A Newsletter Released to Chiropractic Physicians on November 5, 2008

Radiofrequency
For Intractable Low Back Pain

A study released earlier this year in Spine re-examined the effectiveness of percutaneous radiofrequency treatments on recalcitrant low back pain. Nath and colleagues started with 376 patients who had experienced elements of facet joint pain for at least two years. Their pain had proved refractory to manipulation, physical therapy, and/or medication. Nath et al. designed their study as double blinded and placebo controlled. They found that, compared to placebo, radiofrequency denervation/neurotomy significantly improved back pain, leg pain, motion, and quality of life. While the placebo group showed relatively small changes in range of motion, the active treatment group more than doubled its ability in back extension. Their ability for side flexion improved roughly 41%. The active treatment group reduced their use of analgesics by 65% (on a six point scale). One of the differences between this new study and previous placebo controlled studies on radiofrequency was that researchers did a more thorough job of prequalifying participants as having pain that definitely emanated from the facet joints.

The preponderance of published evidence to date supports the efficacy of radiofrequency for controlling chronic pain of the neck and back.^1-11 In lumbar facet pain, relief was measured to last a mean time of 10.5 months.⁴ One descriptive study that thoroughly prequalified patients as having facet pain showed that 80% of patients enjoyed 60% relief and 60% of patients enjoyed 80% relief lasting 12 months.

With this treatment, after anesthetizing the skin, a fine electrode uses radiofrequency to temporarily degenerate small diameter nociceptive fibers.^12,13 Radiofrequency denervation serves as a non-pharmacological, minimally invasive, pain control option with no side effects. Insurance typically reimburses for radiofrequency.

At my practice, I perform a combination of pulsed and constant radiofrequency to maximize the positive outcomes. The recommended treatment plan is 2 to 4 treatments per year or as required. The results I have seen with both back and extremity pain are particularly encouraging considering that the pain involved has always proved refractory to normal care. Of course, radiofrequency is only a pain relief modality that does not address the initial insult leading up to the chronic pain. Radiofrequency can serve as an effective, drug-free compliment to chiropractic care for that subset of patients who do not respond quickly to adjustments or who plateau in their progress.

Call Neal S. Taub, MD, Physiatrist for
pain management & rehabilitation.

References

1. Nath S, Nath C, Petterson K. Percutaneous lumbar zygapophysial (facet) joint neurotomy using radiofrequency current, in the management of chronic low back pain: A randomized double-blind trial. Spine. 2008; 33(12): 1291-1297.
   
2. Rohof O. radiofrequency treatment of peripheral nerves. Pain Pract 2002; 2: 257-260.
   Malik K, Benzon H. Pulsed radiofrequency: a critical review of its efficacy. Anaesth Intensive Care. 2007; 35(6): 863-73.
   
3. Schofferman J, Kine G. Effectiveness of repeated radiofrequency neurotomy for lumbar facet pain. 2004; 29(21): 2471-3.
   
4. Simopoulos T, Kraemer J, Nagda J, et al. Response to pulsed and continuous radiofrequency lesioning of the dorsal root ganglion and segmental nerves in patients with chronic lumbar radicular pain. Pain Physician. 2008; 11(2): 137-44.
   
5. Van Wijk R, Geurts J, Wynne H, et al. Radiofrequency denervation of lumbar facet joints in the treatment of chronic low back pain: a randomized, double-blind, sham lesion-control trial. Clin J Pain. 2005; 21(4): 335-44.
   
6. Martin D, Willis M, Mullinax L, et al. Pulsed radiofrequency application in the treatment of chronic pain. Pain Pract 2007; 7:31-35.
   
7. Van Zundert J, Patijn J, Kessels A, et al. Pulsed radiofrequency adjacent to the cervical dorsal root ganglion in chronic cervical radicular pain: a double blind sham controlled randomized clinical trial. Pain 2007; 127: 173-182.
   
8. Mikeladze G, Espinal R, Finnegan R, et al. Pulsed radiofrequency application in treatment of chronic zygapophyseal joint pain. Spine J 2003; 3:360-362.
   
9. Coohen S, Sireci A, Wu C, et al. Pulsed radiofrequency of the dorsal root ganglia is superior to pharmacotherapy or pulsed radiofrequency of the intercostals nerves in the treatment of chronic postsurgical thoracic pain. Pain Physician 2006; 9:227-235.
   
10. Dreyfuss P, Halbrook B, Pauza K, et al. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Spine 2000; 25: 1270-7.
    
11. Hamann W, Abou-Sherif S, Thompson S, et al. Pulsed radiofrequency applied to dorsal root ganglia causes a selective increase in ATF3 in small neurons. Eur J Pain 2007; 10:171-176.
    
12. Takahashi N, Tasto J, Ritter M. Pain relief through an antinociceptive effect after radiofrequency application. Am J Sports Med. 2007 May; 35(5): 805-10.