biacuplasty

[ERvet]

Well, folks, I am forging ahead with this little gem. I've read about all I can find about it, it seems a reasonable thing to try, and perhaps avoid surgery altogether, while cleaning up my language at the same time! I've been just lurking since I returned from Minnesota last month, had a great time on the water and in the woods, but returning to life in the faster lane has returned me to the annoying side of back pain. Had another ESI, along with an SI joint injection (because, well, why not?) along with one in the opposite trochanteric bursa (overuse? who knows?) which gave me a week of bliss. Only to come roaring back a week later. So I sat down with my pain doc and went over the options, and biacuplasty is the one that seems possible now, available now, and I gotta do something. Disc replacement is still out of reach, and the fibrin sealant I have learned about from Linda's posts seems out of reach until clinical trials are completed (unless someone knows something I haven't found out...if so, DO tell). And fusion I won't even talk about. I will keep all y'all posted on the when, who, what and other mundane aspects. I've only seen a few mentions of this procedure on this site. So, we shall all learn more, eh? All that really stands in the way is insurance. Quite possibly a large barrier. But doc didn't seem to think it would be a problem. We shall see. Hope all are well out in the world. Sorry for the wordy post which doesn't say much, but it's 4:30am, I've only got 3 patients in the hospital, and they are all sleeping. Which is a good thing in the veterinary ER.

Ciao
Susan/ERvet

[CharlesinCharge]

Susan,

My Pain Management doctor highly recommended Biaculaplasty on my L3-L4 disc, but my insurance refused to pay for it (calling it "investigational" as they often do). My doctor admitted that most of his patients had been having the same problem, so don't be surprised if you do as well (since it is such a new procedure). I also did a lot of research on it, and the trials only showed a 40% success rate. My Pain Management doctor admitted that that was true, but he said that since the procedure was so minimally invasive and could not cause any further pain, why not "flip a coin" and give it a try? I agreed, but then insurance turned me down.

So, if your insurance will pay it is definitely worth it for you to try it, but go in knowing that the trials only had true success (lessened pain) in less than 1/2 of the patients.

[ERvet]

Charles: I have been looking for additional articles on this procedure, wanting to know more, but needing to pursue something to find some relief. If you have titles, authors, etc regarding outcomes, trials, etc, could you pass them along? Not sure why, but my pain doc seemed to indicate my insurance would cover the procedure....but I'm not exactly holding my breath, eh? I'm going to access our local university library this evening and see what I can find. But anything you might have would be very helpful.


Susan/ERvet

[Harrison]

"...Biaculaplasty... trials only showed a 40% success rate..."

I know, some of the studies show better, others worse...but we don't see many great outcomes here with IDET. But here's where you can help me -- isn't this the "modern" version of IDET? I looked into this last year, and almost forgot about it. See this page here.

If anyone can find info that differentiates this procedure with "old world" IDET, please do share. There are some articles out there, I saw them a while back.

Sue, I think it would be wise to sift through as many studies as possible on the "new" IDET. I hope they show better results, with less range of results in the outcomes. Also, have you talked to any IDET patients? Please do if you can. I'll try to help you with that too!

PS: Scroll down to the bottom of this page; you will see the "similar threads" feature that shows two related discussions on this procedure.

[Harrison]

New radiofrequency technique reduces disc pain with quick recovery time

NEW YORK (Reuters Health) - A new radiofrequency technique - intradiskal biacuplasty - appears to be superior to intradiskal electrothermal therapy for treating chronic discogenic pain, a physician team from Cleveland Clinic reported this week at the 23rd annual meeting of the American Academy of Pain Medicine in New Orleans.

Biacuplasty uses two radiofrequency probes placed on the opposite posterolateral sides of the treated annulus, to coagulate and decompress the disc material.

Biacuplasty is "simple and straightforward to perform," compared with electrothermal therapy, presenter Dr. Leonardo Kaparal told Reuters Health. It offers greater relief from discogenic pain, and because it is minimally invasive, he added, "Recovery time is shorter."

Kaparal and his associates in Ohio performed a pilot study on 13 patients who were treated with biacuplasty and followed for 6 months. There were no complications during the procedure or during follow-up.

Within the first month after the procedure, most patients reported greatly reduced pain and much better functional capacity.

At 6 months, median opioid use had decreased from 40 to 5 mg/day (p = 0.014). Median pain scores had fallen from 7 prior to the procedure to 3 (p < 0.001). Functional capacity and quality of life measures had also improved significantly.

Kaparal noted that "eight of 13 patients have minimal or no pain, and five have the same amount of pain as before, but no worse."

[ERvet]

If anyone can find info that differentiates this procedure with "old world" IDET, please do share. There are some articles out there, I saw them a while back.

Sue, I think it would be wise to sift through as many studies as possible on the "new" IDET. I hope they show better results, with less range of results in the outcomes. Also, have you talked to any IDET patients? Please do if you can.

Harrison: I have read everything I can find on biacuplasty, there just isn't much out there without a paid subscription to some pain journals! I have some inquiries in to my pain doc, as I had just worked a 15hr shift when I saw him, and wasn't on top of my game when it came to asking questions then! I probably need to go visit our local univ library, as I seem to no longer have on-line access, and see what I can find. One of the questions I have for my doc is how is this different from IDET? Since that seems to be falling out of favor....when I learn what he knows, I will pass it on. I'm also very interested in the fibrin sealant that Linda had done, but that may not be available for a bit, unless my doc has connections.....he was interested in learning more about that; I gave him an article by Dr. Pauza that Linda made note of. I'm also skeptical that my insurance will even cover biacuplasty...we shall see.

Susan/ERvet

[Harrison]

Sue, thanks -- I should have addressed your points earlier. I re-read my posts and thought they too short (such is the life of a site admin and contributor).

More specifically, perhaps these newer techinques are superior to IDET. If you can tell me what specific articles you need, if you identify them, I'll chase them down for you. If you have access to hospital/college/med libraries, they may be able to help gain access to the articles. I believe these were good resources for the future doctor (Justin) and patient researcher (Steve).

Depending on the library, some will actually email or mail you medical research. Most will not -- but some will! Make sure you buy presents for the ones that will! Librarians are so underpaid and unappreciated! Justin and Steve (and many others) have done amazing work providing articles to all of us here. Thank you, gents for your proactive work.

Sue, email or call anytime. And thanks for sharing in your tough times of decision making. These are very important decisions and none of us take these lightly.

[ERvet]

Harrison: part of the problem is I don't HAVE specific articles! I need to go research this topic at my local library, or the university, or perhaps our local hospital. Some of the specialty docs I work with have a great many connections in the university and in the human medical field, and can likely also point me in the right direction. I am awaiting a reply from my doc, hope to hear from him next week. I'm lucky to have him, I think, as he has actually listened to me, and worked to find the cause of the pain. Too bad he's not a surgeon! So, if I find titles but can't find articles, I will let you know. If I find articles, I will figure out how to post them here. Or I will call and ask you how to do that!

Susan

[ERvet]

Harrison, here are three titles I found on PubMed, but can't access the entire article, at least not from home. There were only 6 articles found with a search of "biacuplasty." Not much out there. I'm planning on continuing my search.

Susan

Intervertebral disk cooled bipolar radiofrequency (intradiskal biacuplasty) for the treatment of lumbar diskogenic pain: a 12-month follow-up of the pilot study.
Kapural L.
Pain Med. 2008 May-Jun;9(4):407-8. No abstract available.
PMID: 18489632 [PubMed - indexed for MEDLINE]

Novel intradiscal biacuplasty (IDB) for the treatment of lumbar discogenic pain.
Kapural L, Mekhail N.
Pain Pract. 2007 Jun;7(2):130-4.
PMID: 17559482 [PubMed - indexed for MEDLINE]

Intradiscal electrothermal therapy (IDET) provides effective symptom relief in patients with discogenic low back pain.
Maurer P, Block JE, Squillante D.
J Spinal Disord Tech. 2008 Feb;21(1):55-62.
PMID: 18418138 [PubMed - indexed for MEDLINE

[Eddie_G]

If there is the SLIGHTEST chance that the insurance co. would pay I would not give up.
An insurance company employee's job is to save money and deny deny deny until us victims give up. Normally the victims will give up because we are too infermed or have little support and the insurance creeps count on that.

I fought with mine for months, once to get a surgeon with over 100 ADR's as opposed to 1 ADR to work on me. Once to get a Prodisc over a Charite. I may ned to fight again if I find out I have arthritis caused by my spine problems.

If you find an option that may help you I would'nt give up.