Radiofrequency Denervation for Chronic Low Back Pain

Authors: Juch JNS et al., JAMA 2017 Jul 4; 318:68

The procedure conferred no clinically important improvement in pain related to facet or sacroiliac joints or intervertebral discs.

Radiofrequency denervation, or nerve ablation, is used to treat patients with chronic low back pain associated with facet or sacroiliac joints or intervertebral discs. However, evidence of the procedure’s effectiveness is modest, at best. Now, researchers report the results of three nonblinded randomized trials from the Netherlands that involved 681 patients with chronic low back pain arising from facet joints, sacroiliac joints, or a combination of these joints and intervertebral discs, as assessed by physical examination and confirmed by diagnostic nerve blocks. Patients were randomized to radiofrequency denervation plus an exercise program or to exercise alone. The exercise program consisted of 8 to 12 hours of movement education during 3 months.

At 3 months and 12 months, no clinically important differences were observed between intervention and control groups on prespecified primary and secondary measures of pain and function, and almost no differences were statistically important. Groups also did not differ in adverse events.

Comment

Any bias introduced by lack of blinding should have favored radiofrequency denervation, so these negative results are even more compelling in their lack of support for this procedure.