Although the headline’s a bit more positive than perhaps it should be, and information about financial costs and potential harms is missing, this story aptly describes the main results, weaknesses, rationale and design of a small study of radio frequency therapy for lower back pain.
As the medical literature shows, lower back pain is over-treated surgically and notoriously susceptible to placebo effects, and this article on from NBC News nicely puts the study’s results in context of those factors, quoting outside experts. Thoughtful readers should come away from this article with a sense of caution about this therapy, if not a ten-foot-pole wariness.
Note: We also reviewed the Radiological Society of North America news release about the study.
Evidence-based “best practices” research shows that exercise, good posture, weight loss, the judicious use of medication, and even the simple passage of time can prevent or resolve most cases. But a study that promises a majority of patients a year’s worth of relief from a 10-minute, one-time, minimally invasive, safe and apparently painless therapy is going to get a lot of attention. The problem is that the design of the study — just 80 patients and no control group — doesn’t scientifically make the case that the treatment works, or is necessary, for all or even many patients, and articles reporting on the procedure should contain a heavy dose of caution. This one did a pretty good job at that.
Given the widely documented over-treatment issues already linked to lower back pain due to herniated discs, readers with an interest in any proposed therapy should be told what a therapy costs.
Although details were sparse with respect to the patient study group (age, gender, baseline and post-treatment disability and function), as well as the actually number of patients who experienced complete relief and what that relief represented in terms of function, the article did include the “pain free” endpoint data, the number of those who needed a second treatment session, and the percentage who were able to “avoid surgery,” presumably to repair or remove the displaced discs.
While the story didn’t quite connect the dots, it did report the long-known fact that one in five people with acute back pain still have pain one year later. In other words 80% are “cured” at a year–this is the same result as the new study. Looking at the longer term picture will be important.
Even minimally invasive procedures carry risks. The article doesn’t mention what those might be, either from the therapy directly, or from preoperative preparations.
The story uses quotes from outside experts to make pretty clear that back pain is “complex” and that for most people it goes away without any treatment. It also is explicit about the weaknesses in the study and why patients and clinicians should use the results with caution. And it underscores the need for a randomized controlled trial. Well done.
The article makes effective use of outside experts to put back pain and its treatment alternatives into context.
The article goes into some detail about alternatives to radio frequency therapy.
The overall impression is that the therapy is available at least from specialists in hospitals, but readers don’t know what kinds of specialists (neurologists? orthopedic surgeons?) provide it, or where else it may be available.
The story makes no claim that the therapy is brand new, so we’ll rate this Satisfactory, though it was a tough call. The story could have been strengthened with some information about the history of the treatment and previous research with it. For example, a 2014 review in the journal Pain Research and Management (“Radiofrequency ablation for chronic low back pain: A systematic review of randomized controlled trials”) found 1,063 published reports, but just 11 were sham-controlled randomized trials. The current research was not a randomized trial and would not have been included in the final analysis. The results were mixed for pain from disc disease (the focus of the current research).
The article makes substantial use of outside sources. Note: We also reviewed the Radiological Society of North America news release about the study.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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