MedicalResearch.com Interview with:
Esther Maas, PhD
Postdoctoral Research Fellow
Partnership for Work, Health and Safety
School of Population and Public Health
University of British Columbia
MedicalResearch.com: What is the background for this study?
Esther Maas, PhD Chronic low back pain causes more disability than any other condition, and has major social and economic consequences. Radiofrequency denervation is a commonly used treatment in pain clinics for a subgroup of patients with chronic low back pain resulting from anatomical structures such as facet joints, sacroiliac joint and intervertebral disc. Radiofrequency denervation uses an electric current that damages the innervating nerve of the painful structure. Despite its frequent application, until now, there was only very low quality and conflicting evidence for its effectiveness. The aim of this study was to establish whether radiofrequency denervation in addition to a standardized exercise program is more effective than the standardized exercise program alone in the selected subgroup of patients with chronic low back pain.
MedicalResearch.com: What are the main findings?
Response: In three randomized clinical trials of 681 patients with chronic low back pain due to facet joints, sacroiliac joints, or a combination of facet joints, sacroiliac joints, and/or intervertebral discs, radiofrequency denervation combined with a standardized exercise program resulted in a statistically significant difference in pain intensity between the groups in the sacroiliac joint and combination study after three months. However, this difference was smaller than the pre-specified minimal clinically important difference of 2 points on an 11 point numeric rating scale.
MedicalResearch.com: What should readers take away from your report?
Response: The findings do not support the added value of radiofrequency denervation to a standardized exercise program to treat a subgroup of patients with chronic low back pain from resulting from anatomical structures such as facet joints, sacroiliac joint and intervertebral discs. Based on our findings, a standardized exercise program alone has to be the first choice in the treatment of these patients.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: The role for radiofrequency denervation in the treatment of a subgroup of patients with chronic low back pain resulting from anatomical structures such as facet joints, sacroiliac joints and intervertebral discs remains questionable. Currently it is not recommended in standard care and should be performed in a research setting only. Future research to the diagnosis and treatment for this subset of patients with chronic low back pain is necessary and should focus on better patient selection and improvement of treatment techniques and tools for outcome measurement.
In the meantime, patients with chronic low back pain who show no improvement in symptoms after conservative treatment seem to be left empty-handed as effective alternatives for this patient population are lacking. Funding of new research is more than ever important to conquer this highly prevalent disease with not only individual but due to high direct and indirect costs also huge societal impact.
Disclosures: This study was funded by The Netherlands Organization for Health Research and Development. Three of the authors are anesthesiologists/pain specialists. The authors report no conflict of interest.
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Juch JNS, Maas ET, Ostelo RWJG, Groeneweg JG, Kallewaard J, Koes BW, Verhagen AP, van Dongen JM, Huygen FJPM, van Tulder MW. Effect of Radiofrequency Denervation on Pain Intensity Among Patients With Chronic Low Back PainThe Mint Randomized Clinical Trials. JAMA. 2017;318(1):68-81. doi:10.1001/jama.2017.7918
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