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Radiofrequency denervation is a commonly used treatment for chronic low back pain, but high-quality evidence for its effectiveness is lacking.
Radiofrequency denervation is a specialized process which
uses heat to amend nerve signaling that goes to joint facets. This property of
radiofrequency denervation is used to manage low back pain problem as injured
facet joints in the spine cause pain by pressing the nerves. This trial help to
rectify exact role of the technique in low back pain management.
Radiofrequency denervation is a commonly used treatment for
chronic low back pain, but high-quality evidence for its effectiveness is
lacking. To evaluate the effectiveness of radiofrequency denervation added to a
standardized exercise program for patients with chronic low back pain.
Three pragmatic multicenter, nonblinded randomized clinical
trials on the effectiveness of minimal interventional treatments for
participants with chronic low back pain (Mint study) were conducted in 16
multidisciplinary pain clinics in the Netherlands. Eligible participants were
included between January 1, 2013, and October 24, 2014, and had chronic low
back pain, a positive diagnostic block at the facet joints (facet joint trial,
251 participants), sacroiliac joints (sacroiliac joint trial, 228
participants), or a combination of facet joints, sacroiliac joints, or
intervertebral disks (combination trial, 202 participants) and were
unresponsive to conservative care. All participants received a 3-month
standardized exercise program and psychological support if needed. Participants
in the intervention group received radiofrequency denervation as well. This is
usually a 1-time procedure, but the maximum number of treatments in the trial
was 3. The primary outcome was pain intensity (numeric rating scale, 0-10;
whereby 0 indicated no pain and 10 indicated worst pain imaginable) measured 3
months after the intervention. The pre-specified minimal clinically important
difference was defined as 2 points or more. Final follow-up was at 12 months,
ending October 2015.
Among 681 participants who were randomized (mean age, 52.2
years; 421 women [61.8%], mean baseline pain intensity, 7.1), 599 (88%)
completed the 3-month follow-up, and 521 (77%) completed the 12-month
follow-up. The mean difference in pain intensity between the radiofrequency
denervation and control groups at 3 months was −0.18 (95% CI, −0.76 to 0.40) in
the facet joint trial; −0.71 (95% CI, −1.35 to −0.06) in the sacroiliac joint
trial; and −0.99 (95% CI, −1.73 to −0.25) in the combination trial.
In 3 randomized clinical trials of participants with
chronic low back pain originating in the facet joints, sacroiliac joints, or a
combination of facet joints, sacroiliac joints, or intervertebral disks,
radiofrequency denervation combined with a standardized exercise program
resulted in either no improvement or no clinically important improvement in
chronic low back pain compared with a standardized exercise program alone. The
findings do not support the use of radiofrequency denervation to treat chronic
low back pain from these sources.
JAMA. 2017; 318(1):68-81.
Effect of Radiofrequency Denervation on Pain Intensity Among Patients With Chronic Low Back Pain: The Mint Randomized Clinical Trials
Johan N. S. Juch et al.
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