Radiofrequency Denervation for Chronic Low Back Pain

Rimmalapudi, Varun; Buchalter, Jeff; Calodney, Aaron

doi:10.1001/jama.2017.16378

Cited by 8 publications

(10 citation statements)

References 4 publications

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“…However, among the studies which showed negative results, Juch et al 61 included 251 patients with 126 patients in the control group. Even though the study had a variety of limitations, [71][72][73][74][75][76][77][78] it is considered as one of the important studies in the literature. A second high-quality trial also showed lack of significant improvement with radiofrequency neurotomy.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Radiofrequency Neurotomy in Chronic Low Back Pain: A Systematic Review and Meta-Analysis

Janapala¹,

Manchikanti²,

Sanapati³

et al. 2021

JPR

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Purpose The objective of the systematic review and meta-analysis is to evaluate the efficacy of radiofrequency neurotomy as a therapeutic lumbar facet joint intervention. Patients and Methods Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, a systematic review and meta-analysis was performed. A comprehensive literature search of multiple data sources from 1966 to September 2020 including manual searches of bibliography of known review articles was performed. The inclusion criteria were based on the selection of patients with chronic low back pain with diagnosis confirmed based on controlled diagnostic blocks and with the publication of at least 6 months of results of appropriate outcome parameters. Quality assessment of the trials was performed with Cochrane review criteria and interventional pain management techniques-quality appraisal of reliability and risk of bias assessment (IPM-QRB). The level of evidence of effectiveness is classified at five levels ranging from Level I to Level V. The primary outcome measure was a significant reduction in pain, eg, short term (up to 6 months) and long term (more than 6 months). The secondary outcome measure was an improvement in functional status. Results A total of 12 randomized controlled trials (RCTs) met the inclusion criteria for evaluating the efficacy of lumbar radiofrequency neurotomy. Radiofrequency neurotomy showed Level II evidence for efficacy for both the short term and long term. Conclusion This systematic review of the assessment of the efficacy of radiofrequency neurotomy in managing chronic low back pain was based on the inclusion of 12 RCTs with a diagnostic block and at least 6 months of follow-up results that showed Level II evidence for both short-term and long-term improvement.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Radiofrequency Neurotomy in Chronic Low Back Pain: A Systematic Review and Meta-Analysis

Janapala¹,

Manchikanti²,

Sanapati³

et al. 2021

JPR

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“… 125 In conclusion, the longer the time as well as the higher the temperature, the radiofrequency lesion size will be bigger, and there could be a difference in radiofrequency lesion size due to needle size and placement of radiofrequency denervation. 89 , 116 , 126 …”

Section: Managementmentioning

confidence: 99%

Facet Joint Syndrome: Pathophysiology, Diagnosis, and Treatment

Du¹,

Xu²,

Bai³

2022

JPR

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Facet joint osteoarthritis (OA) is the most frequent form of facet joint syndrome. Medical history, referred pain patterns, physical examination, and diagnostic imaging studies (standard radiographs, magnetic resonance imaging, computed tomography and single-photon emission computed tomography) may suggest but not confirm lumbar facet joint (LFJ) syndrome as a source of low back pain (LBP). However, the diagnosis and treatment of facet joint syndrome is still controversial and needs further study. It is widely acknowledged that block with local anesthetic is perhaps the most effective method to establish a diagnosis of pain from LFJ. Particularly, there are different rates of success among different populations selected for diagnostic block with various positive criteria. Currently, in addition to conservative treatments for pain such as painkillers, functional exercises, and massage, there are many other methods, including block, denervation of the nerves that innervate the joints by radiofrequency, freezing or endoscopy, and injections. Due to the limited duration of pain relief from neurolysis of medial branch, many scholars have recently turned their targets to dorsal roots and LFJ capsules. Therefore, we reviewed the latest research progress of facet joint syndrome from diagnosis to treatment.

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“…Once the aforementioned Juch et al MINT trial results were published in JAMA , that journal published a series of three letters to the editor18–20 and a response by MINT trial coauthors Maas, Juch, and Huygen,21 as is appropriate and customary. However, elsewhere, other authors and other journals have published criticisms of the Juch et al report, absent a response from the MINT trial authors 22 23.…”

Section: Casting a Broader Netmentioning

confidence: 99%

Evidence versus advocacy, as related to radiofrequency denervation in the treatment of chronic low back pain and the MINT trials

Lanier

Neal

2019

Reg Anesth Pain Med

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In 2017, JAMA: Journal of the American Medical Association published the results of the MINT trials, prospective research involving 681 patients, all of whom received exercise therapy for low back pain. Half of the patients were randomized to additionally receive radiofrequency denervation (RFD) treatment. 88% of patients completed the 3-month follow-up, and 77% completed the 12-month follow-up. In this context, RFD provided no added benefit over the baseline of exercise therapy. In 2018, five authors, all experts in pain medicine, published a ‘Daring Discourse’ article in the journal Regional Anesthesia and Pain Medicine (RAPM), criticizing the findings of the MINT trials. Although 3 of the 5 authors of the RAPM ‘Daring Discourse’ article reported in conflict of interest statements—as is appropriate—that they were consultants to corporations that produce RFD equipment, the authors failed to disclose that 4 of 5 are on the editorial board of RAPM and all 5 are current officers in the medical organization that owns RAPM: that is, the American Society of Regional Anesthesia and Pain Medicine. Noteworthy, there was no published response from the MINT trial investigators to the Daring Discourse criticisms, either in the aforementioned example or in downstream venues where some of the same Daring Discourse authors continued their widely disseminated criticisms of the JAMA/MINT trials report. We believe that these actions taken by the Daring Discourse authors and RAPM have unfairly tipped the scales in the evaluation and application of RFD treatment of low back pain. In our commentary, we discuss: (1) the challenges associated with using clinical trials to predict clinical efficacy, (2) appropriate and inappropriate uses of postpublication commentary on original research findings, (3) the use of inappropriate commentary (and related means) to alter clinical practice in the presence of contradictory research findings, and (4) potential conflicts of interest related to the authors’ and Journal’s publication of the unopposed MINT trials criticism.

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Radiofrequency Denervation for Chronic Low Back Pain

Abstract: UCB]), for serving as project coordinator, a role for which she was compensated; and to Colleen Hoff, PhD (San Francisco State University [SFSU]), for her role in developing the study;

Cited by 8 publications

References 4 publications

Efficacy of Radiofrequency Neurotomy in Chronic Low Back Pain: A Systematic Review and Meta-Analysis

Efficacy of Radiofrequency Neurotomy in Chronic Low Back Pain: A Systematic Review and Meta-Analysis

Facet Joint Syndrome: Pathophysiology, Diagnosis, and Treatment

Evidence versus advocacy, as related to radiofrequency denervation in the treatment of chronic low back pain and the MINT trials

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