Radiofrequency Facet Joint Denervation in the Treatment of Low Back Pain

Leclaire, Richard; Fortin, Luc; Lambert, Richard J.; Bergeron, Yves; Rossignol, Michel

doi:10.1097/00007632-200107010-00003

Cited by 330 publications

(279 citation statements)

References 36 publications

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“…One study investigated 70 patients (36 neurotomy, 34 placebo lesion) who had had a successful intraarticular diagnostic block ("significant pain reduction for 24 hours") with lidocaine/Triamcinolone (Leclaire et al 2001). Minor (p=0.05) positive and short-term (4 weeks) improvements were observed for disability (Roland and Morris scale), but there was no effect on pain (VAS) and Oswestry scale.…”

Section: Effectiveness Of Radiofrequency Facet-denervation Versus Shamentioning

confidence: 99%

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Chapter 4 European guidelines for the management of chronic nonspecific low back pain

Airaksinen¹,

Brox²,

Cedraschi³

et al. 2006

Eur Spine J

2,264

1,673

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Section: Effectiveness Of Radiofrequency Facet-denervation Versus Shamentioning

confidence: 99%

“…This was not done in one of the trials included in formulating these guidelines (Leclaire et al 2001).…”

Section: Commentsmentioning

confidence: 99%

Chapter 4 European guidelines for the management of chronic nonspecific low back pain

Airaksinen¹,

Brox²,

Cedraschi³

et al. 2006

Eur Spine J

2,264

1,673

View full text Add to dashboard Cite

“…On the one hand, Leclaire et al reported that the procedure is effective in terms of pain improvement only in the short term (4 weeks after the procedure) and the improvement failed to last even beyond 12 weeks [8]. Other studies supported these data, including one recently published in the Lancet [1,6,8]. On the other hand, other authors showed long-term improvement in pain even for years after the procedure [4,17,19,22].…”

Section: Introductionmentioning

confidence: 97%

“…The principle is production of heat in order to damage some or all nerve fibers in the target nervous structure (in the case of "conventional" RF) or application of an electromagnetic field to the nervous structure (in the case of pulsed RF), with the ultimate aim of blocking transmission of pain stimuli from peripheral receptors to the central pain structures. In recent years, some publications have reported contradictory results following RF treatment of back pain [1,4,6,8,17,19,22]. On the one hand, Leclaire et al reported that the procedure is effective in terms of pain improvement only in the short term (4 weeks after the procedure) and the improvement failed to last even beyond 12 weeks [8].…”

Section: Introductionmentioning

confidence: 99%

“…In recent years, some publications have reported contradictory results following RF treatment of back pain [1,4,6,8,17,19,22]. On the one hand, Leclaire et al reported that the procedure is effective in terms of pain improvement only in the short term (4 weeks after the procedure) and the improvement failed to last even beyond 12 weeks [8]. Other studies supported these data, including one recently published in the Lancet [1,6,8].…”

Section: Introductionmentioning

confidence: 99%

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The role of radiofrequency in the treatment of mechanical pain of spinal origin

Pevsner

Shabat

Catz

et al. 2003

European Spine Journal

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Placebo Control and Blinding in Randomized Trials of Procedural Interventions

Rajkumar,

Thomas,

Foley

et al. 2024

JAMA Surg

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ImportanceUnlike medications, procedural interventions are rarely trialed against placebo prior to becoming accepted in clinical practice. When placebo-controlled trials are eventually conducted, procedural interventions may be less effective than previously believed.ObjectiveTo investigate the importance of including a placebo arm in trials of surgical and interventional procedures by comparing effect sizes from trials of the same procedure that do and do not include a placebo arm.Data SourcesSearches of MEDLINE and Embase identified all placebo-controlled trials for procedural interventions in any specialty of medicine and surgery from inception to March 31, 2019. A secondary search identified randomized clinical trials assessing the same intervention, condition, and end point but without a placebo arm for paired comparison.Study SelectionPlacebo-controlled trials of anatomically site-specific procedures requiring skin incision or endoscopic techniques were eligible for inclusion; these were then matched to trials without placebo control that fell within prespecified limits of heterogeneity.Data Extraction and SynthesisRandom-effects meta-regression, with placebo and blinding as a fixed effect and intervention and end point grouping as random effects, was used to calculate the impact of placebo control for each end point. Data were analyzed from March 2019 to March 2020.Main Outcomes and MeasuresEnd points were examined in prespecified subgroups: patient-reported or health care professional–assessed outcomes, quality of life, pain, blood pressure, exercise-related outcomes, recurrent bleeding, and all-cause mortality.ResultsNinety-seven end points were matched from 72 blinded, placebo-controlled trials (hereafter, blinded) and 55 unblinded trials without placebo control (hereafter, unblinded), including 111 500 individual patient end points. Unblinded trials had larger standardized effect sizes than blinded trials for exercise-related outcomes (standardized mean difference [SMD], 0.59; 95% CI, 0.29 to 0.89; P &lt; .001) and quality-of-life (SMD, 0.32; 95% CI, 0.11 to 0.53; P = .003) and health care professional–assessed end points (SMD, 0.40; 95% CI, 0.18 to 0.61; P &lt; .001). The placebo effect accounted for 88.1%, 55.2%, and 61.3% of the observed unblinded effect size for these end points, respectively. There was no significant difference between unblinded and blinded trials for patient-reported end points (SMD, 0.31; 95% CI, −0.02 to 0.64; P = .07), blood pressure (SMD, 0.26; 95% CI, −0.10 to 0.62; P = .15), all-cause mortality (odds ratio [OR], 0.23; 95% CI, −0.26 to 0.72; P = .36), pain (SMD, 0.03; 95% CI, −0.52 to 0.57; P = .91), or recurrent bleeding events (OR, −0.12; 95% CI, −1.11 to 0.88; P = .88).Conclusions and RelevanceThe magnitude of the placebo effect found in this systematic review and meta-regression was dependent on the end point. Placebo control in trials of procedural interventions had the greatest impact on exercise-related, quality-of-life, and health care professional–assessed end points. Randomized clinical trials of procedural interventions may consider placebo control accordingly.

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Radiofrequency Facet Joint Denervation in the Treatment of Low Back Pain

Abstract: Although radiofrequency facet joint denervation may provide some short-term improvement in functional disability among patients with chronic low back pain, the efficacy of this treatment has not been established.

Cited by 330 publications

References 36 publications

Chapter 4 European guidelines for the management of chronic nonspecific low back pain

Chapter 4 European guidelines for the management of chronic nonspecific low back pain

The role of radiofrequency in the treatment of mechanical pain of spinal origin

Placebo Control and Blinding in Randomized Trials of Procedural Interventions

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