Docs May Be Slow to Diagnose Arthritis of Back, Study Suggests
FRIDAY July 23, 2010 -- Doctors add as much as $10,000 to patient's medical costs by strictly following guidelines regarding the diagnosis of arthritis-related back pain, a new study suggests.
The study authors report that it isn't necessary to perform diagnostic nerve blocks to prove arthritis is a cause of pain. Instead, they recommend that doctors skip that step and turn directly to another treatment -- radiofrequency denervation -- when they think arthritis is the culprit.
Radiofrequency denervation, a common, noninvasive procedure, disrupts the nerve-pain signals in arthritic joints.
"The whole way we're doing this is wrong," study leader Dr. Steven P. Cohen, an associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine, said in a university news release. "If we just do the radiofrequency procedure first, we're going to help more people and we're going to save a lot of money."
The researchers came to their conclusion after studying 151 patients with possible arthritis-related back pain. They divided them into three groups: one treated with radiofrequency denervation by itself, another with radiofrequency denervation after a diagnosis through one nerve block, and the other with the treatment after diagnosis through two nerve blocks.
One third of the patients in the first group reported significant pain relief for at least three months, but just 16 percent and 22 percent, respectively, of the other groups did.
The treatment in the first group cost about $6,300, less than half the cost of the other treatments, the study authors said.
The patients who got the nerve blocks had long delays and multiple procedures before finding pain relief, and some may have missed out on radiofrequency denervation because of false-negative results, the authors said.
"Our goal is to get people feeling better," Cohen said in the news release. "When you do two blocks, you may be wrongly weeding out many people who would actually benefit from radiofrequency denervation."
But another specialist questioned whether the cost-effective approach is better for patients.
In an interview, Dr. Daniel Mazanec, associate director of the Cleveland Clinic Center for Spine Health, said that, while it may cost more, performing the two diagnostic nerve blocks and proceeding to the radiofrequency treatment if indicated is "clearly superior" in terms of helping relieve pain and improving function in patients.
The study appears in the August issue of the journal Anesthesiology.
For more about back pain, visit the U.S. National Library of Medicine.
Posted: July 2010