Radiofrequency denervation for neck and back pain

Niemisto L, Kalso EA, Malmivaara A, Seitsalo S, Hurri H

Published Online:

March 17, 2010

Radiofrequency denervation can relieve pain from neck joints, but may not relieve pain originating from lumbar discs, and its impact on low-back joint pain is uncertain.

Ongoing neck or back pain can be caused by a joint or damaged disc between two vertebral joints. Injections to block these specific joint nerves can pinpoint if this is the source of the pain. Radiofrequency denervation aims to de-activate the nerve responsible by applying electric current to cauterise it (damage with heat).

The review found that radiofrequency denervation can provide short-term pain relief for a small proportion of people with specific joint problems in the neck. There is conflicting evidence about effects for low-back joint pain, and some evidence that it does not relieve pain from low-back disc problems.

Abstract (click to read)

Background:

The diagnosis of cervical or lumbar zygapophyseal joint pain can only be made by using local anaesthesia to block the nerves supplying the painful joint. There is a lack of effective treatment for chronic zygapophyseal joint pain or discogenic pain. Radiofrequency denervation appears to be an emerging technology, with substantial variation in its use between countries.

Objectives:

To assess the effectiveness of radiofrequency denervation for the treatment of musculoskeletal pain disorders.

Search strategy:

We searched MEDLINE, PsycLIT, and EMBASE from start to February 2002, plus the Cochrane Library 2002, Issue 2. The references of identified articles were checked and three experts in the field of radiofrequency treatment were consulted to identify studies we might have missed.

Selection criteria:

Randomized controlled trials (RCTs) of radiofrequency denervation for musculoskeletal pain disorders, with no language or date restrictions.

Data collection and analysis:

Two authors selected RCTs that met predefined inclusion criteria, extracted the data, and assessed the main results and methodological quality of the selected trials, using standardized forms. Qualitative analysis was conducted to evaluate the level of scientific evidence.

Main results:

We found only nine articles, reporting on seven relevant RCTs. Six of the seven were considered to be high-quality. The selected trials included 275 randomized patients, 141 of whom received active treatment. One study examined cervical zygapophyseal joint pain, two cervicobrachial pain, three lumbar zygapophyseal joint pain, and one discogenic low-back pain. The study sample sizes were small, follow-up times short, and there were some deficiencies in patient selection, outcome assessments, and statistical analyses. The level of scientific evidence for the short-term effectiveness of radiofrequency denervation was limited for cervical zygapophyseal joint and cervicobrachial pain, and conflicting for lumbar zygapophyseal joint pain. There was limited evidence suggesting that intradiscal radiofrequency thermocoagulation was not effective for discogenic low-back pain.

Authors' conclusions:

The selected trials provide limited evidence that radiofrequency denervation offers short-term relief for chronic neck pain of zygapophyseal joint origin and for chronic cervicobrachial pain; conflicting evidence on the short-term effect of radiofrequency lesioning on pain and disability in chronic low-back pain of zygapophyseal joint origin; and limited evidence that intradiscal radiofrequency thermocoagulation is not effective for chronic discogenic low-back pain. There is a need for further high-quality RCTs with larger patient samples and data on long-term effects, for which current evidence is inconclusive. Furthermore, RCTs are needed in non-spinal indications where radiofrequency denervation is currently used without any scientific evidence.

This record should be cited as:

Niemisto L, Kalso EA, Malmivaara A, Seitsalo S, Hurri H. Radiofrequency denervation for neck and back pain. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD004058. DOI: 10.1002/14651858.CD004058

Assessed as up to date:

February 28, 2002

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Primary Review Group:

Back Group

Health topics:

Orthopaedics & trauma > Back disorders > Cervical spine

Orthopaedics & trauma > Back disorders > Non-specific low back pain

Rheumatology > Back disorders > Cervical spine

Rheumatology > Back disorders > Non-specific low back pain

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Radiofrequency denervation for neck and back pain

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