Therapeutic Disc injections for axial back pain

[nopain1234]

I am hearing some pain physicians have started doing intradiscal steroid injections with lidocaine for treatment of back pain. Most of us were not trained to pursue this even though the disc can be a source of back pain. What are your thoughts?

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[Ducttape]

it seems as a whole the field is moving away from steroids at any location.

injecting steroids into a sterile secluded environment that could result in serious infection does not seem to be the best idea to me.

 

[SSdoc33]

I am hearing some pain physicians have started doing intradiscal steroid injections with lidocaine for treatment of back pain. Most of us were not trained to pursue this even though the disc can be a source of back pain. What are your thoughts?

then you are hearing incorrectly

 

[nvrsumr]

That is very old fashioned approach. Was a doc in Birmingham who did this alot back in the day

 

[Ferrismonk]

Intradiscal injections with anything are high risk, low yield. I can't even fathom doing them for "back pain".

My guess is the person you're referring to is either doing it because they don't know any better or they are billing WC, Auto, or PI.

 

[RoloTomassi]

Yeah old school tried and failed idea. Don't know anyone trying to revisit.

 

[nopain1234]

So you guys would say this is far outside the standard of care? I didn’t want to jump to conclusions bc I am not familiar with this treatment modality for back pain.

Hence, nobody I know who’s properly trained performing these nor did I observe anyone in residency or fellowship doing them for isolated axial symptoms

 

[RoloTomassi]

Yes, it's akin to injecting methylene blue. Any intradiscal procedure is arguably
outside standard of care, but nowadays it's PRP, BMAC, ViaDisc, or Disc-Fx. Discograms with local are making a bit of a comeback as precursors to the above. Success rates depend on who you ask.

 

[MitchLevi]

I'd love to know how violating the integrity of the mostly avascular annular rings is a good idea if your injectate is steroid...I can't understand that mechanism.

Read Carragee.

 

[SSdoc33]

I'd love to know how violating the integrity of the mostly avascular annular rings is a good idea if your injectate is steroid...I can't understand that mechanism.

Read Carragee.

carragee's work relied mostly on large-bore needles and no documentation of pressurization. sometimes CT-guided. older discogram studies with no real standardization. im not so much swayed by the idea that discography make things worse, but rather that it hold very little clinical utility.

 

[SSdoc33]

That is very old fashioned approach. Was a doc in Birmingham who did this alot back in the day

saw it first-hand. then went to clinic and saw the big vat of pre-filled syringes for a TPI on everyone who walked thru the door.

 

[nopain1234]

Are there any studies you guys have to debunk this procedure?

 

[Ducttape]

logical fallacy.

the burden of proof is on whether the injection works, not whether there is data that shows it does not.

in other words: one cannot make the assumption that the injection is a good idea based on the lack of any article to say that it doesnt work.

 

[lobelsteve]

50+ years of everything tried and failed kind of leaves a bias.

 

[nopain1234]

I found this

 

[Ducttape]

thanks for posting. study suggests no difference at all in intradiscal steroids vs saline.

was in 2004.

some more recent studies do look at intradiscal ozone.

in the most recent ASPN guidelines, i do not see intradiscal ozone listed. i also do not see intradiscal steroids discussed, and recommendations regarding intradiscal regenerative medicine is all over the board.

ASPN Back guideline of interventional treatment: lower back | JPR

The ASPN Back guideline were developed to provide clinicians the most comprehensive review of interventional treatments for lower back disorders.

www.dovepress.com

 

[lobelsteve]

https://cdn.ymaws.com/www.spineintervention.org/resource/resmgr/factfinder/22/12.ff.intradiscal.biologics.pdf

SIS Fact Finder

 

[Baron Samedi]

Oh man I never saw more miserable patients than the young folks who got intradiscal amniofix. Several told me it was the worst decision of their life.

 

[RoloTomassi]

Oh man I never saw more miserable patients than the young folks who got intradiscal amniofix. Several told me it was the worst decision of their life.

What issues? Procedure pain, discitis?

 

[Baron Samedi]

What issues? Procedure pain, discitis?

Yes and yes. I distinctly remember 3 patients, 2 had discitis with continued severe pain >6 months out. The other guy had severe postprocedural pain then returned to baseline symptoms after a few months. All < 40 years old.

 

[bedrock]

Yes and yes. I distinctly remember 3 patients, 2 had discitis with continued severe pain >6 months out. The other guy had severe postprocedural pain then returned to baseline symptoms after a few months. All < 40 years old.

This is why without future amazing longitudinal studies, I refuse to do an intradiscal injection with anything that wasn’t originally part of the patients body. (Might consider PRP, stem cells, no to everything else)

 

[RoloTomassi]

I remember when people were injection Liveyon cord blood and it ended up being contaminated

 

[Dr. Ice]

Intradiscal PRP works brothers..and not even the placebo effect, not sure if there is a real placebo effect for the G spent including sedation for it

Intradiscal Bmac works too..just ask Greg to the lutz, for 10k..it better work and pay for his upper east side residence

 

[lobelsteve]

Intradiscal PRP works brothers..and not even the placebo effect, not sure if there is a real placebo effect for the G spent including sedation for it

Intradiscal Bmac works too..just ask Greg to the lutz, for 10k..it better work and pay for his upper east side residence

Intradiscal PRP works brothers..and not even the placebo effect, not sure if there is a real placebo effect for the G spent including sedation for it

Intradiscal Bmac works too..just ask Greg to the lutz, for 10k..it better work and pay for his upper east side residence