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Independent source injects caution into a HeathDay story on ‘nerve zap’ for back pain

Nerve Zap Might Ease Pain of Herniated Disk

Our Review Summary

This story describes research results presented at a radiology meeting that compared treating patients with lower back pain from disk herniation with either a pulsed radiofrequency (pRF) probe or multiple steroid injections.

We also reviewed a news release about this research.

Among the story’s strengths: It alerts readers that the study — presented as an abstract — has yet to be peer-reviewed and published, and it provides cautious comments from an independent source, although they appear at the very end.

However, the story leaves readers in the dark about how the treatment was evaluated and what it costs, and misses some important limitations with the evidence.

It largely ignored potential harms, including the possibility that some patients might be treated unnecessarily because the cause of back pain can be difficult to diagnose.

 

Why This Matters

Back pain is a common problem. Often it goes away with time and exercise. But chronic pain that does not respond to conservative treatment and includes shooting pain into the buttocks and leg (sciatica) is a leading cause of disability and an economic burden.

More treatment options are needed, but identifying the true source of pain is part of the battle.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story says pRF is “far cheaper” than steroid injections, but there’s no data on its cost.

We found one web site, MD Save, offering procedures for $2,500, but it’s unclear whether that’s representative.

The story could have helped readers by comparing the cost of CT-guided pRF, CT-guided steroid injections, and lumbar disk surgery.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story calls this treatment a potential “boon to back pain patients for whom standard therapies have failed,” and includes a glowing personal endorsement by the study’s lead author.

Only near the end do we get a small amount of data:

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

The story doesn’t tell readers what “perceived” recovery means and how it was measured.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story doesn’t discuss the harms of this treatment. It’s full of language — “a simple zap to the spine,” “scalpel-free,” “noninvasive,” “less risky” — that might mislead readers into being falsely assured.

A procedure that introduces instruments close to the spine and makes contact with major nerve roots carries risks of infection and nerve damage. Those should have been mentioned.

The story does say that “diagnostic uncertainty can undermine the ability of surgery to get at the true source of a patient’s pain.” However, we think the story should have underscored the point that low back pain is often treated unnecessarily. Even if a herniated disk shows up in imaging — which is common — it might not be the cause of a patient’s pain. That opens the possibility that some patients will undergo a procedure that won’t help them, but could do harm.

Does the story seem to grasp the quality of the evidence?

Satisfactory

This is a close call.

The story deserves credit for pointing out that the research presented at a medical meeting “is considered preliminary until published in a peer-reviewed journal.”

We also like that it quoted a doctor who cautioned that it “remains an open question as to whether the pRF procedure really cured the condition,” since back pain often resolves on it own.

Still, there are other points we wish the story had addressed:

  • The study outcomes are based on patient questionnaires — which can be unreliable, difficult to reproduce, and subject to bias.
  • The study compared pRF with epidural steroid injections, but there’s no evidence that such injections help with pain from a compressed nerve. It is therefore not an appropriate control group.
  • The story also could have underscored that in the absence of details about the study’s design, it’s difficult to fully evaluate the quality of evidence.

Does the story commit disease-mongering?

Satisfactory

Back pain is common, and this story does not disease monger. It gives a concise description of what disk herniation of the lower back is.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

Laudably, the story contains cautionary comments from a physician who was not involved with the study. He points out that most people with back pain “improve with time and exercise alone,” and “it remains an open question as to whether the pRF procedure really cured the condition.”

We wish some of the cautions had been placed higher in the story.

The story did not mention conflicts of interest, and we could not find any that the authors have disclosed.

Does the story compare the new approach with existing alternatives?

Satisfactory

The story mentions interventions that are commonly recommended for low back pain, including waiting it out. Generally speaking, there’s no standard treatment for most back pain, and often no treatment is recommended.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

This story mentions this treatment has been FDA-approved, but doesn’t explain whether it’s widely available, particularly for treating spinal disk herniation with spinal nerve compression.

Does the story establish the true novelty of the approach?

Satisfactory

The story explains early on that pRT is “not new” although it’s claimed that recent technology advances enable doctors to deploy it with better accuracy.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story doesn’t rely on a news release.

Total Score: 6 of 10 Satisfactory

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