Radiofrequency denervation fails to deliver promised results.
There are some things in life that sound good in theory, but in practice they turn out to be letdowns. On a macro scale, think of all the failed utopian experiments throughout history. On a micro scale, think of giving yourself permission to eat all the chocolate you want. No matter how appealing the idea of an ideal society or a chocolate binge might be, the reality doesn’t hold up.
Two published studies suggest that an invasive procedure intended to alleviate facet joint pain called radiofrequency (RF) denervation is not as effective as it once promised to be. (It is also called RF rhizotomy or RF neurotomy.) Once a person has been diagnosed with facet joint pain by means of injections that temporarily numb the pain, in theory it should be possible produce longer term relief by cutting off pain messages to the brain. Thus, the goal of RF denervation is to apply enough heat to damage the nerves that conduct pain sensations from deteriorated facet joints, in hopes of reducing or eliminating the sensation of pain.
Before summarizing the two studies, here is a basic description of the procedure:
- Patients must be awake in order to follow directions and give feedback so mild sedation is used.
- All insertions of needles or probes are done under x-ray guidance.
- A thin needle with an electrode is inserted into the nerve next to the facet joint. A light current may be applied to stimulate muscle contraction in order to confirm correct placement.
- An anesthetic is injected into the nerve to numb it.
- The electrode needle is then activated for about 60 seconds, creating a high temperature to destroy the nerve and break the line of communication to the brain.
- This procedure is repeated as needed in other affected joints.
- While the numbing anesthetic is still in effect, there may be no sensation of pain. However, when it wears off, pain at the same or worse level as before typically occurs for several days up to a few weeks before the full effect of the treatment is known.
- If successful, pain relief can last up to 18 months, but averages 6-9 months.
The two studies I mention both examine RF denervation to treat lower back facet joint pain (lumbar facet joint pain). They differ from one another in that one was a randomized, controlled double-blind study involving 60 patients, and the other was a review and analysis of previously published studies.
A. In the randomized study by Van Tilburg et al. (2016)i sixty patients diagnosed with lumbar facet joint pain were randomly assigned to one of two groups: either the treatment group (RF denervation) or a group that underwent a “mock” treatment (an identical procedure but no heat was activated to destroy the nerve). Patients did not know which procedure they had. Both groups also underwent a physical therapy protocol. The study goal was to capture patient-reported decreases in pain and improved function using standard measures. In fact, over time the amount of pain diminishment and reported satisfaction were similar between the two groups, the RF group reporting no significant benefit over the mock treatment group.
B. In the literature review by Maas et al. (2015)ii the authors examined 23 published reports of randomized, controlled studies involving radiofrequency denervation applied for lumbar facet joint pain. They found “no high-quality evidence suggesting that RF denervation provides pain relief” and no convincing evidence of improved function. They also felt that the quality of evidence was low-to-moderate, and remarked on the lack of long term data.
While these are only two papers, each of them casts a critical eye upon the results of RF denervation as reported in professional, peer-reviewed journals. Facet joint pain is a difficult condition to manage if it does not respond to over-the-counter anti-inflammatories, improved posture, physical therapy and prescribed exercises – all of which have been shown to have greater or lesser effect if practiced diligently over time. Sometimes, a therapeutic intervention into the nerve will be the next level of care offered to patients. Medicine is rapidly trending toward minimal-to-noninvasive therapies. However, some minimally invasive procedures, such as RF denervation, can actually cause pain during and after treatment.
From the patient’s viewpoint, a noninvasive ultrasound procedure offered by the Sperling Medical Group has distinct advantages over inserting an electrode into a spinal nerve. It is called MR-guided focused ultrasound (MRgFUS). Nothing is inserted through the skin into the spine because it uses no needles or probes. Thanks to the radiation-free, superior imaging fidelity of MRI, MRgFUS offers superior patient comfort during and after the procedure. Clinical studies demonstrate promising results.
For more information about MRgFUS for facet joint pain in the neck or lower back region, contact the Sperling Medical Group.
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iVan Tilburg CW, Stronks DL, Groeneweg JG, Huygen FJ. Randomised sham-controlled double-blind multicentre clinical trial to ascertain the effect of percutaneous radiofrequency treatment for lumbar facet joint pain. Bone Joint J. 2016 Nov;98-B(11):1526-1533.
iiMaas ET, Ostelo RW, Niemisto L, Jousimaa J et al. Radiofrequency denervation for chronic low back pain. Cochrane Database Syst Rev. 2015 Oct 23;(10):CD008572. doi: 10.1002/14651858.CD008572.pub2.
- CATEGORY:
- Facet Pain
