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Evidence summaries

Radiofrequency Denervation for Chronic Low Back Pain

Radiofrequency (RF) denervation might possibly produce pain relief and improve function for patients with chronic low back pain (CLBP), but the evidence is insufficient. Level of evidence: "D"

The quality of evidence is downgraded by study limitations (several issues), inconsistency and imprecise results.

Summary

A Cochrane review [Abstract] 1 included 23 studies with a total of 1309 subjects. Both men and women with a mean age of 50.6 years were included.

Twelve studies examined suspected facet joint pain, five studies disc pain, two studies SI joint pain, two studies radicular CLBP, one study suspected radiating low back pain and one study CLBP with or without suspected radiation. Overall facet joint RF denervation had a greater effect on pain compared with placebo over the short term (MD -1.47, 95% CI -2.28 to -0.67). Facet joint RF denervation was more effective than placebo for function over the short term (MD -5.53, 95% CI -8.66 to -2.40) and over the long term (MD -3.70, 95% CI -6.94 to -0.47). Facet joint RF denervation is more effective for pain than steroid injections over the short (MD -2.23, 95% CI -2.38 to -2.08), intermediate (MD -2.13, 95% CI -3.45 to -0.81), and long term (MD -2.65, 95% CI -3.43 to -1.88). RF denervation used for disc pain produced conflicting results, with no effects for RF denervation compared with placebo over the short and intermediate term, and small effects for RF denervation over the long term for pain relief (MD -1.63, 95% CI -2.58 to -0.68) and improved function (MD -6.75, 95% CI -13.42 to -0.09). Lack of evidence of short-term effectiveness undermines the clinical plausibility of intermediate-term or long-term effectiveness. When RF denervation is used for SI joint pain, evidence reveals no differences from placebo in effects on pain (MD -2.12, 95% CI -5.45 to 1.21) and function (MD -14.06, 95% CI -30.42 to 2.30) over the short term, and one study shows a small effect on both pain and function over the intermediate term. RF denervation is an invasive procedure that can cause a variety of complications. The quality and size of original studies were inadequate to permit assessment of how often complications occur.

Clinical comments

Note

Date of latest search: 2014-5-29

    References

    • Maas ET, Ostelo RW, Niemisto L et al. Radiofrequency denervation for chronic low back pain. Cochrane Database Syst Rev 2015;10():CD008572. [PubMed]

Primary/Secondary Keywords