Backing it Up
Todd Douglas's piercing, intolerable back pain started more than 10 years ago and steadily worsened over time. Then the Colchester resident met Dr. Robert Monsey, professor of orthopedics and rehabilitation, and Dr. James Rathmell, associate professor of anesthesia and director of Fletcher Allens pain management center. Now, thanks to the two doctors' comparative clinical trial of a new treatment the only investigation of its kind worldwide Douglas finally has found some relief.

"They were the 12th and 13th doctors I went to in my grand quest across the state to find a doctor who could help me," said Douglas.

Douglas, who is married and has two young children, was originally diagnosed with arthritis and had received cortisone injections. Those helped for a couple of months, and then their effect faded. His only other recourse was daily pain medication. After he visited Rathmell and Monsey they identified the true source of his pain: degenerative disc disease.

The standard treatments for the condition are spinal fusion surgery or ongoing pain medication. But it happened that Rathmell and Monsey were recruiting patients for their clinical trial comparing the effectiveness of an experimental, less-invasive treatment for chronic low-back pain called intradiscal electrothermal therapy (or IDET) with that of traditional spinal fusion surgery. Douglas opted for the trial and was the first participant selected and the first to undergo the IDET procedure.

"IDET is used to treat degenerative disc disease when there is no evidence of nerve root compression, which causes such symptoms as sciatica or leg pain," explains Rathmell. "This study is trying to determine if IDET is a viable alternative to spinal fusion for degenerative disc disease."

IDET is a 40-minute out-patient procedure, while spinal fusion is back surgery and requires a two-day hospital stay. So the attractions of IDET are obvious if it works. "This treatment has been highly touted, but we were skeptical of the science behind it. So we wanted to test it," Monsey says.

Getting wired
To prepare for the procedure, Douglas had to stop taking his pain pills for several days. His back flared up with an agonizing vengeance; he could barely walk into the clinic from the parking lot the Thursday morning of his scheduled therapy. After hobbling in and reviewing the planned procedure with his doctors, Douglas laid on the treatment table while he received a series of "unpleasant

pokes and picks" that identified the exact spot on the disc where the electrothermal therapy a hot wire would be inserted. The doctors made two small insertions in Douglas spine and began the 40-minute process of using the hot wire to shrink collagen fibrals, the soft center of the disc, and stiffening nerve tissue to reduce pain. Douglas was conscious and talking throughout the treatment.

Following the procedure, Douglas had two days of bed rest and took medication. By the third day, he was walking comfortably and taking less pain medication. By the fifth day a Monday he was back at work and taking no medication at all. He also wore a back brace for about six weeks and received physical therapy for about 10 weeks. The study protocol also required that he come to regular follow-up appointments with his doctors; his last is next week.

"Oct. 11, 2001 is the day I got my life back after ten years of not having it," says Douglas, who now speaks to prospective trial participants about his experience with the procedure. "I hope my case will help relieve others back pain in the years to come."

Not a miracle
Douglas's story inspires optimism, but it is only a small fraction of the trial. The study eventually will involve at least 40 patients. About 18 have been recruited already. Monsey declines to say much about how things have progressed so far he's waiting to complete an initial analysis of the trial's results with Rathmell after 20 patients have participated. If the initial analysis is promising, the team will complete the study and publish sometime in the next 12- to 18-months. In the meantime, Monsey offers this: "We've had some good successes from IDET, but we've also had occasions where we had to repeat the procedure."

So a miracle cure it is not. Back pain still will afflict about 80 percent of the population at one time or another. "The pain," Monsey says, "is a consequence of living upright on a planet with gravity." But as research into new imaging techniques, biochemical markers and treatment procedures continues, Monsey is optimistic that the enhanced knowledge will help doctors find better treatments to an ever-present yet elusive ailment.

"Better matching symptoms to an appropriate treatment is the art and science of where we're going," he says. "That's the crux."

Article Sources:
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