Radiofrequency May Help Manage Chronic Facet Joint Pain
Chronic back pain is a common complaint and from 15 to 52 percent is caused by facet joint syndrome. The nerve endings inside and outside the joints in the back can become irritated and stressed over time from movement or from injury. Researchers have found using radiofrequency, in a procedure called percutaneous conventional radiofrequency (CRF) can help relieve facet joint pain. More recently, other researchers have tried a procedure called pulsed RF (PRF). This procedure uses pulsed time cycles and high temperatures to relieve pain. The authors of this study wanted to compare the effects of both procedures in the treatment of facet joint pain.
Researchers randomly assigned 20 patients each to one of three groups: CRF, PRF, and the control group. The patients in the control group thought they were having a procedure but they were not. The patients ranged in age from 48 years to 69 years. There were more women (56.6 percent) than men. The patients' pain levels were assessed at 6 hours after the procedure and again at 6 months and 1 year. The patients were asked to rate their pain using the Visual Analog Scale (VAS) and their function with the Oswestry Disability Index (ODI), both before and after the procedure. Patients who scored above 4 on the VAS were allowed to take pain relievers called nonsteroidal anti-inflammatory drugs or NSAIDs.
The researchers found that there were no complications among any of the patients. all the patients has scored lower VAS and ODI scores after the procedures, and those in the PRF and CRF groups were lower than those in the control group. The patients in the CRF group kept the lower ODI scores through to 6 months, but not those in the PRF group. After 1 year, the CRF group continued to score lower than either the PRF and the control groups, which both had similar scores.
The patients were permitted to take pain relievers if needed and more patients in the PRF and control groups did than those in the CRF group. The control patients took the most. In rating satisfaction, the CRF group scored the highest satisfaction with 65 percent reporting excellent results, 30 percent good, and 5 percent moderate. Among the PRF patients, 35 percent reported excellent results, 50 percent good, and 15 percent moderate. Among the control group, 20 percent reported excellent results, 50 percent good, 25 percent moderate, and 5 percent bad.
In conclusion, the authors point out that there have not been enough controlled trials to verify the effectiveness of this treatment in managing chronic facet joint pain. HOwever, they say that both CRF and PRF are safe and effective treatments, although CRF has a longer-lasting effect than does PRF.
Idil Tekin, MD, et al. A Comparison of Conventional and Pulsed Radiofrequency Denervation in the Treatment of Chronic Facet Joint Pain. In Clinical Journal of Pain. July/August 2007. Vol. 23. No. 6. Pp. 524-529.