Randomised sham-controlled double-blind multicentre clinical trial to ascertain the effect of percutaneous radiofrequency treatment for lumbar facet joint pain

Tilburg, Cornelis Wilhelmus Jacobus van; Stronks, Dirk L.; Groeneweg, George; Huygen, Frank

doi:10.1302/0301-620x.98b11.bjj-2016-0379.r2

Cited by 38 publications

(34 citation statements)

References 32 publications

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“…These findings are in accordance with a recent, more methodologically rigorous series of studies that found no difference between true and sham interventions for denervation of the facet joints,4 the lumbar disc5 or the sacroiliac joints 6…”

Section: Radiofrequency Denervation Does Not Work For Lbpsupporting

confidence: 92%

Recent data from radiofrequency denervation trials further emphasise that treating nociception is not the same as treating pain

et al. 2018

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Section: Radiofrequency Denervation Does Not Work For Lbpsupporting

confidence: 92%

Recent data from radiofrequency denervation trials further emphasise that treating nociception is not the same as treating pain

et al. 2018

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“…One should always consider that proper selection and technical factors can play an equal or greater role in the results of an interventional study than methodologic variables. 22 For example, placebo-controlled studies that selected patients for radiofrequency ablation via intraarticular injections have yielded equivocal or negative results, 23–25 while those that selected patients by medial branch blocks generally, 26–29 but not always, 30 reported positive findings, although methodologic differences preclude direct comparisons. The argument supporting a prognostic procedure that targets the nerves rather than the joints themselves to be ablated is intuitive and supported by a multicenter study demonstrating better radiofrequency ablation outcomes in patients who undergo medial branch blocks rather than intraarticular injections, 31 a small study comparing the prognostic value of medial branch blocks and pericapsular facet injections before cryodenervation, 32 and an experimental study demonstrating that 11% of individuals who receive medial branch blocks will continue to experience pain from facet joint capsular distension, which suggests aberrant innervation.…”

mentioning

confidence: 99%

Effectiveness of Lumbar Facet Joint Blocks and Predictive Value before Radiofrequency Denervation

Cohen¹,

Doshi

Constantinescu

et al. 2018

Anesthesiology

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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.

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“…The two placebo-controlled trials that used parallel electrode insertion both yielded positive results, 82 83 while only one 81 of three 19 81 84 that inserted the electrodes perpendicular to the targeted nerves reported positive findings. The negative, randomized MINT study 17 was also widely criticized for using a perpendicular needle approach.…”

Section: Question 13: Should Electrodes Be Positioned In a Certain Ormentioning

confidence: 99%

Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group

Cohen

Bhaskar

Bhatia

et al. 2020

Reg Anesth Pain Med

186

215

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BackgroundThe past two decades have witnessed a surge in the use of lumbar facet blocks and radiofrequency ablation (RFA) to treat low back pain (LBP), yet nearly all aspects of the procedures remain controversial.MethodsAfter approval by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, letters were sent to a dozen pain societies, as well as representatives from the US Departments of Veterans Affairs and Defense. A steering committee was convened to select preliminary questions, which were revised by the full committee. Questions were assigned to 4–5 person modules, who worked with the Subcommittee Lead and Committee Chair on preliminary versions, which were sent to the full committee. We used a modified Delphi method, whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chair, who incorporated the comments and sent out revised versions until consensus was reached.Results17 questions were selected for guideline development, with 100% consensus achieved by committee members on all topics. All societies except for one approved every recommendation, with one society dissenting on two questions (number of blocks and cut-off for a positive block before RFA), but approving the document. Specific questions that were addressed included the value of history and physical examination in selecting patients for blocks, the value of imaging in patient selection, whether conservative treatment should be used before injections, whether imaging is necessary for block performance, the diagnostic and prognostic value of medial branch blocks (MBB) and intra-articular (IA) injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for a prognostic block, how many blocks should be performed before RFA, how electrodes should be oriented, the evidence for larger lesions, whether stimulation should be used before RFA, ways to mitigate complications, if different standards should be applied to clinical practice and clinical trials and the evidence for repeating RFA (see table 12 for summary).ConclusionsLumbar medial branch RFA may provide benefit to well-selected individuals, with MBB being more predictive than IA injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of more false-negatives. Clinical trials should be tailored based on objectives, and selection criteria for some may be more stringent than what is ideal in clinical practice.

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Randomised sham-controlled double-blind multicentre clinical trial to ascertain the effect of percutaneous radiofrequency treatment for lumbar facet joint pain

Cited by 38 publications

References 32 publications

Recent data from radiofrequency denervation trials further emphasise that treating nociception is not the same as treating pain

Recent data from radiofrequency denervation trials further emphasise that treating nociception is not the same as treating pain

Effectiveness of Lumbar Facet Joint Blocks and Predictive Value before Radiofrequency Denervation

Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group

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