Treatments ~ Additional
Intradiscal Electrothermal Therapy
Intradiscal electrothermal therapy (IDET) is a minimally invasive procedure for treating low back pain occurring as a result of worn spinal discs. IDET is usually performed after discography or other diagnostic testing has verified that the condition can be remedied by the procedure.
Candidates for IDET
Candidates for IDET must be at least 18 years of age and have lower back pain originating in the discs that is exacerbated by sitting. IDET is an appropriate treatment when the back pain has persisted for several months and remains unresponsive after 6 or more weeks of nonsurgical treatment methods.
The IDET Procedure
IDET is performed under a combination of sedation and local anesthesia. In order to prevent infection, antibiotics are administered, either intravenously or through injection, during the procedure. Fluoroscopy is used to enhance visualization as a catheter and heating device are inserted. The heating device, which reaches roughly 149 degrees Fahrenheit, is placed around the external coating of the disc in order to break down the nerve fibers and strengthen the disc tissue. This process closes any small tears in the region.
Recovery from IDET
For the first few days after IDET, pain may at first increase, but will then subside. To ensure optimal back function, physical therapy will be necessary for a month or two following the procedure. For the first few months after IDET, patients must refrain from bending, sitting for extended periods or lifting heavy objects. Patients are usually advised to wait at least 6 months before resuming strenuous activities.
Risks of IDET
While IDET relatively safe, all such procedures carry some slight risk of complication. In the case of IDET, these risks may include adverse reaction to anesthetic or medication, nerve damage, disc infection, or disc damage.
A number of different types of pharmacological medications may be used to reduce pain in various parts of the body. Any of the medications described below may be helpful in relieving pain, depending on the medical condition of the patient and the severity of the pain being experienced. Other factors that may be taken into consideration when determining how to treat a patient through the use of medication include the patient's overall health and medical history.
Medications may be needed on a short-term or long-term basis. They may be administered in a doctor's office, hospital setting or in the patient's home. In many cases, it is best to incorporate pharmaceutical pain management as one technique within an overall treatment plan. Various forms of medication may be necessary, sometimes in conjunction with one another.
Over-the-counter medications are frequently helpful in relieving symptomatic pain that is mild to moderate. Such medications may include analgesics such as acetaminophen and non-steroidal anti-inflammatory drugs, or NSAIDS, such as ibuprofen and naproxen. It is important for patients to consult with their physicians regarding appropriate dosages and to avoid possible interactions with prescribed medications or over-the-counter preparations they may already be taking.
For severe or post-operative pain, opioids, sometimes referred to as narcotics, may be necessary. These may include codeine, propoxyphene (Darvocet), hydrocodone (Vicodin) and oxycodone (Percocet, Oxycontin). While these drugs can be extremely effective against pain, they tend to be addictive. Ultram (Tramadol), a prescribed medication called an opioid analgesic, is somewhere between an over-the-counter medication and a narcotic, but it too may be habit-forming.
Muscle relaxants can also help to relieve symptoms of pain, particularly when such symptoms are associated with muscle spasms. Examples of commonly used muscle relaxants are cyclobenzaprine (Flexeril), carisoprodol (Soma) and diazepam (Valium).
Physical therapy is a treatment method for improving limited body movement and functionality that are a result of disease, injury or aging. Treatment involves restorative exercises that focus on developing muscle strength, flexibility, balance, posture and coordination, and that provide overall pain relief. Physical therapy is designed to promote a patient's overall health and fitness, prevent reinjury and maximize quality of life. It may be prescribed as an initial form of treatment for certain conditions or injuries, or to restore strength and function after surgery.
Physical Therapy Sessions
The core of a physical therapy session usually involves physical exercises to strengthen the body; the exercises are designed around the patient's injury or disease. Exercises usually progress in difficulty and intensity over the course of the sessions. A physical therapy session usually ends with an icing session or therapeutic massage; electrostimulation may be used during this cool-down period. The physical therapist records and states the patient's progress for the day, as well as possible goals for the next session.
At-Home Physical Therapy
In many cases, physical therapy can be performed at home, without the therapist's being present; this usually speeds up the recovery process. The patient should be given exercises or stretches that can safely be done on her or his own. Adhering to the physical therapy program and the entire rehabilitation process are essential for achieving effective results.
Radiofrequency Nerve Ablation
The nervous system of the body is the network through which important messages are sent at extremely high speeds. These messages can be vital to the human's survival, but in some cases can be too inflated or erroneous in nature. In these cases, the extra notes transferring through the system can be converted into disproportionate amounts of pain, especially when a nerve cord itself is disturbed. Radiofrequency nerve ablation (RF) is used to dull these messages superficially, so they either cease to exist or resemble the relevant amount of pain.
Facet joint pain occurs between two vertebrae in the spine, where the articular and inferior processes meet. The nerves that run to and from the spinal cord, which resides within the column of vertebrae, can become impinged or pressured if these joints become swollen. Although the nerve isn't necessarily being damaged nor is the specific area they innervate at risk, the patient continually receives pain messages through their nervous system. This pain can become debilitating, hampering the person's quality of life and their ability to focus on immediate tasks such as driving.
Radiofrequency nerve ablation reduces this pain by dampening the system; the heat caused by the radiofrequency needle destroys chief nerve organelles, causing them to either lose their ability to function or perform at a very ineffectual rate. This "productive destruction" must be very precisely targeted so that only the messages of pain are muffled and other messages such as temperature, touch and proprioception are unaffected.
The RF Procedure
Radiofrequency nerve ablation is performed using a tiny needle that is guided by an X-ray apparatus close to the patient. Once the correct nerve is targeted, a microelectrode is manipulated through the inside of the needle to the tip which is right next to the intended nerve. This electrode releases high-frequency waves over a period of sixty to ninety seconds that heat up the adjacent tissue to the point of deformation. Each joint generally has multiple nerves monitoring it, so the process must be repeated for each nerve to effectively reduce the pain.
Results and Recovery
Recovery is quite fast, taking at most two days before patients can return to work, although full results may not be seen for a week or two. The pain will slowly diminish over this time to somewhere between 50% of the original pain to nonexistence. These results will slowly revert to their pre-operational status over a period of six months as the nerves grow back. Some patients do not experience this and will maintain their reduced pain for life. The procedure can be repeated as needed for the desired results. Rehabilitation is focused on taking advantage of the reduced pain in the joint in order to strengthen it before the nerve regrows and makes it painful again.