MONDAY, July 26 (HealthDay News) -- Performing one or more temporary diagnostic nerve blocks to establish arthritis as the cause of back pain before treatment with radiofrequency denervation results in unnecessary tests, delayed pain relief, and added cost, according to a study in the August issue of Anesthesiology.
Steven P. Cohen, M.D., of the Johns Hopkins School of Medicine in Baltimore, and colleagues randomized 151 patients with suspected lumbar facetogenic pain to one of three alternative treatment regimens: a group that received radiofrequency denervation directly based only on clinical findings, a group that underwent denervation after positive response to a single diagnostic block, and a group that had denervation after positive responses to two blocks with lidocaine and bupivacaine.
The researchers found that, among patients in the direct-to-denervation group, 33 percent had a successful outcome at three months compared to 16 percent in the single-block and 22 percent in the double-block groups. Rates of denervation success were 64 percent for the double-block group, 39 percent for the single-block group, and 33 percent for the direct-to-denervation group. At three months, the double-block group had lower pain and disability scores than the single-block or direct-to-denervation groups. The costs for successful treatment were $6,286, $17,142, and $15,241 in the direct-to-denervation, single-block, and double-block groups, respectively.
"Using current reimbursement scales, these findings suggest that proceeding to radiofrequency denervation without a diagnostic block is the most cost-effective treatment paradigm," the authors conclude.
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