Think Before You Inject

Provenzano, David

doi:10.1097/aap.0000000000000114

Cited by 6 publications

(1 citation statement)

References 17 publications

(32 reference statements)

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“…The importance of needle diameter and the length of active tip is based on electrophysiological principles, along with technical and physical aspects of radiofrequency [ 21 , 38 , 39 ], as it was reported also for knee joint radiofrequency [ 40 ]. Moreover, the transverse diameter of lumbar MBs is < 2 mm and even smaller (0.5 mm) at L5 level [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Delphi-Based Expert Consensus Statements for the Management of Percutaneous Radiofrequency Neurotomy in the Treatment of Lumbar Facet Joint Syndrome

Occhigrossi¹,

Carpenedo²,

Leoni³

et al. 2023

Pain Ther

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Introduction A modified Delphi strategy was implemented for obtaining recommendations that could be useful in the management of percutaneous radiofrequency treatment of lumbar facet joint syndrome, as the literature on the argument was poor in quality. Methods An Italian research team conducted a comprehensive literature search, defined the investigation topics (diagnosis, treatment, and outcome evaluation), and developed an explorative semi-structured questionnaire. They also selected the members of the panel. After an online meeting with the participants, the board developed a structured questionnaire of 15 closed statements (round 1). A five-point Likert scale was used and the cut-off for consensus was established at a minimum of 70% of the number of respondents (level of agreement ≥ 4, agree or strongly agree). The statements without consensus were rephrased (round 2). Results Forty-one clinicians were included in the panel and responded in both rounds. After the first round, consensus (≥ 70%) was obtained in 9 out of 15 statements. In the second round, only one out of six statements reached the threshold. The lack of consensus was observed for statements concerning the use of imaging for a diagnosis [54%, median 4, interquartile range (IQR) 3–5], number of diagnostic blocks (37%, median 4, IQR 2–4), bilateral denervation (59%, median 4, IQR 2–4), technique and number of lesions (66%, median 4, IQR 3–5), and strategy after denervation failure (68%, median 4, IQR 3–4). Conclusion Results of the Delphi investigations suggest that there is a need to define standardized protocols to address this clinical problem. This step is essential for designing high-quality studies and filling current gaps in scientific evidence. Supplementary Information The online version contains supplementary material available at 10.1007/s40122-023-00512-2.

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Section: Discussionmentioning

confidence: 99%

Delphi-Based Expert Consensus Statements for the Management of Percutaneous Radiofrequency Neurotomy in the Treatment of Lumbar Facet Joint Syndrome

Occhigrossi¹,

Carpenedo²,

Leoni³

et al. 2023

Pain Ther

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Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group

et al. 2021

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Background The past two decades have witnessed a surge in the use of cervical spine joint procedures including joint injections, nerve blocks and radiofrequency ablation to treat chronic neck pain, yet many aspects of the procedures remain controversial. Methods In August 2020, the American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine approved and charged the Cervical Joint Working Group to develop neck pain guidelines. Eighteen stakeholder societies were identified, and formal request-for-participation and member nomination letters were sent to those organizations. Participating entities selected panel members and an ad hoc steering committee selected preliminary questions, which were then revised by the full committee. Each question was assigned to a module composed of 4–5 members, who worked with the Subcommittee Lead and the Committee Chairs on preliminary versions, which were sent to the full committee after revisions. 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 Chairs, who incorporated the comments and sent out revised versions until consensus was reached. Before commencing, it was agreed that a recommendation would be noted with >50% agreement among committee members, but a consensus recommendation would require ≥75% agreement. Results Twenty questions were selected, with 100% consensus achieved in committee on 17 topics. Among participating organizations, 14 of 15 that voted approved or supported the guidelines en bloc, with 14 questions being approved with no dissensions or abstentions. Specific questions addressed included the value of clinical presentation and imaging in selecting patients for procedures, whether conservative treatment should be used before injections, whether imaging is necessary for blocks, diagnostic and prognostic value of medial branch blocks and intra-articular joint injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for designating a block as positive, how many blocks should be performed before radiofrequency ablation, the orientation of electrodes, whether larger lesions translate into higher success rates, whether stimulation should be used before radiofrequency ablation, how best to mitigate complication risks, if different standards should be applied to clinical practice and trials, and the indications for repeating radiofrequency ablation. Conclusions Cervical medial branch radiofrequency ablation may provide benefit to well-selected individuals, with medial branch blocks being more predictive than intra-articular injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of false-negatives (ie, lower overall success rate). Clinical trials should be tailored b...

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Anatomical Comparison of Radiofrequency Ablation Techniques for Sacroiliac Joint Pain

et al. 2018

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Think Before You Inject

Cited by 6 publications

References 17 publications

Delphi-Based Expert Consensus Statements for the Management of Percutaneous Radiofrequency Neurotomy in the Treatment of Lumbar Facet Joint Syndrome

Delphi-Based Expert Consensus Statements for the Management of Percutaneous Radiofrequency Neurotomy in the Treatment of Lumbar Facet Joint Syndrome

Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group

Anatomical Comparison of Radiofrequency Ablation Techniques for Sacroiliac Joint Pain

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