Background & Aims
Radiofrequency denervation is a commonly performed procedure for lumbar facet joint pain. It is recommended by health authorities such as National Institute for health and Care Excellence(1). Pragmatic randomised controlled trials question the efficacy of the procedure(2). Emphasis has been placed on the patient selection and technical aspects of the procedure (3). Apart from the use of double diagnostic blocks as the key for selection, there is very little emphasis about the co-morbidities such as presence of chronic primary pain, psychiatric, spinal and rheumatological conditions. In this retrospective analysis, we present the patient factors which has the potential to influence low back pain and the outcomes for RF denervation.
Methods
After approval from the institutional Quality Improvement & Assurance team, study data were collected and managed using REDCap electronic data capture tools hosted at University of Aberdeen. Patients who underwent lumbar RD denervation in a 3-year period from January 2016 to December 2019 were included in the study. The following data were collected: demographics; pain topography; presence of chronic primary pain conditions, spinal conditions, rheumatological conditions and psychiatric comorbidities; medications; diagnostic blocks; procedural aspects; duration of follow-up and percentage of pain relief obtained (Table 1). RF was deemed successful if patients had reported at least 50% pain control at 9 months. Descriptive statistics and correlation analysis was performed using SPSS statistical software.
Results
Ninety patients had undergone RF denervation over 3 years. Their demographics and baseline characteristics are tabulated in Table 2. The procedure was deemed successful in 41.6% of participants. The presence of nociceptive type pain, and response to diagnostic blocks reached significant correlation at 0.05 level (2-tailed) for success. There was no correlation between presence of chronic primary pain, spinal conditions, or psychiatric co-morbidities and outcomes. The presence of rheumatological conditions, use of dependence forming medications and sensory detection threshold exceeding 0.5 v trended towards the negative influence on the outcome.
Conclusions
In conclusion, this retrospective analysis sheds light on the multifaceted nature of patient factors influencing the outcomes of RF denervation for lumbar facet joint pain. We found that the presence of nociceptive type pain and positive response to diagnostic blocks (> 80%) significantly correlated with procedural success, highlighting the relevance of accurate pain classification and diagnostic accuracy. Additionally, the presence of rheumatological conditions, use of dependence forming medications and heightened sensory detection thresholds showed trends towards a negative influence on outcomes, warranting closer attention in future research. Overall, our findings underscore the nuanced nature of patient factors in determining the effectiveness of RF denervation and emphasize the importance of personalized approaches to pain management.
References
1. Low back pain and sciatica in over 16s: assessment and management (2016) NICE guideline NG59.
2. Juch JNS, Maas ET, Ostelo RWJG, et al. Effect of Radiofrequency Denervation on Pain Intensity Among Patients With Chronic Low Back Pain: The Mint Randomized Clinical Trials. JAMA. 2017 Jul 4;318(1):68-81.
3. Cohen SP, Bhaskar A, Bhatia A, et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Reg Anesth Pain Med. 2020 Jun;45(6):424-467.
Presenting Author
Saravana Kanakarajan
Poster Authors
Topics
- Treatment/Management: Interventional Therapies – Injections/Blocks