Randomized Trial of Radiofrequency Lumbar Facet Denervation for Chronic Low Back Pain (original) (raw)
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Clinical Predictors of Success and Failure for Lumbar Facet Radiofrequency Denervation
The Clinical Journal of Pain, 2007
Objective: To determine the clinical factors associated with the success and failure of radiofrequency denervation of the lumbar facet joints. Methods: Clinical data were garnered from 3 academic medical centers on 192 patients with low back pain who underwent radiofrequency denervation after a positive response to diagnostic blocks. Success was defined as Z50% pain relief lasting at least 6 months. Factors evaluated for their association with outcome included duration of pain, opioid use, symptom location, paraspinal tenderness, pain exacerbated by extension/ rotation (ie, facet loading), MRI abnormalities, diabetes, smoking, scoliosis, obesity, prior surgery and levels treated. Results: The only factor associated with a successful outcome was paraspinal tenderness. Variables that correlated with treatment failure were 'facet loading,' long duration of pain, and previous back surgery. Conclusions: It is counterproductive to use 'facet loading' as the sole basis for choosing patients for facet interventions. In patients at high risk for treatment failure, taking additional steps to reduce the rate of false-positive screening blocks may improve outcomes.
British Journal of Pain, 2021
Background and aim: The RADICAL trial has been funded by the National Institute for Health Research (NIHR) to evaluate the clinical and cost-effectiveness of radiofrequency denervation (RFD) for low back pain. Recommendations have been published which aim to standardise selection of patients and RFD technique. However, it is important to ensure these recommendations are acceptable to clinicians within the context of the trial. The aim of this work was to develop standardised criteria for the trial entry and RFD technique for implementation within the RADICAL trial. Methods: Fourteen pain clinicians completed a survey, which involved reviewing the current recommendations and indicating whether they disagreed with any of the recommendations and if so why. Responses were collated and presented at a half-day workshop with 14 attendees. During the workshop, the National Low Back and Radicular Pain Pathway (NLBRPP) guidelines for patient selection and an article by Eldabe and colleagues p...
Radiofrequency Denervation for Facet Joint Low Back Pain A Systematic Review
Spine
Study Design. A systematic review and meta-analysis of randomized controlled trials.Objective. To assess treatment effects (benefits and harms) of radiofrenquency denervation for patients with facet joint related chronic low back pain.Summary of Background Data. There is no consensus regarding the treatment efficacy of facet joint radiofrequency denervation (FJRD) and how it compares to nerve blockades and joint infiltration with anesthetics and/or corticosteroids.Methods. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and LILACS for randomized controlled trials (RCTs) that compared FJRD with blockades, infiltrations, or placebo. Primary outcomes were pain, functional status, and quality of life. Secondary outcomes were cost-effectiveness and complications.Results. Fifteen studies were selected and nine were eligible. Overall quality of evidence was rated low to moderate. The evidence favored FJRD regarding pain control. There was no sufficient evid...