Key to improving low back pain is likely ability to measure it
PHILADELPHIA — The best way to find an effective treatment for low back pain is to find an effective and accurate method to measure low back pain, a presenter at the Philadelphia Spine Research Symposium said.
Jeffrey C. Lotz, PhD, director of the Orthopaedic Bioengineering Laboratory at University of California San Francisco, said there is an urgent need for more noninvasive tools to identify painful discs in patients.
To solve this dilemma, Lotz and colleagues developed an effective noninvasive tool to identify how discs cause back pain in patients.
“Even accurate tests may not improve outcomes. Can it add clinical value? We want to look at the data longitudinally to see if the test has the ability to predict outcomes. The value of the test is determined by future clinical events, event rates and relative risk,” he said during his presentation.
The noninvasive tool measures the stimulus of the disc, the quality of the barrier to the stimulus within the disc and the response of the disc tissue to the stimulus.
For example, it has been found lactate may accumulate in painful discs. Disc acidity has also been correlated with preoperative back pain and may be a stimulus, he said.
Over the past 10 years, the researchers developed an MRI protocol to collect spectroscopy data for spinal discs, process the data to maximize signal and noise and calculate parameters from the spectroscopy results that were then validated against the current reference standard of provocative discography, according to Lotz.
In a clinical study, investigators used the tool they developed to measure 250 discs. They found the tool has a 99% clinical success rate and a 94% technical success rate. Furthermore, it can essentially replace discography for identifying painful discs and tracking disc changes over time, Lotz said.
A validated tool of this kind may help identify painful discs, serve as a benchmark to follow up on currently painful discs and predict ones that may be painful in the future, such as those associated with adjacent level disease. He said the measurement tool also has the potential to guide low back pain algorithms and track the progress of biologic therapies used. – by Robert Linnehan
Lotz JC. Paper #S2.2. Presented at: Philadelphia Spine Research Symposium; Nov. 9-12, 2015; Philadelphia.
Disclosure: Lotz reports no relevant financial disclosures.