Recently, Spine printed a randomized, double-blind study that re-examines the effectiveness of percutaneous radiofrequency denervation treatments on recalcitrant low back pain. Nath and colleagues started with 376 patients who had experienced elements of facet joint pain for at least two years. Their pain had proved refractory to medication, physical therapy, and/or manipulation. The study finds that, compared to placebo, radiofrequency denervation/neurotomy significantly improves back pain, leg pain, motion, and quality of life. While the placebo group shows relatively small changes in range of motion, the active treatment group more than doubles its ability in back extension. Their ability for side flexion improves roughly 41%. The active treatment group reduces their use of analgesics by 65% (on a six point scale). One of the differences between this new study and previous placebo-controlled studies of radiofrequency was that researchers did a more thorough job of prequalifying participants as having pain that definitely emanated from the facet joints.
The preponderance of published evidence to date supports the efficacy of radiofrequency for controlling chronic pain of the neck and back.(1-11) In lumbar facet pain, relief was measured to last a mean time of 10.5 months. (4) One descriptive study that thoroughly prequalified patients as having facet pain shows that 80% of patients enjoy at least 60% relief, and 60% of patients enjoy 80% relief lasting 12 months.
With this treatment, after anesthetizing the skin, a fine electrode uses radiofrequency to temporarily degenerate small diameter nociceptive fibers.(12,13) Radiofrequency denervation serves as a non-pharmacological, minimally invasive, pain control option with no side effects. Insurance typically reimburses for radiofrequency.
Radiofrequency denervation serves as one of the many pain medicine options at Care Medical Center. The recommended treatment plan is 2 to 4 treatments per year or as required. The results I have seen with both back and extremity pain are particularly encouraging considering that the pain involved has always proved refractory to normal care. The advantage of having procedure suites in our offices allows me to treat and return your patient within one to two weeks of your referral. As a referral-based, pain management practice, we only treat your patients for the pain management complaint or rehabilitation need.
References
1. Nath S, Nath C, Petterson K. Percutaneous lumbar zygapophysial (facet) joint neurotomy using radiofrequency current, in the management of chronic low back pain: A randomized double-blind trial. Spine. 2008;33(12): 1291-1297.
2. Rohof O. Radiofrequency treatment of peripheral nerves. Pain Pract 2002; 2: 257-260.
3. Malik K, Benzon H. Pulsed radiofrequency: a critical review of its efficacy. Anaesth Intensive Care. 2007; 35(6): 863-73.
4. Schofferman J, Kine G. Effectiveness of repeated radiofrequency neurotomy for lumbar facet pain. 2004; 29(21): 2471-3.
5. Simopoulos T, Kraemer J, Nagda J, et al. Response to pulsed and continuous radiofrequency lesioning of the dorsal root ganglion and segmental nerves in patients with chronic lumbar radicular pain. Pain Physician. 2008; 11(2): 137-44.
6. Van Wijk R, Geurts J, Wynne H, et al. Radiofrequency denervation of lumbar facet joints in the treatment of chronic low back pain: a randomized, double-blind, sham lesion-control trial. Clin J Pain. 2005; 21(4): 335-44.
7. Martin D, Willis M, Mullinax L, et al. Pulsed radiofrequency application in the treatment of chronic pain. Pain Pract 2007; 7:31-35.
8. Van Zundert J, Patijn J, Kessels A, et al. Pulsed radiofrequency adjacent to the cervical dorsal root ganglion in chronic cervical radicular pain: a double blind sham controlled randomized clinical trial. Pain 2007; 127: 173-182.
9. Mikeladze G, Espinal R, Finnegan R, et al. Pulsed radiofrequency application in treatment of chronic zygapophyseal joint pain. Spine J 2003; 3:360-362.
10. Coohen S, Sireci A, Wu C, et al. Pulsed radiofrequency of the dorsal root ganglia is superior to pharmacotherapy or pulsed radiofrequency of the intercostals nerves in the treatment of chronic postsurgical thoracic pain. Pain Physician 2006; 9:227-235.
11. Dreyfuss P, Halbrook B, Pauza K, et al. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain.
Spine 2000; 25: 1270-7.
12. Hamann W, Abou-Sherif S, Thompson S, et al. Pulsed radiofrequency applied to dorsal root ganglia causes a selective increase in ATF3 in small neurons. Eur J Pain 2007; 10:171-176.
13. Takahashi N, Tasto J, Ritter M. Pain relief through an antinociceptive effect after radiofrequency application. Am J Sports Med. 2007 May; 35(5): 805-10.
For Your Health,
Dr. Ryan Moorman
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