Radiofrequency denervation for chronic low back pain displayed no clinically relevant improvement in pain for patients, according to a study conducted by 16 multidisciplinary pain clinics in the Netherlands and published in JAMA (2017;318:68-81). Radiofrequency denervation is a commonly used treatment for patients with chronic low back pain, but the treatment had lacked quality evidence of its effectiveness.
Researchers set up three pragmatic multicenter, nonblinded randomized clinical tests from January 2013 to October 2014 to determine whether radiofrequency denervation, in addition to a standardized exercise program, would be effective for patients with chronic low back pain. In total, 681 participants were observed: 251 with a positive diagnostic block at the facet joints, 228 at the sacroiliac joints, and 202 at a combination of the facet joints, sacroiliac joints or intervertebral disks. The participants were chosen due to their unresponsiveness to conservative care. All were given a three-month standardized exercise program and psychological support, if required. Those in the intervention group also received radiofrequency denervation.
Physicians measured participant pain on a numeric scale of 0 to 10, with 0 indicating no pain and 10 indicating the worst pain possible. Patients were questioned about their pain rating three months after the intervention; the minimal clinically important difference was 2 points or higher. Participants rated their pain until the final follow-up in October 2015.
Of the 681 participants, 421 were women (61.8%), the mean age was 52.2 years, and the mean baseline pain intensity was 7.1. Overall, 599 (88%) of the participants completed the three-month follow-up and 521 (77%) completed the 12-month follow-up. Physicians found the mean difference in pain intensity 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.
Researchers concluded that the findings did not support the use of radiofrequency denervation to treat patients with chronic low back pain.