Radiofrequency denervation of lumbar facet joints in the treatment of chronic low back pain : a randomized, double-blind, sham lesion-controlled trial

Departments of Anaesthesia, Royal Adelaide Hospital & Queen Elizabeth Hospital, Adelaide, Australia. [corrected]
Clinical Journal of Pain (Impact Factor: 2.53). 11/2004; 21(4):335-44.
Source: PubMed


Radiofrequency facet joint denervation procedures have been common practice for 2 decades in treatment of chronic low back pain. We designed this multicenter, randomized, double-blind, sham treatment controlled trial to determine the efficacy of radiofrequency facet joint denervation, as it is routinely performed.
Inclusion criteria were low back pain, duration more than 6 months, and >or=50% Visual Analog Scale (VAS) reduction on diagnostic block. Exclusion criteria were prior radiofrequency treatment, radicular syndrome, coagulopathies, specific allergies, cancer, and pregnancy. A total of 81 out of 462 patients were randomized to undergo radiofrequency facet joint denervation or sham treatment. The first evaluation was carried out 3 months after treatment. Primary outcome was determined with a combined outcome measure comprising VAS, physical activities, and analgesic intake, from a twice-weekly recorded diary. Secondary outcome measures were the separate diary parameters, global perceived effect (complete relief, >50% relief, no effect, pain increase), and SF-36 Quality of Life Questionnaire.
There were no dropouts before the first evaluation. The combined outcome measure showed no differences between radio- frequency facet joint denervation (n=40; success 27.5%) and sham (n=41; success 29.3%) (P=0.86). The VAS in both groups improved (P<0.001). Global perceived effect improved after radiofrequency facet joint denervation (P<0.05). The other secondary outcome parameters showed no significant differences. Relevant costs were evaluated.
The combined outcome measure and VAS showed no difference between radiofrequency and sham, though in both groups, significant VAS improvement occurred. The global perceived effect was in favor of radiofrequency. In selected patients, radiofrequency facet joint denervation appears to be more effective than sham treatment.

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    • "This evaluation could have been accomplished with scales such as the Zung-DV (Zung Self Rating Depression Scale) or MPI-DLV (Pain-Related Psychosocial and Behavioral Aspects). Nevertheless, van Wijk et al. (36) used these measures and observed no differences in depression prevalence between treated and placebo groups of patients undergoing radiofrequency denervation. Another study limitation is that, although we recorded the opioid use by our chronic low back patients, we did not perform a quantitative or qualitative analysis on this or any other analgesic. "
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    ABSTRACT: OBJECTIVES: To verify the incidence of facetary and low back pain after a controlled medial branch anesthetic block in a three-month follow-up and to verify the correlation between the positive results and the demographic variables. METHODS: Patients with chronic lumbar pain underwent a sham blockade (with a saline injection) and then a controlled medial branch block. Their symptoms were evaluated before and after the sham injection and after the real controlled medial branch block; the symptoms were reevaluated after one day and one week, as well as after one, two and three months using the visual analog scale. We searched for an association between the positive results and the demographic characteristics of the patients. RESULTS: A total of 104 controlled medial branch blocks were performed and 54 patients (52%) demonstrated >50% improvements in pain after the blockade. After three months, lumbar pain returned in only 18 individuals, with visual analogue scale scores >4. Therefore, these patients were diagnosed with chronic facet low back pain. The three-months of follow-up after the controlled medial branch block excluded 36 patients (67%) with false positive results. The results of the controlled medial branch block were not correlated to sex, age, pain duration or work disability but were correlated with patient age (p<0.05). CONCLUSION: Patient diagnosis with a controlled medial branch block proved to be effective but was not associated with any demographic variables. A three-month follow-up is required to avoid a high number of false positives.
    Full-text · Article · Aug 2014 · Clinics (São Paulo, Brazil)
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    • "Therapeutic lumbar facet joint nerve blocks provide significant pain relief and improvement in functional status [7]. In addition, image-guided radiofrequency lesioning is commonly used for the management of facet origin pain [8-10]. Manejias et al. [11] reported that radiofrequency denervation in non to mild lumbar stenosis patients with chronic zygapophysial joint medicated low back pain improved pain in the long-term. "
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    ABSTRACT: Facet joint have been implicated as a source of chronic low back pain. Radiofrequency denervation has demonstrated the most solid evidence. To increase safety and efficacy of treatment, computed tomography (CT) guidance injection has been used in several disease. The purpose of this study was to evaluate the efficacy of CT-guided radiofrequency rhizotomy in the treatment of facet joint pain. A total of 40 patients were randomized to undergo radiofrequency facet joint denervation under CT guidance or C-arm guidance. All patients were examined visual analogue scale (VAS) score before treatment, 1 month, and 3 months after treatment. The VAS in both groups showed significant improvement over the 1-month interval. No significant difference in the VAS score among the group was observed. In this study there was no significant difference between CT guidance lumbar rhizotomy and C-arm guidance lumbar rhizotomy. Therefore CT-guided radiofrequency denervation of the lumbar facet joint was a minimally invasive technique that appears effective.
    Full-text · Article · Jun 2010 · The Korean journal of pain
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    • "A 50% or greater improvement in pain as criteria for a successful diagnostic medial branch block has also been used by other investigators [93–98]. Studies that employed diagnostic intra-articular blocks as apposed to medial branch blocks have also used similar criteria of 50% or greater improvement of pain [99, 100, 107]. However, others have suggested that a more strict definition of a confirmatory block is necessary to avoid performing radiofrequency denervation on patients who may have low back pain of other etiologies. "
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    ABSTRACT: Abstract Low back pain is the most common pain symptom experienced by American adults and is the second most common reason for primary care physician visits. There are many structures in the lumbar spine that can serve as pain generators and often the etiology of low back pain is multifactorial. However, the facet joint has been increasingly recognized as an important cause of low back pain. Facet joint pain can be diagnosed with local anesthetic blocks of the medial branches or of the facet joints themselves. Subsequent radiofrequency lesioning of the medial branches can provide more long-term pain relief. Despite some of the pitfalls associated with facet joint blocks, they have been shown to be valid, safe, and reliable as a diagnostic tool. Medial branch denervation has shown some promise for the sustained control of lumbar facet joint-mediated pain, but at this time, there is insufficient evidence that it is a wholly efficacious treatment option. Developing a universal algorithm for evaluating facet joint-mediated pain and standard procedural techniques may facilitate the performance of larger outcome studies. This review article provides an overview of the anatomy, pathophysiology, diagnosis, and treatment of facet joint-mediated pain.
    Preview · Article · Apr 2009 · Current Reviews in Musculoskeletal Medicine
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