Studies

Heat Shock against Chronic Back Pain

The new thermo-therapy is especially useful in the treatment of arthrosis and other degenerative processes of the joints, helping to stop the pain of nerve irritation cold. It can bring relief in those situations when one has been told "There's nothing more we can do. You'll have to learn to live with the pain."

It is the curse of a civilization of sitters. Seventy percent of all Germans suffer from back pain, with one out of three suffering from chronic back pain. Every year nearly 100,000 Germans undergo back surgery. Most of these surgeries are, however, unnecessary. They often bring no benefit at all.

As a consequence medical professionals are overwhelmed trying to deal with "chronic back pain." The patient feels increasingly left alone with his or her pain, eventually wandering further and deeper into the back pain labyrinth. And this pattern is reinforced more often than not by physicians, since "there's nothing more to do. You have to learn to live with your pain."

Often, however, just the opposite is true. Modern procedures, able to alleviate the severest pain without surgery, can help bring one out of the labyrinth. Patients can even benefit for whom surgery is not an option. "There's a therapy for every back pain," says the Munich-based orthopedist and pain specialist Dr. Reinhard Schneiderhan. "The problem is that new, internationally recognized therapies, although available in Germany, are still relatively unknown here." Physicians are familiar with hundreds of various presentations of back pain. Therefore, although each back pain sufferer experiences pain somewhat differently, most pain can be identified and categorized.

It is important to be able to answer certain questions: does the pain come with every movement or only when sitting down or getting up? Or does it hurt when standing, sitting or lying down? Is it a radiating pain? The answers to these questions are the first step in diagnosing the exact cause of pain. A careful examination then allows the physician to determine, for example, whether a disk is indeed herniated and whether the herniation is truly responsible for the pain. Often simple treatment of compression and inflammation of the nerve is enough. But disks are not always responsible for the pain. Arthrosis and degenerative change of the small vertebral joints may then come into question. It is here, where most patients no longer know where to turn for answers, that a new procedure can help: thermo-therapy with the heat catheter.

Andrea Reß (35) suffered from severe chronic back pain for 12 years, brought on especially by movement. The pain was so debilitating that the Munich-based business woman could no longer sit or drive a car. The worst thing about this situation, though, was the fact that no physician could help Andrea. After a long odyssey from doctor to doctor Andrea turned to Dr. Schneiderhan.

Dr. Schneiderhan examined Andrea and made his diagnosis: Degeneration of the small joints of the vertebrae, most likely caused by a year-long problem with posture. Dr. Schneiderhan used the new therapy, neutralizing the pain-producing nerve with a computer-guided heat catheter. The new procedure is called "thermocoagulation" and can be used to handle arthrosis and degeneration of the spinal column and vertebral joints.

Dr. Schneiderhan explains how this technique works: "We thread a 0.4mm thin high-tech catheter tipped with an electrode through a cannula into the back. The catheter is then worked forward to the spine. The tip of the catheter is connected to a computer, which brings the tip up to an exactly determined temperature. An area of nerve tissue the size of a pea is then heated to a temperature of about 70 degrees Celsius. This destroys the pain-carrying fibers of the nerve. The brain cannot receive any more pain signals from the nerve, and the pain is gone."

Andrea Reß remembers: "I laid on my belly for the length of the procedure and received only a local anesthetic. I didn't feel anything during the length of the procedure."

The success of the procedure came as somewhat of a surprise: "My pain was never really properly diagnosed," says Andrea. "Everyone thought it was a disk. I needed shots every week and had to take such strong pain medication that my stomach couldn't take it anymore. Dr. Schneiderhan was the first to realize that the small vertebral joints were the source of my pain. He couldn't repair what had been done, of course, but he could take away the pain by disrupting the pain pathway." The hardest thing about the therapy is finding the affected vertebral joint and the section of nerve from which the pain originates. In order to achieve this Dr. Schneiderhan, guided by X-ray, injects local anesthetic into the area suspected of causing pain: "If the pain in an area injected with local anesthetic is reduced by more than one half after one hour, we've found the right area for thermocoagulation." Dr. Schneiderhan has not been able to identify any side-effects of the procedure: "We use X-ray to exactly position the catheter. And, before we actually perform the procedure, we use the catheter and a computer to determine the exact pain pathways of the affected nerve. In this way we have been able to avoid complications." The procedure takes about 30 to 40 minutes. Often, many different areas must be treated. The thermocoagulation itself takes only 60 seconds. Dr. Schneiderhan: "This procedure is offered on an in- and out-patient basis. Patients from out-of-town often prefer short in-patient procedures, since examinations must be preformed before the day of the actual procedure."

Thermocoagulation is appropriate for all pain caused by improper posture, degeneration and instability of the spinal column; in short, all back pain originating through movement and not radiating into the arms or legs. This includes arthrosis of the vertebral joints, for which not even multiple injections can be of much help for more than a few days. Thermocoagulation is also appropriate for patients who have not benefited from previous disk surgery and still suffer from pain, the so-called post-nucleotomy syndrome.