; Nov. 27, 2018, Radiological Society of North America annual meeting, Chicago

Copyright ©2017 HealthDay. All rights reserved.
Electrical Pulses May Ease Pain From ‘Slipped’ Disc

Electrical Pulses May Ease Pain From ‘Slipped’ Disc

Radiofrequency ablation:

A new treatment that aims electrical pulses at irritated nerves around the spinal cord appears effective at relieving chronic lower back pain and sciatica, a preliminary study suggests.

The minimally invasive procedure, called image-guided pulsed radiofrequency, eased lingering pain in 80 percent of 10 patients after a single 10-minute treatment. Ninety percent were able to avoid surgery.

“Given the very low risk profile of this technique, patients suffering herniated disc and nerve root compression symptoms may undergo a safe and fast recovery, going back to normal activities within days,” said study author Dr. Alessandro Napoli. He’s an interventional radiologist at Sapienza University, in Rome, Italy.

“In fact,” he added, “one of the dramatic advantages of this technology is that we can perform it in a day-surgery setting, without anesthesia, and [patients] go home the same day.”

Napoli’s study is scheduled for presentation Wednesday at the Radiological Society of North America’s annual meeting, in Chicago. Studies presented at scientific conferences typically haven’t been peer-reviewed or published, and results are considered preliminary.

About 8 in 10 people suffer from lower back pain at some point in their lives, according to study documents. This pain can be due to a herniated disc in the lower spine. Sciatica is radiating leg pain caused by a pinched nerve in the lower spine, which also may be due to a herniated disc.

Also called a slipped or ruptured disc, a herniated disc occurs when the spongy material inside a spinal disc squeezes through its tough outer shell because of aging or injury. This material can press on surrounding nerves, causing pain and numbness or tingling in the legs, according to the American Academy of Orthopaedic Surgeons (AAOS).

Conservative, nonsurgical approaches typically ease symptoms of a herniated disc over time, according to the AAOS. These treatments include rest, gentle exercise, pain relievers, anti-inflammatory drugs, cold or hot compresses and physical therapy.

However, about 20 percent of those with acute low back pain don’t find relief through these measures. That leads some to decide on surgery to remove disc material pressing on their spinal nerves. For these people, Napoli said, image-guided pulsed radiofrequency treatment may become a viable option if larger studies reinforce his findings.

Napoli’s research included 80 people who had experienced at least three months of low back pain from a herniated disc that hadn’t responded to conservative treatments.

Image-guided pulsed radiofrequency treatment uses computed tomography — a CT scan — to help physicians insert a needle to the location of the herniated disc and surrounding nerves. A probe that’s inserted through the needle tip delivers pulsed radiofrequency energy to the area over a 10-minute period, resolving the herniation without touching the disc, Napoli explained.

More than 80 percent of the 80 study participants were pain-free a year after a single treatment. Six people required a second treatment session.

Pulsed radiofrequency has been widely used in pain medicine for other types of chronic pain, Napoli noted.

He said the treatment works by “eliminating the inflammation process” in nerves surrounding the herniated disc, hindering painful muscle contractions. “The aim was to interrupt this cycle and give the body the chance to restore a natural healing,” he added.

Dr. Scott Roberts, a physiatrist with Christiana Care Health System in Wilmington, Del., said the new findings showed “an impressive drop in pain and improvement in function.” However, he noted that the research didn’t include a control group for comparison with people not given the treatment.

“With no control group, we don’t know how much of the improvement we’re seeing would have happened anyway,” Roberts said. “I was very encouraged by [the study] because its results are significant, but it’s far from conclusive without a control group.”