In three randomised trials, treatment of chronic low back pain (CLBP) with radiofrequency denervation resulted in either no improvement or no clinically important improvement in pain, according to a study published by the Journal of the American Medical Association (JAMA).
Even though radiofrequency denervation is a commonly-used treatment, high-quality evidence for its effectiveness is lacking. Esther T Maas, of Vrije Universiteit Amsterdam, Amsterdam, the Netherlands, and colleagues report the results of three randomised clinical trials that were conducted in 16 pain clinics in the Netherlands. Trial participants, who were unresponsive to conservative care, experienced CLBP potentially originating in the facet joints, the sacroiliac joints, or a combination of facet joints, sacroiliac joints, or intervertebral discs.
All participants received a three-month standardised exercise program and psychological support if needed. Participants in the intervention group received radiofrequency denervation as well, which is usually a one-time procedure, but the maximum number of treatments in the trial was three.
Among 681 participants who were randomised, 599 (88%) completed the three-month follow-up, and 521 (77%) completed the 12-month follow-up. The researchers found that two trials assessing radiofrequency denervation for the sacroiliac joints and a combination of the facet joints, sacroiliac joints, or intervertebral disks showed a statistically significant but not clinically important improvement in pain intensity three months after the intervention. No clinically important or statistically significant differences between the groups were shown in the trial assessing radiofrequency denervation for facet joint pain.
“The findings do not support the use of radiofrequency denervation to treat chronic low back pain from these sources,” the authors write.
Because the aim of the study was to provide evidence of the added value of radiofrequency denervation in a multidisciplinary setting, as done in daily practice, the study was limited by a lack of both participant and clinician blinding.