The following transcript is computer generated

Show: The Relaxback UK Show
Host: Mike Dilke
Guests: Dr. David McKean (Consultant Radiologist & Spine Specialist) and Emma Fletcher (Personal Trainer, Gymnast, and Former Chronic Back Pain Sufferer)
Topic: Vertebrogenic Back Pain and the Intracept System (Basivertebral Nerve Ablation)
In this episode of The Relaxback UK Show, host Mike Dilke explores chronic low back pain with Dr. David McKean, a consultant radiologist and spine specialist, alongside Emma Fletcher, a fitness instructor and former severe back pain sufferer.
Back pain affects roughly 60% of the UK population during their lifetime, with one in six experiencing it at any given moment. Beyond the physical toll, chronic pain costs the UK economy approximately £50 billion annually, with primary healthcare expenses alone reaching £3 to £3.5 billion. While many cases arise from benign muscular strain that improves with conservative care—such as movement, physiotherapy, and core strengthening—approximately one in six chronic sufferers have vertebrogenic back pain. This condition originates from damaged vertebral endplates and disc degeneration (identified as Modic changes on MRI scans) transmitting distress through the basivertebral nerve inside the vertebral body.
Dr. McKean explains that standard facet joint injections and conventional therapies often fail for vertebrogenic pain. Instead, a targeted, minimally invasive outpatient procedure called Intracept (developed by Boston Scientific) offers enduring relief. Guided by fluoroscopic X-rays under conscious sedation, a specialized curved needle enters the vertebral body. Radiofrequency energy then heats the basivertebral nerve to approximately 70°C, permanently ablating it and halting pain signals without compromising structural spinal mobility or requiring invasive spinal fusion surgery.
Over ten years of clinical data show that approximately one-third of patients achieve complete (100%) pain resolution, while nearly three-quarters experience greater than 50% relief, sustained across seven to ten years. Emma Fletcher recounts how her debilitating 18-month chronic pain dropped dramatically within 24 hours of her one-hour procedure, enabling her to walk that afternoon and fully resume gymnastic back bends and fitness training. Currently accessible in the UK through the INPROVE clinical study and select private hospitals, formal NICE approval is anticipated in the coming years.
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Key Discussion Highlights & Statistics
1. Prevalence & Economic Toll: 60% lifetime UK prevalence; 1 in 6 adults have back pain at any time. Chronic pain drains ~£50B annually from the UK economy (£3–3.5B in direct NHS primary care).
2. Under-Recognized Root Cause: Vertebrogenic pain accounts for an estimated 1 in 6 chronic cases, caused by vertebral endplate inflammation (Modic changes) rather than muscular or facet joint issues.
3. Targeted Nerve Ablation: The Intracept device uses radiofrequency energy (~70°C) to denervate the basivertebral nerve within the bone without affecting spinal stability or other surrounding sensory nerves.
4. Clinical Efficacy: ~33% experience total (100%) pain relief; ~75% achieve ≥50% reduction. Benefits endure for 7–10+ years because the nerve inside the bone does not regenerate.
5. Rapid Day-Case Recovery: Performed in about one hour under conscious sedation; patients walk out the same day with minor soreness manageable by paracetamol.
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Complete Cleaned Transcript
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Section 1: Introduction & Episode Overview
[00:00 – 01:28]
[00:02] Intro/Outro: Hi, I’m Mike Dilke and you’re listening to the Relaxback UK Show, the show that explores all kinds of health topics relevant to you, your family, and your friends. Each week, I talk to expert guests from a range of backgrounds to inform and entertain you. So please do join the Relaxback UK family, and stay tuned.
[00:21] Mike Dilke: Hi, and thank you for joining me on the Relaxback UK Show. The topic this week is back pain.
[00:27] Dr. David McKean: Modern life—prolonged sitting, reduced movements, higher body weight, and so on—just puts loads on the spine that it’s not really evolved to handle every day.
[00:37] Mike Dilke: Dr. David McKean gives reasons why you might get back pain, how to help it, getting a diagnosis, and one particular method to treat it called Intracept. Emma Fletcher was a back pain sufferer, and this treatment helped her greatly.
[00:53] Emma Fletcher: He did say he had to get the bigger hammer out because my bone was too strong. But I didn’t feel any pain throughout, and I didn’t feel a thing. Afterwards, I was hardly in any pain after.
[01:05] Mike Dilke: So please, do stay tuned for a great show. Thank you.
[01:14] Mike Dilke: So my guests today are Dr. David McKean, an expert in helping people with back pain, and Emma Fletcher, an ex-back pain sufferer. My first question to them was: just how common is back pain, and are we a bad design?
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Section 2: Prevalence of Back Pain and Evolutionary Design
[01:29 – 02:34]
[01:29] Dr. David McKean: Well, back pain is extremely common. It’s one of the most common causes of chronic pain that anyone will have. I think the lifetime prevalence for low back pain in the UK is about 60%.
[01:45] Mike Dilke: So 60% of people will get back pain?
[01:47] Dr. David McKean: Yeah, at some point during their lives. At any one time, about one in six people in the UK will have back pain at any time. So it is extremely common. That said, I wouldn’t say that we’re necessarily badly designed. It’s just that the human spine is excellent for things like upright walking and load-bearing, but modern life—prolonged sitting, reduced movements, higher body weight, and so on—just puts loads on the spine that it’s not really evolved to handle every day. So it is a very common cause of pain, but not necessarily a bad design. The way that we live nowadays does put a lot of stress on everyone’s spine.
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Section 3: Emma Fletcher’s Background & Sitting Strain
[02:34 – 03:55]
[02:34] Mike Dilke: How about you, Emma? Were you just unlucky in your back health, or did you fall off a horse or something?
[02:40] Emma Fletcher: No, I was just slightly unlucky, actually. I’m very fit, always have been—a gymnast from a young age, and I’ve been fit all through my life. I think a lot of mine has come through maybe a bit of wear and tear, maybe overuse. But I think a lot of mine stemmed from sitting too much. In my day job I sit a lot, in front of my laptop all day, and then in my other job in the evenings and weekends, I’m a personal trainer and fitness instructor. So I’ve got the benefit of the two, but I found sitting a lot really made my back uncomfortable. I think that contributed to a lot of the pain that I suffered with as well.
[03:22] Mike Dilke: David, is that something you hear a lot of your patients saying?
[03:26] Dr. David McKean: Yeah, absolutely. Back pain covers a very broad range of different things, so there’s lots of different potential causes for back pain. But yes, a sedentary lifestyle, sitting for a long time, can certainly contribute. Emma’s very fit, so it wasn’t excess body weight or anything like that in her case. But doing gymnastics and putting all that load through your spine can also cause wear and tear, and that can contribute to a patient’s risk of back pain as well.
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Section 4: Diagnostic Complexity & The Clinical Minefield
[03:56 – 06:51]
[03:56] Mike Dilke: You might have partially addressed this already, but if it is so common, why is it so hard to treat and so hard to find out what the problem is? Surely you guys have been trying to answer this question for the last 200 years, at least.
[04:14] Dr. David McKean: Well, part of the issue is that there are so many different causes for back pain. Your spine is a very complicated bit of your body. There’s lots of things that can potentially cause pain.
[04:26] Mike Dilke: I’ll admit, I did a bit of Googling before we chatted. I just put in ‘list the kinds of reasons why you might get back pain’, and there were at least 50 that came up.
[04:38] Dr. David McKean: Exactly. There’s a huge number of different things. In the vast majority of cases, it’s going to be what we call non-specific, often just some muscle spasm, something that will often settle with time. But there’s also going to be subsets of patients who have issues that will go on to cause them chronic pain for many, many years. You can have issues with the paraspinal muscles around the spine; you can get issues with your facet joints, the joints at the back of the spine; you can have degeneration of intervertebral discs; you can have what we’re going to talk about, vertebrogenic back pain, where you’re getting changes within the endplates, within the bones within the spine itself. And then there’s all the other causes: fractures, sometimes infection, sometimes tumor. So a huge range of different things, from things that are very benign and will get better by themselves quite quickly, all the way through to things that will cause chronic pain for many years, and occasionally things that require urgent treatment. So it’s a real minefield for doctors trying to make the diagnosis.
[05:50] Mike Dilke: Is that why patients often seem to take potentially years to get a diagnosis? Because it actually is very complicated and not easy?
[06:01] Dr. David McKean: I think that’s part of it, absolutely. I think also historically in the UK, we’ve perhaps not always investigated back pain as quickly as we could. A lot of people will go to their GP and be told: “Everyone gets back pain; do some exercise, have some physio, and best of luck.” While that works in many cases, there’s also patients who actually need more investigations, essentially MRI scans and so on, to help diagnose the underlying cause of pain. Accessing that hasn’t always been very straightforward. I think what we need is essentially to find better ways to triage patients and create the pathways so those patients can access the tests that they need to identify the cause of their symptoms.
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Section 5: Economic & Societal Impact of Chronic Pain
[06:52 – 08:35]
[06:52] Mike Dilke: We’ll come on to potential cures in a moment. But before that, I’ve got what is essentially quite an unfair question, but I’m going to ask it anyway. It’s more of an economics type question. With one in six people having back pain at any one time, 60% of us having it at some point in our lifetime, has anyone tried to quantify how much this costs the UK from days off sick, NHS time, and all this kind of stuff? Because I’m thinking it must be billions.
[07:28] Dr. David McKean: Absolutely, it is billions. The cost of chronic low back pain and the impact it has is absolutely enormous. There was a recent report from the Health Foundation that said the impact of chronic pain—which is very broad, but a lot of those patients will be chronic low back pain—is up to £50 billion annually to the UK economy. So it has a huge impact. More specifically for back pain, the primary healthcare costs alone are estimated to be between £3 to £3.5 billion annually. That doesn’t count all the other economic costs for lost productivity, sickness absence, disability benefits, and so on.
[08:15] Mike Dilke: Less tax paid if people aren’t working?
[08:17] Dr. David McKean: Exactly. And then there’s all the costs that are very difficult to measure: people may be at work, but far less productive than they would be normally because of the chronic pain that they’re suffering. So yes, chronic back pain has a huge impact on the UK economy and productivity generally.
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Section 6: Emma’s Diagnosis Journey & Personal Impact
[08:36 – 10:53]
[08:36] Mike Dilke: Let’s bring Emma in for a moment as well, because I’m thinking if you are suffering from back pain, and it’s going on for months or years and it’s difficult to get a diagnosis, this is just going to weigh you down. This is going to be, for most people, not great for mental health, family issues, relationships; it can affect a lot of different parts of your life. Were you lucky, or is that your experience?
[09:07] Emma Fletcher: I had the pain for quite a while before I actually got to see David—luckily seeing David. I suppose for me, I do work at home a lot for my day job, but it was my work which was getting noticed. People in my team and my clients were noticing a difference in me. I didn’t feel it myself, because I was trying to take painkillers and trying to do as much as I could to overcome the pain. But it was being noticed by others; people were actually bringing it to me and asking me if I was okay, because you didn’t seem yourself. For the past 18 months before I got the right treatment, I was in chronic pain. I tried not to take as much medication as possible, because you try not to, and tried to help myself the best way with physiotherapy and other things. But it has a massive effect on everything, from your day job to not being able to do the things that you love doing, because you just can’t move as well. You’re scared to move, because you might damage yourself even more.
[10:14] Mike Dilke: A vicious circle, yeah.
[10:15] Emma Fletcher: Yeah, exactly.
[10:16] Mike Dilke: In some ways, if you were suffering for 18 months, this might sound crazy, but actually you might have been relatively lucky. Because you hear stories of people that suffer for decades.
[10:28] Emma Fletcher: Gosh, yeah. I know of people who have suffered a lot longer than me. But I was lucky enough to get into the system, and I was lucky enough for David to spot my MRI at the right time. It was all about timing. It was good to actually get onto some of the treatment that’s now available under trial.
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Section 7: First Steps, Red Flags & Conservative Care
[10:54 – 15:08]
[10:54] Mike Dilke: Let’s move on to talking about treatments a little bit. From my Googling and from what you said, David, potentially 50 different causes for back pain, I’m quite sure there are hundreds of potential different treatments. So if someone wakes up tomorrow morning, or if someone has back pain that’s been around for a number of weeks, what would you first thing suggest they do?
[11:23] Dr. David McKean: Well, the right treatment is going to depend on identifying the cause of the back pain. That’s the key thing, really. In the vast majority of cases, as we were saying, it’s going to be some muscle pain which will often resolve by itself. But there are certain red flags you need to look out for: if the pain is associated with trauma and you’re worried about a fracture, then you’ve got to go in. If you’ve got symptoms affecting your bladder or your bowel—so if you’re losing control of your bladder or bowel—then that’s often a sign that those nerves are being compressed and you’ve got to see somebody urgently. If you’ve got a fever or you’re losing weight and you think that there’s some other underlying condition, then again, seek help urgently. But if it’s just back pain, then often it can take quite a few months for patients to try conservative management and then start to potentially look for the potential underlying cause. In quite a lot of cases, imaging—things like MRI scans—are going to be very useful for identifying any potential structural causes for the patient’s back pain. Again, the treatment then is going to depend on whether it’s coming from the facet joints, whether it’s coming from things like pars defects where you’ve got some small defects within the bone, or whether, as it was in Emma’s case, you’ve got vertebrogenic back pain, which is a relatively under-recognized cause of back pain. But we think that maybe one in six patients who has chronic back pain actually have this vertebrogenic back pain, which we can treat, and that’s the key thing.
[13:16] Mike Dilke: In the first instance, trying things that are not invasive—a bit of massage, a bit of physio, or going to see a chiropractor or an osteopath, or going for a walk around the block—has got to be the way to go first off, hasn’t it?
[13:35] Dr. David McKean: Absolutely. Moving, staying active, are going to be really important both for your back pain and for your general health. Keeping the muscles strong around your spine—your core muscles, those paraspinal muscles—keeping those strong is really important for chronic low back pain. Because one way to think about it is that if your core muscles are strong, that’s actually taking some pressure off the spine, and staying active is actually helping the discs of the spine to stay hydrated, you’re keeping the blood flow going, and so on. So staying active is really important. But in some cases, the pain will persist and sometimes get worse, and in those cases you may want to pursue other investigations to identify what’s causing that.
[14:26] Mike Dilke: Other investigations, we’re talking about a scan that you mentioned?
[14:31] Dr. David McKean: Exactly, things like an MRI scan. Certainly for the back pain that Emma had, an MRI is absolutely crucial for identifying those patients. You couldn’t pick those patients out without the scan. With any treatment for back pain, actually getting the diagnosis right, getting the patient selection right, is crucial.
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Section 8: MRI Scans: Modic Changes & Diagnostic Nuance
[15:09 – 17:11]
[15:09] Mike Dilke: Is a scan a black and white answer of “Oh, that’s definitely that”, or is it a little bit more—I get the impression, actually, it’s a bit of a black art?
[15:19] Dr. David McKean: Well, yes, I think that’s very true. If you scanned everybody’s spine when we all get to a certain age, everyone’s going to have some wear and tear in there. In many cases, that’s not going to be associated with patient pain. So the art is to correlate the patient symptoms with the scan findings, and then to make a call as to where we think the problem is coming from. But you’re right: in some cases, people can over-interpret the scan and point to a number of different things that are just signs of normal wear and tear, which will happen to us all as we get a bit older. That said, getting the diagnosis right is really crucial for the next part of the story, which is getting the right treatment. So imaging is very important; don’t over-interpret the scans. My only other bit of advice is who reports your scan can be very important. There’s a range of opinions out there, and you want a radiologist who knows what they’re talking about to report your scan, I suppose is the point I would make.
[16:30] Mike Dilke: Are you saying there’s like a bit of a postcode lottery or something going on here?
[16:35] Dr. David McKean: Potentially. I think that for things like vertebrogenic back pain, which is what Emma had, it’s a diagnosis that not all radiologists, not all surgeons would even be aware of. Although this is something that we’ve known about for decades, it’s a relatively new concept, particularly in the UK. So yes, there is, I suppose, a bit of a postcode lottery.
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Section 9: Vertebrogenic Back Pain & The Basivertebral Nerve
[17:12 – 20:07]
[17:12] Mike Dilke: You’ve mentioned this thing a couple of times, so let’s just go into that: vertebrogenic back pain. This is something that you can see on the MRI. What is it?
[17:22] Dr. David McKean: Vertebrogenic back pain is a particular type of back pain where the disc between the vertebral bodies is often a bit worn, and you get some irregularity, some breakdown of the endplates, which are the tops and the bottoms of the vertebral bodies. You get this reaction within the bones, and you get these very characteristic findings on the MRI scan, something that we call Modic changes. Those are very strongly associated with low back pain: deep, axial back pain, often worse when bending forward, worse when doing things like sneezing. This is a type of back pain that doesn’t respond to standard injections or anything like that, which usually target the posterior column of the spine—those are the facet joints at the back of the spine. This is a back pain that’s coming from the front of the spine, and up until recently, was relatively hard to treat. Patients would often suffer with this type of pain for many, many, many years.
[18:42] Mike Dilke: Was Emma a classic patient? Did Emma have classic diagnosis and classic problems?
[18:47] Dr. David McKean: Absolutely. She had some wear and tear of the disc, this inflammation within the bones; she had classic symptoms of pain bending forward and when she was working as a personal trainer. Her MRI was again classic Modic 1 reactive endplate changes, where there’s this very inflammatory-looking appearance to the bones.
[19:16] Mike Dilke: So it’s a specific nerve, is it, that this particular wear and this Modic change in this part of the vertebrae catches on or causes a problem with?
[19:28] Dr. David McKean: Exactly. There’s a nerve within the vertebral body called the basivertebral nerve that comes in through the posterior wall of the vertebral body. It goes to the middle of the vertebral body, and then it arborizes up and down—so essentially it innervates the endplates. If we could only find a way to deaden that nerve, or essentially suppress the signals going through that nerve, you can take away a lot of the pain that patients feel. The team at Boston Scientific and Intracept developed a device that allowed us to do that, and that’s what we were able to do just last year.
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Section 10: The Intracept Procedure & Radiofrequency Ablation
[20:08 – 26:10]
[20:08] Mike Dilke: Describe that device a little bit, because I must admit, I looked at a video on their website, and it looked somewhat medieval. So describe it and what you do with it.
[20:20] Dr. David McKean: It’s actually a pretty straightforward procedure. What we do is the patient would be lying face down on the table in the interventional suite. We use X-rays to guide a small needle that goes down into the vertebral body, and then we need to curve it round to a specific point within the vertebral body where this nerve sits.
[20:54] Mike Dilke: Was Emma awake at this point, or is it a GA, a general anesthetic?
[20:58] Dr. David McKean: It varies a little bit; different hospitals will have different protocols. When we did it, we did it with just some conscious sedation. Emma was awake, and we could talk to her, but she wasn’t in any pain. She was a bit sleepy. We tap this curved needle round to a specific point in the vertebral body, and then when we get to the nerve, we can target it.
[21:26] Mike Dilke: I’m just going to interrupt you a little bit. The same video I was looking at: you described it as tapping. The one I saw, the guy driving the machinery, I would say was whacking.
[21:40] Dr. David McKean: Whacking! There can be a little bit of whacking, depending on how dense the patient’s bone is. I hope Emma doesn’t mind me saying, Emma’s bone was very hard. Because she’s an athlete and a personal trainer, and has obviously put lots of load through her spine, and she’s also young, with no history of osteoporosis or anything like that. Her bone was strong, and so there was a bit of whacking.
[22:07] Mike Dilke: Was it Emma in the video? I couldn’t tell from the shot; I’m assuming not.
[22:11] Dr. David McKean: There was a photographer there when we treated Emma, so it might have been, who knows!
[22:24] Dr. David McKean: You’re right: we do have to use a little hammer to tap this device down into the bone. But once it’s in the right position, we then put a small probe down into the channel that we’ve created, and then we heat that up—something called radiofrequency ablation. We heat up the nerve to lesion the nerve, which will essentially stop those pain signals coming from the bone, and it can significantly improve patients’ pain.
[22:52] Mike Dilke: How hot is this getting?
[22:56] Dr. David McKean: Pretty hot. Hot enough to kill the nerve, so over 70 degrees. Anything over 50 degrees you’re going to get denaturing of the proteins in the cells and cell death, but about 70 degrees is sufficient to deaden this nerve.
[23:11] Mike Dilke: And how is that heat got there? Is that electrical, or is someone fancy gas expanding?
[23:18] Dr. David McKean: It’s radiofrequency ablation, so it’s electrical, and you’re generating this ablation zone which is maybe about a centimeter or so in size. That’s sufficient to ablate the nerve within the bone and take away the patient’s pain. My route into this technique was actually doing something similar, but for patients with cancer in the spine. The pain from cancer in the spine can be very severe and very hard to treat. But we knew for many years that essentially if you used this ablation technique to ablate the cancer in the spine, the patients’ pain got significantly better because you were killing the nerve which was supplying the bone. This is a similar idea, but much more targeted: rather than ablating the entirety of the bone, you’re just ablating a small part where this nerve is sitting.
[24:19] Mike Dilke: So you’re stopping the nerve working. The nerve is going to be there for a reason, doing something fairly special, I would imagine. Is it always a good idea to turn nerves off? Because they’re there for a reason, or has the nerve gone wrong—is that what’s causing the problem?
[24:35] Dr. David McKean: In this case, the pain that the patients are suffering is disproportionate to the underlying wear and tear, and that’s why we want to try and deaden this nerve a bit. It’s not that the patient will become completely insensate at that level. There are other nerves supplying the spine, something called the sinuvertebral nerve which is going to be also supplying the area. So we’re not taking away every nerve; we’re just taking away the nerve that’s carrying the majority of the pain signal. This has been a treatment available in the US for about a decade now, and they’ve had long-term follow-up for patients for seven, ten years in some cases. It’s very well tolerated, so we haven’t seen cases where patients are developing complications from the nerve being ablated. The fantastic thing about this technique is that one alternative would be to do a spinal fusion, where you actually fuse the bones together to stop them moving.
[25:40] Mike Dilke: An ex-gymnast is not going to like that, I’m assuming.
[25:43] Dr. David McKean: Exactly. Creating a very stiff segment, a stiff block in your spine, often puts increased wear and tear and increased stress at the levels above and below that fusion, and can actually lead to accelerated degeneration on either side of the fusion. With this technique, we’re preserving your anatomy, and we’re not damaging anything else; we’re just deadening the nerve. Long-term, that’s probably going to be a better option.
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Section 11: Emma’s Experience: From Procedure to Recovery
[26:11 – 29:30]
[26:11] Mike Dilke: David, we’ve had the theory; let’s have the practice. What actually happens? Emma, you went in one morning, had the thing done at lunchtime, and were home by tea time? How long were you in hospital?
[26:24] Emma Fletcher: Really quick. I was literally in for the day—in and out in no time.
[26:31] Mike Dilke: How long were you on the slab for?
[26:34] Emma Fletcher: I can’t quite remember; I was a bit out of it, but not very long, it didn’t feel like.
[26:40] Dr. David McKean: It took us an hour, but it went very smoothly.
[26:46] Mike Dilke: As far as the levels of discomfort, tell us about that, but more about the discomfort when you’re recovering from the thing.
[26:59] Emma Fletcher: During, I didn’t feel a thing. I was heavily sedated. Every time I kept coming round, I kept having this very weird sensation of something pulling and pushing, not quite sure what was going on.
[27:16] Mike Dilke: That was David using the hammer.
[27:17] Emma Fletcher: Yeah, it was! When he did say he had to get the bigger hammer out because my bone was too strong. But I didn’t feel any pain throughout, and I didn’t feel a thing. Afterwards, I was hardly in any pain after, to be fair. I literally took a couple of paracetamols, and that was about it. I thought I would be in more pain than I was, but I wasn’t. It just got better. I went home, chilled out for a few days, tried to chill out.
[27:50] Mike Dilke: Were you walking the next day? Were you walking that day?
[27:52] Emma Fletcher: I walked out of there! Just obviously with someone walking with me; I didn’t drive. But yeah, I walked out. Hardly any pain at all. So it was a fantastic procedure.
[28:07] Mike Dilke: How long until the aftereffects of the procedure carried on for? A week or two, or a couple of months?
[28:20] Emma Fletcher: Not long at all. I found that within 24 hours my pain level had dropped completely—not completely at all, but it dropped quite dramatically from what it was because it was chronic. And then it just got better and better over the days. I was out walking a little bit the next day, not too much, and I was probably walking a good three or 4k—maybe I wasn’t supposed to, but I was—very gently by the end of the week. Gentle walking, with a pain level that was at, say, a nine down to about a three. And it just got better and better.
[29:03] Mike Dilke: How long ago did you have this done now, Emma?
[29:05] Emma Fletcher: A year ago. It’s about a year ago, wasn’t it?
[29:09] Mike Dilke: Where are you now? Are you back to your old self?
[29:13] Emma Fletcher: Yes, back to my old self! I can back bend, I can forward bend. Oh yeah, I can do all that now. I can do all the things that I was doing before the chronic pain started, which is fabulous.
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Section 12: Clinical Trial Data, Success Rates & Durability
[29:30 – 33:28]
[29:30] Mike Dilke: That is a success story, I would say, David. But tell me: I like data on this show, so I’m assuming there are peer-reviewed published papers before you’re allowed to do it on patients. Give us some statistics of how many patients have had the procedure done and how many have been followed through successfully for a number of years.
[30:01] Dr. David McKean: One of the advantages that we have is that this technique’s been around in the US for about 10 years, so we’ve got loads of data, very robust data that’s come out over the last few years. The success rates for this treatment are really pretty excellent: about a third of patients will get a 100% reduction in their pain, which is fantastic; about three-quarters of patients will get an over 50% reduction in their pain (that includes the 100%, so three-quarters will get an over 50% reduction in their pain, so from an eight to a four or something like that, or better). That still does mean that there’s about a quarter of patients who get a less than 50% reduction in their pain score. So it works very well. It doesn’t work for everyone, but it does work well. If you respond, the pain relief seems to be very long-lasting. They’ve followed patients up to seven years after this treatment, and if you’ve responded, that response seems to be sustained up to many years post-treatment. We think that’s because if you ablate this nerve successfully and it’s the cause of your pain, the nerve doesn’t grow back, and so the pain’s gone, potentially forever. So if it works, it works for a very long time.
[31:41] Dr. David McKean: There’s always small risks of complications with any procedure, but the complications that have been reported with this technique are really pretty minor. A small number of patients will get a bit of irritation of one of the nerves going down their leg after the procedure, something called radiculopathy. If that were to happen, we would give some steroid injection to try and calm that down, although I’ve actually never had a case of that. There’s been a couple of cases where people have had some bleeding after the procedure. Both of those complications are really related to the technique of getting down into the bone: if you’re a little bit too lateral, then you can cause some bleeding; if you’re a bit too medial, you can cause irritation of the nerve. But if you’re just in the right place, then both of those complications are vanishingly unlikely.
[32:31] Mike Dilke: How large is the target?
[32:33] Dr. David McKean: The pedicle—it depends which bone you’re going down, but the pedicle, which is the bit of the bone we’re trying to put the needle through, is going to be maybe six or seven millimeters wide, maybe eight millimeters wide. So it’s a narrow little channel you’re trying to direct your needle down. The nerve itself is a small nerve, so the target is maybe less than a centimeter within the middle of the vertebral body. That’s another point I would definitely make, Mike: as with any targeted treatment, the key is to ablate the right bit of the bone. If you put your ablation probe into the wrong place, somewhere else in the vertebral body, this won’t work. You’ve got to be precise in how you do this. But in the right patients, with the right technique, this can work very well.
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Section 13: NHS Availability, NICE Approval & Trial Pathways
[33:28 – 37:17]
[33:28] Mike Dilke: Tell me how this is available, because actually this is not approved by NICE, is it, I don’t think?
[33:34] Dr. David McKean: Not yet. Myself and some other practitioners have written to NICE asking them to start the process of considering basivertebral nerve ablation for this particular type of chronic low back pain. I anticipate that they will do that in the next year or so. In the meantime, you’re right: it’s not straightforward to access because of NHS funding and so on. In our trust, we’ve actually been enrolled in a trial called the INPROVE study, which essentially means that we’re able to treat patients through this research project. But it’s not available widely in the UK yet, certainly not in the NHS. It is available at some private hospitals.
[34:30] Mike Dilke: Presumably, from what you’ve described, it sounds like it’s very cost-effective. There’s no overnight stay: you go in for the day, all goes well, you go home, and you get better in a couple of days. So for the right person, this does sound like a very cost-effective type treatment, so maybe NICE will approve it.
[34:55] Dr. David McKean: I hope so. I feel pretty confident that they will, because it’s a one-off treatment, can have a huge impact on patients’ pain, quality of life, productivity, and all the economic benefits of that down the line. It’s safe; there’s ten years-plus worth of data to support its use. So I would hope that NICE would look favorably on this, and I expect that they will approve this in the next few years.
[35:30] Mike Dilke: If people are currently suffering from back pain which is proving hard to diagnose, and they’d like to find out a little more about this because they might be one of the patients that this could help, what’s a good source to get a little bit more information just to find out a bit more—and I don’t mean for doctors, I mean for regular people?
[35:51] Dr. David McKean: There’s a few good resources out there. There’s a page on the website from Boston Scientific talking about chronic pain treatment options, and specifically the Intracept device, which is the name for this treatment for basivertebral nerve ablation. That’s got lots of information on the success rates, the data, the device itself. That would give you a lot of information about this type of back pain and the potential treatment options. Then you might have to search a little bit harder to find radiologists or pain physicians who are able to offer this in the UK at the moment. I think the number of people offering this will increase over the next few years, certainly. At the minute, there’s a relatively small number of people offering this in the UK, but people can probably hunt them down on the internet if they look for basivertebral nerve ablation.
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Section 14: Show Wrap-Up & Outro
[37:02 – 38:16]
[37:02] Mike Dilke: Thank you, both of you, for coming to chat about this. I think this is interesting, and it’s certainly helped Emma greatly, that’s obvious, and potentially can help many more people. So many thanks.
[37:15] Dr. David McKean: Pleasure. Thanks, Mike.
[37:16] Emma Fletcher: Thank you.
[37:18] Mike Dilke: Thank you very much to my guests on this week’s show. They were Dr. David McKean and Emma Fletcher, ex-back pain sufferer. The topic was back pain, in particular the Intracept system of curing back pain. If you are a back pain sufferer and you suffer when sitting at your desk, do take a look at my website, relaxbackuk.com, where you can see the BackApp chair, which has helped many hundreds of people who suffer pain when sitting at their desk. It can exercise your core muscles very gently when you’re sitting down, and you can apply to try out a BackApp chair. The website again is relaxbackuk.com. Many thanks.
[38:00] Intro/Outro: Thanks for listening to the Relaxback UK Show. Join me, Mike Dilke, again next week for more fascinating interviews and chat. If you’re listening to the podcast version, please subscribe, like, and share it with your family and friends. Have a healthy week, until next week.