title: A Prospective, Randomized, Multicenter, Open-label Clinical Trial Comparing Intradiscal Biacuplasty to Conventional Medical Management for Discogenic Lumbar Back Pain.
abstract: METHODS
  This study was a prospective, randomized, crossover, multicenter trial for the evaluation of comparative effectiveness of intradiscal biacuplasty (IDB) versus conventional medical management (CMM) in the treatment of lumbar discogenic pain.
  
  
  OBJECTIVE
  The objective was to demonstrate the superiority of IDB over CMM in the treatment of discogenic pain with respect to the primary outcome measure.
  
  
  BACKGROUND
  Current therapeutic options for the treatment of chronic low back pain of discogenic origin are limited. CMM is often unsatisfactory with regard to the treatment of discogenic pain. IDB offers a minimally invasive treatment that has been demonstrated to be superior to placebo in the past.
  
  
  METHODS
  A total of 63 subjects with lumbar discogenic pain diagnosed via provocation discography were randomized to IDB + CMM (n = 29) or CMM-alone (n = 34). At 6 months, patients in the CMM-alone group were eligible for crossover if desired. The primary outcome measure was the change in visual analog scale (VAS) from baseline to 6 months. Secondary outcome measures included treatment "responders," defined as the proportion of subjects with a 2-point or 30% decrease in VAS scores. Other secondary measures included changes from baseline to 6 months in (1) short form (SF) 36-physical functioning, (2) Oswestry Disability Index, (3) Beck Depression Inventory, (4) Patient Global Impression of Change, (5) EQ-5D VAS, and (6) back pain-related medication usage.
  
  
  RESULTS
  In the IDB cohort, the mean VAS score reduction exceeded that in the CMM cohort (-2.4 vs. -0.56; P = 0.02), and the proportion of treatment responders was substantially greater (50% vs. 18%). Differences in secondary measures favored IDB. No differences in opioid utilization were noted between groups.
  
  
  CONCLUSIONS
  Superior performance of IDB with respect to all study outcomes suggests that it is a more effective treatment for discogenic pain than CMM-alone.
  
  
  METHODS
  2.
authors.affiliation: George Washington University Medical Center, Washington, DC.|International Spine, Pain, and Performance Center, Washington, DC.
authors.forename: Mehul J
authors.initials: MJ
authors.lastname: Desai
authors.affiliation: Center for Clinical Research, Winston-Salem, NC.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Kapural
authors.affiliation: PainCare, Linwood, NJ.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Petersohn
authors.affiliation: Millennium Pain Center, Bloomington, IL.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Vallejo
authors.affiliation: JPS Orthopedic and Sports Medicine, Arlington, TX.
authors.forename: Robert
authors.initials: R
authors.lastname: Menzies
authors.affiliation: Compass Research, Orlando, FL.
authors.forename: Michael
authors.initials: M
authors.lastname: Creamer
authors.affiliation: Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Gofeld
mesh_terms: D000328:Adult; D018592:Cross-Over Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000000981:diagnostic imaging* / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods* / Q000592:standards; D059408:Pain Management / Q000379:methods* / Q000592:standards; D010147:Pain Measurement / Q000379:methods / Q000592:standards; D011446:Prospective Studies