This study demonstrated clinically meaningful improvements in pain and physical function up to six months following cRFA. A prognostic genicular nerve block using a local anesthetic volume of 1 mL at each injection site and a threshold of ≥ 50% pain relief for subsequent cRFA eligibility did not improve the rate of treatment success.

Background and objectivesNo previous study has assessed the outcomes of cooled radiofrequency ablation (C-RFA) of the medial branch nerves (MBN) for the treatment of lumbar facet joint pain nor compared its effectiveness with traditional RFA (T-RFA). This study evaluated 6-month outcomes for pain, function, psychometrics, and medication usage in patients who underwent MBN C-RFA versus T-RFA for lumbar Z-joint pain.MethodsIn this blinded, prospective trial, patients with positive diagnostic MBN blocks (>75% relief) were randomized to MBN C-RFA or T-RFA. The primary outcome was the proportion of ‘responders’ (≥50% Numeric Rating Scale (NRS) reduction) at 6 months. Secondary outcomes included NRS, Oswestry Disability Index (ODI), and Patient Global Impression of Change.ResultsForty-three participants were randomized to MBN C-RFA (n=21) or T-RFA (n=22). There were no significant differences in demographic variables (p>0.05). A ≥50% NRS reduction was observed in 52% (95% CI 31% to 74%) and 44% (95% CI 22% to 69%) of participants in the C-RFA and T-RFA groups, respectively (p=0.75). A ≥15-point or ≥30% reduction in ODI score was observed in 62% (95% CI 38% to 82%) and 44% (95% CI 22% to 69%) of participants in the C-RFA and T-RFA groups, respectively (p=0.21).ConclusionsWhen using a single diagnostic block paradigm with a threshold of >75% pain reduction, both treatment with both C-RFA and T-RFA resulted in a success rate of approximately 50% when defined by both improvement in pain and physical function at 6-month follow-up. While the success rate was higher in the C-RFA group, this difference was not statistically significant.Trial registration number NCT02478437.

Objective To systematically evaluate the scientific literature examining the effect of corticosteroid type, dose, and volume of small‐ and intermediate‐size joint injections on pain and function. Type Narrative review. Literature Survey Medline (PubMed), Cochrane Central Register of Controlled Trial, and SportDiscus databases were searched. Methodology Inclusion criteria included prospective studies evaluating pain‐ and/or function‐related improvements following a corticosteroid injection of a small‐ or intermediate‐size joint. Synthesis A total of 28 articles were included, all studying patients with osteoarthritis and/or rheumatoid arthritis. Eleven studies were randomized‐controlled trials comparing corticosteroid injections to a control treatment and three were randomized trials comparing corticosteroid dose or type; the rest were prospective case series without a control. Most studies used 10 to 20 mg of methylprednisolone or triamcinolone for small joints and 20 to 40 mg for intermediate joints; wrist joints were the only joint studied that directly compared doses—20 mg was noninferior to 40 mg. Triamcinolone hexacetonide was found to be superior to methylprednisolone in the interphalangeal finger joints in a single randomized‐controlled trial; no other studies compared steroid types in any joint. No studies evaluated the effect of volume on clinical outcomes. Conclusions Very few studies directly examine the effect of corticosteroid type, corticosteroid dose, or injectate volume on clinical outcomes for small‐ or intermediate‐size joint arthralgia. Future studies are needed to better elucidate the most effective treatment protocols. Level of Evidence IV.

No abstract

No abstract