Rheumatology 2000; 39: 925
© 2000 British Society for Rheumatology
Letters to the Editor |
Sclerosing injections in patients with chronic low back pain
Rheumatology Unit, Western General Hospital NHS Trust, Crewe Road, Edinburgh EH4 2XU, UK
SIR, Dechow et al. [1] are to be congratulated for undertaking a randomized, controlled trial in this difficult area. The study shows that, within the very reasonable design limits of their study, sclerosing injections are no better than placebo in this group of patients and therefore contradicts the results of previous studies. However, the authors seem to lack confidence in this conclusion and argue that the negative result may be due to factors such as patient selection or failure to include other treatment modalities. This rather misses the point, which is that those who now wish to continue the practice should produce evidence of efficacy, if necessary by conducting a larger study with greater power on those patients they consider most likely to benefit. Without better evidence the practice should be abandoned as ineffective and expensive.
Accepted 24 January 2000
References
- Dechow E, Davies RK, Carr AJ, Thompson PW. A randomized, double-blind, placebo-controlled trial of sclerosing injections in patients with chronic low back pain. Rheumatology1999;38:1255–9.
[Abstract/Free Full Text]
Reply
Poole Hospital NHS Trust, Longfleet Road, Poole, Dorset BH15 2JB, UK
THE letters of Drs Hurst and Sweetman emphasize that sclerosing injections may be beneficial for a subgroup of individuals with chronic back pain. However, we were unable to identify subgroups in our studies, which may reflect the comparatively small numbers or the heterogeneous nature of the study sample.
While there has been considerable discussion about clinical features such as instability, it is not clear to us from our experience or study of the literature how patients likely to respond to the injections can be simply identified. Dr Sweetman presents data from his study suggesting that it is possible to match treatments to clinical findings, but his publications do not include sclerosing injections as treatment.
We would be interested in hearing from practitioners concerning the identification of patients likely to respond to treatment. From our experience of running this study it appears likely that the number of such patients would be small. Perhaps, if they can be identified using an agreed protocol, a multicentre clinical trial could be undertaken in this important area.
Accepted 24 January 2000
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