IDET Controversy: Answers from a Pain Management Specialist
IDET—intradiscal electrothermic (or electrothermal) therapy—is a relatively new treatment option, as compared to more traditional chronic back pain treatments, such as surgery. Because IDET has not been in widespread use for many years, there is lack of long-term study data available to prove its effectiveness. As a result, some spine specialists use IDET and are very pleased with the outcomes. Other specialists want to see more long-term results before giving IDET their "stamp of approval."
In the following interview, Dr. Lawrence Kamhi, an interventional pain management specialist, responds to the controversy around IDET. He references important studies that support IDET as a treatment option for discogenic pain (pain directly related to your intervertebral discs). If your doctor recommends IDET for your pain, Dr. Kamhi's answers provide very helpful information to help you talk about and understand this treatment option.
To learn more about the basics of IDET, you can read IDET Explanation: Basic Information from a Pain Management Specialist.
Q: Would you consider IDET an experimental procedure?
A: No, IDET was approved by the FDA in March 1998. As of January 2007, it became fully reimbursable under Medicare.
I think it is fair to state that the IDET procedure has earned credibility in the spine community because:
- There has been sufficient interest in it so that more than one major medical device company manufactures IDET equipment and catheters.
- Enough IDET procedures have now been performed to generate a dozen or so articles in peer-reviewed spine journals in the USA and Europe.
For example, Saal and Saal published a study in Spine—one of the spine community's leading journals (27(9): 966-974). In the study, the IDET procedure compared favorably with spinal fusion surgery in affording pain relief in documented cases of discogenic low back pain. The pain outcome with IDET is similar to surgery, but IDET is far less invasive. Some patients may prefer a less invasive procedure over surgery, so IDET may be a good option for them.
Q: How would you respond to doctors who are concerned about the effectiveness of IDET or who still consider it an experimental procedure?
A: As I mentioned above, there are quite a few published studies on the IDET procedure in the spine literature, and some of those studies report favorable outcomes.
This debate about "experimental" interventional techniques and more traditional treatments has been going on longer than IDET has been around. For example, in the early 1980s, we had the coronary angioplasty vs. open heart coronary bypass surgery debates. Essentially, that was a debate of interventional techniques vs. traditional techniques, too, and the final outcome has been that we now have more treatment options to offer patients. I believe that in the long-run, these "experimental" interventional techniques benefit the patients. It's up to doctors and the rest of the medical community to devise the best possible treatments with the best possible outcomes and the shortest healing and recovery periods.