Background Sacroiliac joint pain is a challenging condition accounting for approximately 20% of cases of chronic low back pain. Currently, there are no effective long-term treatment options for sacroiliac joint pain. Methods A randomized, placebo-controlled study was conducted in 28 patients with injection-diagnosed sacroiliac joint pain. Fourteen patients received L4-5 primary dorsal rami and S1-3 lateral branch radiofrequency denervation using cooling-probe technology following a local anesthetic block, and 14 patients received the local anesthetic block followed by placebo denervation. Patients who failed to respond to placebo injections crossed over and were treated with radiofrequency denervation using conventional technology. Results One, 3 and 6-months post-procedure, 11 (79%), 9 (64%) and 8 (57%) of radiofrequency treated patients experienced ≥ 50% pain relief and significant functional improvement. In contrast, only 2 (14%) patients in the placebo group experienced significant improvement at their 1-month follow-up, and none experienced benefit 3-months post-procedure. In the crossover group (n=11), 7 (64%), 6 (55%) and 4 (36%) patients experienced improvement 1, 3 and 6-months post-procedure. One year after treatment, only 2 (14%) patients in the treatment group continued to demonstrate persistent pain relief. Conclusions These results provide preliminary evidence that L4 and L5 primary dorsal rami and S1-3 lateral branch radiofrequency denervation may provide intermediate-term pain relief and functional benefit in selected patients with suspected sacroiliac joint pain. Larger studies are needed to confirm our results, and determine the optimal candidates and treatment parameters for this poorly understood disorder.

Using current reimbursement scales, these findings suggest that proceeding to radiofrequency denervation without a diagnostic block is the most cost-effective treatment paradigm.

Whereas several factors were found to influence outcome, no single clinical variable reliably predicted treatment results. The use of more stringent selection criteria was not associated with better outcomes.

No abstract

Epidural entanercept holds promise as a treatment for lumbosacral radiculopathy.

Agency for Healthcare Research and Quality.

Reducing the volume during cervical medial branch blocks may improve precision and accuracy.

What We Already Know about This Topic What This Article Tells Us That Is New Background With facet interventions under scrutiny, the authors’ objectives were to determine the effectiveness of different lumbar facet blocks and their ability to predict radiofrequency ablation outcomes. Methods A total of 229 participants were randomized in a 2:2:1 ratio to receive intraarticular facet injections with bupivacaine and steroid, medial branch blocks, or saline. Those with a positive 1-month outcome (a 2-point or more reduction in average pain score) and score higher than 3 (positive satisfaction) on a 5-point satisfaction scale were followed up to 6 months. Participants in the intraarticular and medial branch block groups with a positive diagnostic block (50% or more relief) who experienced a negative outcome proceeded to the second phase and underwent radiofrequency ablation, while all saline group individuals underwent ablation. Coprimary outcome measures were average reduction in numerical rating scale pain score 1 month after the facet or saline blocks, and average numerical rating scale pain score 3 months after ablation. Results Mean reduction in average numerical rating scale pain score at 1 month was 0.7 ± 1.6 in the intraarticular group, 0.7 ± 1.8 in the medial branch block group, and 0.7 ± 1.5 in the placebo group; P = 0.993. The proportions of positive blocks were higher in the intraarticular (54%) and medial branch (55%) groups than in the placebo group (30%; P = 0.01). Radiofrequency ablation was performed on 135 patients (45, 48, and 42 patients from the intraarticular, medial branch, and saline groups, respectively). The average numerical rating scale pain score at 3 months was 3.0 ± 2.0 in the intraarticular, 3.2 ± 2.5 in the medial branch, and 3.5 ± 1.9 in the control group (P = 0.493). At 3 months, the proportions of positive responders in the intraarticular, medial branch block, and placebo groups were 51%, 56%, and 24% for the intraarticular, medial branch, and placebo groups, respectively (P = 0.005). Conclusions This study establishes that facet blocks are not therapeutic. The higher responder rates in the treatment groups suggest a hypothesis that facet blocks might provide prognostic value before radiofrequency ablation.