Burning away that back pain

by ROGER DOBSON, Daily Mail

A tiny, £700 tube has changed Cathy Melcionno's life. For the past 16 years, since her son James was born, she suffered low back pain, caused by a damaged disc, that gradually worsened.

She tried almost everything to ease the pain, from acupuncture to injections, but nothing helped - until now.

The new procedure, available both on the NHS and privately, involves heating the disc using a specially designed catheter, or tube, inserted into the back.

'I feel that for the first time something has worked and I am optimistic about the future,' says Cathy, 43.

Tens of thousands of people like Cathy suffer with disc trouble, and one increasingly common problem is caused by the outer coating of the disc tearing.

The gel inside the disc, which acts as a shock absorber, starts to move towards the tear, squeezing the nerve and causing pain.

Spinal surgeon David Harrison says: 'The tear in the disc is a potent cause of backache. When nature tries to repair it, little blood vessels and nerve endings grow into it, too. So what was a strong but painless structure becomes weakened, with new nerve endings.'

For many, exercise and other manipulative treatments will ease the problem, but for those whose lives are severely disrupted, surgery may be necessary. That usually involves fusing the bones at either side of the disc.

'Some patients are faced with a choice of either living with their symptoms or having some kind of fusion operation. That involves tricking the bones above and below into thinking they should be one piece and getting them to grow and join together.

'There is a loss of mobility as a result. It is like having a stiff link on your bicycle chain. You also get wear and tear on adjacent structures because it is not working properly,' says Mr Harrison of Frimley Park and Clare Park Hospitals in Surrey.

The new procedure is carried out under local anaesthetic. The tiny tube, which is coated with nonslip material, contains four different electrodes, two for supplying current and the others for monitoring the temperature.

The catheter is passed down a needle and into the damaged disc. Once in place, it coils itself around the inside of the disc and is then heated using radio frequency energy.

The temperature of the equipment is tightly controlled, starting off at a hand-hot 65°C and increasing by one degree every 30 seconds to a peak of 90°C, which is too hot to touch. The heat is spread over the disc to a distance of around one centimetre.

The heating physically strengthens the wall of the disc, making it more resistant to pressure, and repairs the tear.

A major bonus is that the heat also destroys the unwanted nerve endings that have got caught up in the original repair process, and so reduces or gets rid of the pain.

Research results anticipated soon from spine specialists in America who have been using the technique are expected to show a substantial success rate for the treatment.

'This is a new concept,' says Mr Harrison. 'These are patients who are well motivated, and were not helped by conservative therapy. The indications are that about two-thirds to three-quarters will improve.

'Those at risk from this kind of condition are in the 25 to 55 age group, and there are significant numbers of people this new treatment could help.

'It is available on the NHS and privately costing around £4,000. The biggest single cost is the hightech catheter used to heat the discs. It costs £650 and is used once then thrown away.

If two discs need to be done, the cost goes up to £1,300. From the NHS point of view, if two-thirds of patients avoid surgery, it is obviouslygoing to be cost-effective.'

Cathy Melcionno underwent the procedure three months ago and says the changes she's experienced have been dramatic.

'The pain began about nine months after I had James,' she says. 'I'd never had back ache before, but I have had low back pain ever since. Sometimes it was a nagging pain, or like an electric shock and, on some occasions, I would lose feeling down one leg. When I was getting out of bed my back would lock, too.

'I have used muscle relaxants, strong painkillers, acupuncture, heatwaves, ultrasound, injections, physiotherapy - you name it, I've had it. At one point I was having physiotherapy and I remember sobbing my heart out because I was told it would take nine months to see a consultant.

'I was a young mum but I felt 80. Nothing I tried made any real difference. There was not one day when I wasn't in pain.

'At one point I was told the next step was to fuse my spine, but that is quite a major operation and you hear horror stories about it. I wasn't very keen.

'I went on to the internet and found out about this new treatment. I eventually met Mr Harrison who carried it out at the end of last year. It is the best thing I ever did. The operation was a complete doddle compared to fusing my spine.

'For the first eight weeks I thought it wasn't working and got quite miserable. Then about four weeks ago I began to realise there was a change. Suddenly, I wasn't stiff any more.