IDET Controversy: Answers from a Pain Management Specialist

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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."

Intervertebral DiscIn 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.

Updated on: 10/26/15
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Leonardo Kapural, MD, PhD

It seems that the major issue which affects the success of IDET is patient selection. Recent analysis and review suggested that such variability in patient selection criteria and use of different heating techniques from one study to another could contribute to differences in achieved clinical results (Appleby et al., 2006). The average pain score improvements in 13 studies analyzed were from 1.5 to 5 points. Functional capacity, measured by SF-36 physical function (PF) scores, improved from about 15 to 30 points in four studies.

It appears that the use of additional patient selection criteria may improve overall results of IDET. Pauza and colleagues in their sham-controlled [where some patients think they are getting the full treatment but are actually getting a placebo], prospective IDET study introduced a few additional patient selection criteria and achieved at least 50% improvement in 50% of the patients (Pauza et al., 2004). In another prospective, matched study, patients with any signs of disc degeneration at more than 2 lumbar levels (as seen on an MRI scan) had significantly less improvement in functional capacity and pain relief following the IDET (Kapural et al., 2004). Therefore, it seems that those who are not likely to benefit from IDET include patients with advanced multi-level degenerative disc disease (Kapural et al., 2004) and overweight patients (Cohen et al., 2004).

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