Comparison of effectiveness of facet joint injection and radiofrequency denervation in chronic low back pain

Çivelek, Erdinç; Cansever, Tufan; Kabataş, Serdar; Kircelli, Atilla; Yilmaz, Cem; Müslüman, Murat; Ofluoğlu, Demet; Caner, Hakan

doi:10.5137/1019-5149.jtn.5207-11.1

Cited by 50 publications

(102 citation statements)

References 20 publications

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“…Celik et al 12 reported a positive effect from FJIs in a subsequent trial (n = 80) comparing FJIs with a combination of bed rest, a non-steroidal anti-inflammatory and a muscle relaxant. In a subsequent trial (n = 100) comparing FJIs with facet joint radiofrequency denervation, Civelek et al 59 found better immediate results from injection and better long-term results from denervation.…”

Section: Facet Joint Injections Compared With Other Treatmentsmentioning

confidence: 99%

Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial

Ellard

Underwood

Achana

et al. 2017

Health Technol Assess

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BackgroundThe National Institute for Health and Care Excellence (NICE) 2009 guidelines for persistent low back pain (LBP) do not recommend the injection of therapeutic substances into the back as a treatment for LBP because of the absence of evidence for their effectiveness. This feasibility study aimed to provide a stable platform that could be used to evaluate a randomised controlled trial (RCT) on the clinical effectiveness and cost-effectiveness of intra-articular facet joint injections (FJIs) when added to normal care.ObjectivesTo explore the feasibility of running a RCT to test the hypothesis that, for people with suspected facet joint back pain, adding the option of intra-articular FJIs (local anaesthetic and corticosteroids) to best usual non-invasive care is clinically effective and cost-effective.DesignThe trial was a mixed design. The RCT pilot protocol development involved literature reviews and a consensus conference followed by a randomised pilot study with an embedded mixed-methods process evaluation.SettingFive NHS acute trusts in England.ParticipantsParticipants were patients aged ≥ 18 years with moderately troublesome LBP present (> 6 months), who had failed previous conservative treatment and who had suspected facet joint pain. The study aimed to recruit 150 participants (approximately 30 per site). Participants were randomised sequentially by a remote service to FJIs combined with ‘best usual care’ (BUC) or BUC alone.InterventionsAll participants were to receive six sessions of a bespoke BUC rehabilitation package. Those randomised into the intervention arm were, in addition, given FJIs with local anaesthetic and steroids (at up to six injection sites). Randomisation occurred at the end of the first BUC session.Main outcome measuresProcess and clinical outcomes. Clinical outcomes included a measurement of level of pain on a scale from 0 to 10, which was collected daily and then weekly via text messaging (or through a written diary). Questionnaire follow-up was at 3 months.ResultsFifty-two stakeholders attended the consensus meeting. Agreement informed several statistical questions and three design considerations: diagnosis, the process of FJI and the BUC package and informing the design for the randomised pilot study. Recruitment started on 26 June 2015 and was terminated by the funder (as a result of poor recruitment) on 11 December 2015. In total, 26 participants were randomised. Process data illuminate some of the reasons for recruitment problems but also show that trial processes after enrolment ran smoothly. No between-group analysis was carried out. All pain-related outcomes show the expected improvement between baseline and follow-up. The mean total cost of the overall treatment package (injection £419.22 and BUC £264.00) was estimated at £683.22 per participant. This is similar to a NHS tariff cost for a course of FJIs of £686.84.LimitationsPoor recruitment was a limiting factor.ConclusionsThis feasibility study achieved consensus on the main challenges in a trial of FJIs for people with persistent non-specific low back pain.Future workFurther work is needed to test recruitment from alternative clinical situations.Trial registrationEudraCT 2014-000682-50 and Current Controlled Trials ISRCTN93184143.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 30. See the NIHR Journals Library website for further project information.

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Section: Facet Joint Injections Compared With Other Treatmentsmentioning

confidence: 99%

Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial

Ellard

Underwood

Achana

et al. 2017

Health Technol Assess

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“…Civelek et al used the VAS and NASS instrument for pain assessment and EQ‐5D to determine the efficacy of RFT in patients with chronic low back pain. Their results showed notable pain relief after RFT . In clinical practice, however, most patients with chronic pain are elderly and may not understand the items in the questionnaires or do not know how to express their feelings.…”

Section: Discussionmentioning

confidence: 99%

Use of Heart Rate Variability and Photoplethysmograph‐Derived Parameters as Assessment Signals of Radiofrequency Therapy Efficacy for Chronic Pain

Chuang

Tai

et al. 2017

Pain Practice

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“…Su prevalencia como causa de dolor lumbar está entre el 15-31% 3 con incidencia a lo largo de la vida de hasta el 52% en algunas series [6][7][8][9][10] . Su causa es la degeneración de las articulaciones facetarias, las cuales sufren los cambios propios de cualquier articulación sinovial.…”

Section: Resumen El Dolor Lumbar Es Una Entidad Común Y Frecuente Crunclassified

“…Hay menos evidencias de la utilidad de las terapias conservadoras en su manejo, las cuales únicamente parecen tener utilidad como terapias adyuvantes [15][16] . Actualmente el abordaje estándar de tratamiento consiste en bloqueos nerviosos y rizolisis o neurolisis de la rama medial del ramo dorsal del nervio espinal [8][9][10][11][12][13][14] .…”

Section: Resumen El Dolor Lumbar Es Una Entidad Común Y Frecuente Crunclassified

Abordaje intervencionista del síndrome facetario lumbar: Denervación con radiofrecuencia

et al. 2017

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IntroducciónEl dolor de espalda, en especial en columna lumbar, afecta a un alto porcentaje de la población y presenta un significativo impacto socioeconómico, con altas tasas de ausentismo y bajas laborales. En torno al 70-80% de la población de países desarrollados padece lumbalgia o lumbociatalgia en alguna ocasión a lo largo de su vida, constituyendo el motivo de consulta más frecuente tanto en atención primaria como en otras especialidades como rehabilitación, cirugía ortopédica y reumatología. En los Estados Unidos la prevalencia de dolor crónico de espalda es superior al 10%. Hasta un cuarto de la población sufre al menos un episodio de dolor lumbar al año [1][2][3][4][5] . El síndrome facetario lumbar se encuentra dentro Resumen. El dolor lumbar es una entidad común y frecuente crónica. Se estima que el dolor de causa articular facetaria representa el 15-31% de todas las consultas por dolor lumbar. En sospecha de dolor articular facetario se recomienda realización de bloqueos nerviosos para establecer el diagnóstico. La radiofrecuencia continua percutánea es el tratamiento más efectivo hasta la fecha. Se describe la evidencia actual en el tratamiento mínimamente invasivo del síndrome facetario lumbar y nuestra experiencia con las guías de imagen con TC y fluoroscopía mediante rizolisis de la rama medial del ramo primario dorsal del nervio espinal.Palabras clave: Dolor lumbar, Tratamiento con radiofrecuencia, Bloqueo nervioso.de las etiologías estructurales de dolor de espalda. Su prevalencia como causa de dolor lumbar está entre el 15-31% 3 con incidencia a lo largo de la vida de hasta el 52% en algunas series [6][7][8][9][10] . Su causa es la degeneración de las articulaciones facetarias, las cuales sufren los cambios propios de cualquier articulación sinovial. Clínicamente cursa con dolor lumbar de características mecánicas que aumenta con los movimientos de rotación y flexo-extensión (en especial en hiperextensión). No es rara su irradiación a nalgas y cara posterior de muslos. El comienzo y el curso suelen ser insidiosos, aunque muchos pacientes lo refieren a raíz de un esfuerzo brusco 1 . Actualmente no existen criterios diagnósticos aceptados del síndrome facetario. Debe valorarse Martínez A. et.al. Abordaje intervencionista del síndrome facetario lumbar. Rev Chil Radiol 2017; 23(1): 7-14. Correspondencia: Alberto Martínez-Martínez / rralbert.martinez@gmail.com Trabajo recibido el 27 de agosto de 2016. Aceptado para publicación el 17 de marzo de 2017.

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Comparison of effectiveness of facet joint injection and radiofrequency denervation in chronic low back pain

Cited by 50 publications

References 20 publications

Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial

Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial

Use of Heart Rate Variability and Photoplethysmograph‐Derived Parameters as Assessment Signals of Radiofrequency Therapy Efficacy for Chronic Pain

Abordaje intervencionista del síndrome facetario lumbar: Denervación con radiofrecuencia

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