Randomized Controlled Trial
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Jun 28, 2016; 8(6): 628-634
Published online Jun 28, 2016. doi: 10.4329/wjr.v8.i6.628
Does therapist’s attitude affect clinical outcome of lumbar facet joint injections?
Marcus Middendorp, Konstantinos Kollias, Hanns Ackermann, Annina Splettstößer, Thomas J Vogl, M Fawad Khan, Adel Maataoui
Marcus Middendorp, Department of Nuclear Medicine, Goethe University, 60590 Frankfurt, Germany
Konstantinos Kollias, Thomas J Vogl, M Fawad Khan, Adel Maataoui, Institute for Diagnostic and Interventional Radiology, Goethe University, 60590 Frankfurt, Germany
Hanns Ackermann, Institute of Biostatistics and Mathematical Modeling, Goethe University, 60590 Frankfurt, Germany
Annina Splettstößer, radprax MVZ, 40721 Hilden, Germany
Author contributions: All authors discussed and interpreted the results and implications and commented on the manuscript at all stages.
Institutional review board statement: The study inclusive of patient information and consent form was reviewed and approved by the ethics committee of the State Authorisation Association for Medical Issues of Hesse, Germany (FF 141/2014). Furthermore, the study was registered at the German Clinical Trials Register (DRKS00010011). All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Clinical trial registration statement: The study inclusive of patient information and consent form was reviewed and approved by the ethics committee of the State Authorisation Association for Medical Issues of Hesse, Germany (FF 141/2014). Furthermore, the study was registered at the German Clinical Trials Register (DRKS00010011). All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Informed consent statement: The study inclusive of patient information and consent form was reviewed and approved by the ethics committee of the State Authorisation Association for Medical Issues of Hesse, Germany (FF 141/2014). Furthermore, the study was registered at the German Clinical Trials Register (DRKS00010011). All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors ensure that there are no conflicts of interest.
Data sharing statement: Consent was not obtained but the presented data are anonymized and risk of identification is very low. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Adel Maataoui, MD, Institute for Diagnostic and Interventional Radiology, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. adel.maataoui@gmx.de
Telephone: +49-69-63015534 Fax: +49-69-63014222
Received: December 22, 2015
Peer-review started: December 23, 2015
First decision: January 15, 2016
Revised: February 15, 2016
Accepted: March 22, 2016
Article in press: March 23, 2016
Published online: June 28, 2016
Processing time: 179 Days and 12.8 Hours
Abstract

AIM: To investigate if the clinical outcome of intra-articular lumbar facet joint injections is affected by the therapist’s attitude.

METHODS: A total of 40 patients with facet joint-associated chronic low back pain were randomly divided into two groups. All patients received computed tomography-guided, monosegmental intra-articular facet joint injections. Following the therapeutic procedure, the patients of the experimental group (EG) held a conversation with the radiologist in a comfortable atmosphere. During the dialog, the patients were encouraged to ask questions and were shown four images. The patients of the control group (CG) left the clinic without any further contact with the radiologist. Outcome was assessed using a pain-based Verbal Numeric Scale at baseline, at 1 wk and at 1, 3, and 6 mo after first treatment.

RESULTS: The patient demographics showed no differences between the groups. The patients of the EG received 57 interventional procedures in total, while the patients of the CG received 70 interventional procedures. In both groups, the pain scores decreased significantly over the entire observation period. Compared to the CG, the EG showed a statistically significant reduction of pain at 1 wk and 1 mo post-treatment, while at 3 and 6 mo after treatment, there were no significant differences between both groups.

CONCLUSION: Our results show a significant effect on pain relief during the early post-interventional period in the EG as compared to the CG. The basic principle behind the higher efficacy might be the phenomenon of hetero-suggestion.

Keywords: Facet joint injection; Hetero-suggestion; Low back pain; Lumbar spine; Magnetic resonance imaging; Facet joint osteoarthritis

Core tip: The presented results show a significantly positive effect of the therapist’s attitude on pain relief within the first month after facet joint intra-articular injections. Increased therapeutic efficacy seems to be evident in those patients who have a better understanding of therapies applied on them.