IDAP/IDET & Discogenic pain

MD’s and engineers have worked for many years to try to unlock the mystery and treatment of discogenic pain. Annular tears and compromises of the outer annulus of degenerated discs arguably disable untold millions of 40-60 year olds. IDAP/Intradiscal annuloplasty (Smith & Nephew name brand: IDET/intradiscal endothermic therapy) is a 20 year old procedure which initially appeared to show tremendous promise but failed to really materialize. The premise is similar to cauterizing a wound; a super-heated needle attempts to both ‘hypercollagenate’ torn tissue and obliterate pain nerves. Freeman and colleagues (2005 Anesthesia) conducted a study on individuals with discogenic back pain and annular tears who failed to improve with conservative treatment. No participant met the criteria for a successful outcome. The findings of this study suggest there is no significant benefit of IDAP over placebo. A Cochrane review suggested the same. Discogenic pain (of which annular “tears” constitute a substantial affect) remains an oft recalcitrant problem. Thus far no one else has come up with a significant and validated treatment. Laser, core control, ergonomics, meds and judicious decompression (when pre-tolerance-classified) are still the most sensible treatments.