Radiofrequency denervation does not appear cost effective for low back pain in The Netherlands

2020 ◽  
Vol 848 (1) ◽  
pp. 21-21
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
The Netherlands ◽  
Cost Effective ◽  
Low Back ◽  
Radiofrequency Denervation

scholarly journals Radiofrequency Denervation of the Lumbar Zygapophysial Joints: 10-Year Prospective Clinical Audit

2007 ◽  
Vol 2;10 (3;2) ◽  
pp. 291-299
Author(s):  
Michael Gofeld
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Relief ◽  
Patient Selection ◽  
Clinical Audit ◽  
Low Back ◽  
Zygapophysial Joint ◽  
Radiofrequency Neurotomy ◽  
Radiofrequency Denervation

Background: Evidence for the efficacy of zygapophysial joint nerve radiofrequency neurotomy has remained controversial. Two randomized controlled trials showed positive results, but two others demonstrated no benefit. One carefully performed prospective trial confirmed high efficacy and lasting pain relief after the procedure; however, selection criteria for this study were superfluous, which resulted in a small number of patients available for follow up. Objectives: A large clinical audit with routine patient selection and use of appropriate technique was undertaken to determine the effect of radiofrequency neurotomy of the lumbar facet joints for relief of chronic low back pain. Design: Prospective clinical audit for quality was conducted in the pain clinic affiliated with a tertiary care teaching hospital. Setting: An interventional pain management setting in Canada. Methods: All patients with low back pain of more than 6 months’ duration, with or without non-radicular radiation to the buttock, hip, and leg were included. From January 1991 to December 2000, eligible patients underwent standardized diagnostic work-up, which included a self-reported pain questionnaire, physical examination, review of imaging studies, and diagnostic blockades. Those with an appropriate response to comparative double diagnostic blocks underwent standardized radiofrequency denervation of the lumbar zygapophysial joints. Patients were asked to estimate total perceived pain reduction (on a scale from 0% to 100%) at 6 weeks and at 6, 12, and 24 months after the procedure. Results: Of the 209 patients, 174 completed the study, and 35 were lost to follow-up or did not provide complete data for assessment. Of the 174 patients with complete data, 55 (31.6%) experienced no benefit from the procedure. One hundred and nineteen patients (68.4%) had good (> 50%) to excellent (> 80%) pain relief lasting from 6 to 24 months. Conclusion: This large, prospective clinical audit indicates that proper patient selection and anatomically correct radiofrequency denervation of the lumbar zygapophysial joints provide long-term pain relief in a routine clinical setting. Key words: low back pain, lumbar zygapophysial joint, radiofrequency denervation, clinical audit

Radiofrequency Denervation for Chronic Low Back Pain

JAMA ◽  
2017 ◽  
Vol 318 (22) ◽  
pp. 2256 ◽  
Author(s):  
Ming-Chih Kao ◽  
Michael S. Leong ◽  
Sean Mackey
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Low Back ◽  
Radiofrequency Denervation

scholarly journals Radiofrequency denervation for chronic low-back pain

2010 ◽  
Author(s):  
Leena Niemisto ◽  
Jukkapekka Jousimaa ◽  
Heikki Hurri ◽  
Eija A Kalso ◽  
Antti Malmivaara
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Low Back ◽  
Radiofrequency Denervation

scholarly journals Physiotherapy and low back pain - part 1 outcomes research in the quest for evidence

2002 ◽  
Vol 58 (3) ◽  
Author(s):  
L. D. Bardin
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Practice ◽  
Outcome Measures ◽  
Outcomes Research ◽  
Controlled Trial ◽  
Cost Effective ◽  
Low Back ◽  
Major Health Problem ◽  
Effective Interventions

Low back pain (LBP) is one of the most common and costlyconditions treated by physiotherapists and is acknowledged as a major health problem. Much published research on LBP is of poor design and  optimal outcome measures are not selected for LBP patients. Effective and cost-effective interventions for LBP, particularly chronic LBP, need to be identified using appropriate, valid, reliable and responsive measures of  outcome.  These outcome measures should reflect the biopsychosocial model necessary for evaluating the broad impact of LBP, in particular chronic LBP, on a patient’s life. Outcomes research is a feasible and affordable analysis of clinical practice as it occurs, and provides an opportunity to evaluate the effectiveness of interventions for LBP. This is in contrast to a randomised, controlled trial (RCT) that evaluates efficacy under controlled conditions that often do not reflect clinical practice. Using a battery of outcome measures appropriate for measuring change in the LBP population, outcomes research has the potential to identify effective and cost-effective interventions, promote and influence further research, and contribute to the demand for evidence-based practice.

scholarly journals Cost-Effectiveness of Pain Management Services for Chronic Low Back Pain: A Systematic Review of Published Studies

2020 ◽  
Author(s):  
Saja Almazrou ◽  
Rachel A Elliott ◽  
Roger D Knaggs ◽  
Shiekha S AlAujan
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Cost Effectiveness ◽  
Pain Management ◽  
Cost Effective ◽  
Economic Evaluations ◽  
Low Back ◽  
Management Services

Abstract Background: Chronic low back pain (CLBP) is a highly prevalent condition that has substantial impact on patients, the healthcare system and society. Pain management services (PMS), which aim to address the complex nature of back pain, are recommended in clinical practice guidelines to manage CLBP. Although the effectiveness of such services has been widely investigated in relation to CLBP, the quality of evidence underpinning the use of these services remains moderate. Therefore the aim is to summarize and critically appraise the current evidence for the cost effectiveness of pain management services for managing chronic back pain. Methods: Electronic searches were conducted in MEDLINE, EMBASE and PsycINFO from their inception to February 2019. Full economic evaluations undertaken from any perspective conducted alongside randomized clinical trials (RCTs) or based on decision analysis models were included. Cochrane Back Review Group (CBRG) risk assessment and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist were used to assess the methodological quality of eligible studies. Results: Five studies fulfilled eligibility criteria. The interventions varied significantly between studies in terms of the number and types of treatment modalities, intensity and the duration of the program. Interventions were compared with either standard care, which varied according to the country and the setting; or to surgical interventions. Three studies showed that pain management services are cost effective, while two studies showed that these services are not cost effective. In this review, three out of five studies had a high risk of bias based on the design of the randomised controlled trials (RCTs). In addition, there were limitations in the statistical and sensitivity analyses in the economic evaluations. Therefore, the results from these studies need to be interpreted with caution. Conclusion Pain management services may be cost effective for the management of low back pain. However, this systematic review highlights the variability of evidence supporting pain management services for patients with back pain. This is due to the quality of the published studies and the variability of the setting, interventions, comparators and outcomes.

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