scholarly journals Predicting Treatment Success with Facet Syndrome: An Algorithm to Predict Lumbar Radiofrequency Ablation Responders in a Military Population

Pain Medicine ◽  
2020 ◽  
Author(s):  
Scott Hughey ◽  
Jacob Cole ◽  
Gregory Booth ◽  
Jeffrey Moore ◽  
Benjamin McDowell ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Functional Status ◽  
Scoring System ◽  
Smoking History ◽  
Secondary Outcome ◽  
Medial Branch ◽  
Pain Scores ◽  
C Statistic ◽  
Medial Branch Block ◽  
Facet Syndrome

Abstract Objective Radiofrequency ablation (RFA) of the medial branch nerve is a commonly performed procedure for patients with facet syndrome. RFA has previously been demonstrated to provide long-term functional improvement in approximately 50% of patients, including those who had significant pain relief after diagnostic medial branch block. We sought to identify factors associated with success of RFA for facet pain. Design Active-duty military patients who underwent lumbar RFA (L3, L4, and L5 levels) over a 3-year period were analyzed. Defense and Veterans Pain Rating Scale (DVPRS) and Oswestry Disability Index (ODI) scores were assessed the day of procedure and at the 2-month and 6-month follow-up. These data were analyzed to identify associations between patient demographics, pain, and functional status and patients’ improvement after RFA, with a primary outcome of ODI improvement and a secondary outcome of pain reduction. Results Higher levels of starting functional impairment (starting ODI scores of 42.9 vs. 37.5; P = 0.0304) were associated with a greater likelihood of improvement in functional status 6 months after RFA, and higher starting pain scores (DVPRS pain scores of 6.1 vs. 5.1; P < 0.0001) were associated with a higher likelihood that pain scores would improve 6 months after RFA. A multivariate logistic regression was then used to develop a scoring system to predict improvement after RFA. The scoring system generated a C-statistic of 0.764, with starting ODI, pain scores, and both gender and smoking history as independent variables. Conclusions This algorithm compares favorably to that of diagnostic medial branch block in terms of prediction accuracy (C-statistic of 0.764 vs. 0.57), suggesting that its use may improve patient selection in patients who undergo RFA for facet syndrome.

Periprocedural Pain and Outcome Difference of Local Anesthetic vs Mechanodesensitization During Lumbar Facet Blocks for Low Back Pain

Pain Medicine ◽  
2020 ◽  
Vol 21 (10) ◽  
pp. 2100-2104
Author(s):  
Bilal Aleem ◽  
Muhammad Muslim Mubashir ◽  
Erin Clark ◽  
Daniel Vardeh
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Local Anesthetic ◽  
Secondary Outcome ◽  
Medial Branch ◽  
Low Back ◽  
Pain Scores ◽  
Global Comparison ◽  
Significant Difference ◽  
Lumbar Facet

Abstract Objective To compare periprocedural pain from mechanodesensitization (MD) with local anesthetic (LA) during medial branch blocks (MBBs), with a secondary outcome to compare diagnostic responses during the five hours postprocedure. Methods Forty-four patients with low back pain underwent three level bilateral MMBs. For the LA technique, 0.5 mL of 1% lidocaine was injected subcutaneously on one side, and for MD the skin was stretched using the index finger and thumb on the other. A 25-gauge 3.5-inch spinal needle was inserted over each target area, and the periprocedural pain was recorded on the numeric rating scale (NRS). After fluoroscopic positioning, the patient’s side preference was recorded. Patients were discharged with a pain diary to record pain scores every 30 minutes for five hours. Results Despite reporting higher pain scores with LA vs MD (P = 0.0462, mean difference ± SEM = 0.4924 ± 0.2459), global comparison favored LA. Pain scores with LA dropped from an average baseline of 6.11 to a mean NRS ± SEM of 2.461 ± 0.615, and with MD from 6.11 to 2.599 ± 0.552 (P ≤ 0.001). While there was no significant difference in area under the curve comparison over five hours (P = 0.3341), there was a trend toward lower pain scores with LA use. Conclusions LA before needle insertion for MBBs appears to be more painful compared with MD. Additionally, subcutaneously administered local anesthetic may have a therapeutic effect on nonspecific low back pain, resulting in a potentially false-positive test in the evaluation of lumbar facet pain.

Predictors of response to medial branch block, radiofrequency ablation or facet joint injections: a retrospective study

2020 ◽  
Author(s):  
Saba Javed ◽  
Jordan Chen ◽  
Billy Huh
Keyword(s):  
Radiofrequency Ablation ◽  
Facet Joint ◽  
Demographic Data ◽  
Patient Characteristics ◽  
Medial Branch ◽  
Lumbar Facet Joint ◽  
Predictors Of Response ◽  
Medial Branch Block ◽  
Lumbar Facet ◽  
Joint Injections

Aim: Low back pain is a leading cause of patient disability in the USA. Our goal was to determine association between patient characteristics and their response to lumbar medial branch block, radiofrequency ablation of medial nerves or lumbar facet joint injections. Materials & methods: Medical records for the first 100 patients who underwent lumbar medial branch block, radiofrequency ablation of lumbar medial nerves or lumbar facet joint injections between 1 September 2019 and 31 March 2020 were reviewed and demographic data were recorded. Results: At the 3-month post-procedure visit, positive responders were significantly more likely to be non obese patients (BMI <30) and those with pain <5-years. Conclusion: Obesity and chronicity of pain certainly are found to be predictors of response to the above mentioned procedures.

Lumbar Medial Branch Block and Radiofrequency Ablation

2020 ◽  
pp. 115-124
Author(s):  
Sandra A. S. van den Heuvel ◽  
David G. Vivian ◽  
Paul Verrills
Keyword(s):  
Radiofrequency Ablation ◽  
Medial Branch ◽  
Medial Branch Block

scholarly journals Effectiveness of Lumbar Facet Joint Blocks and Predictive Value before Radiofrequency Denervation

2018 ◽  
Vol 129 (3) ◽  
pp. 517-535 ◽  
Author(s):  
Steven P. Cohen ◽  
Tina L. Doshi ◽  
Octav C. Constantinescu ◽  
Zirong Zhao ◽  
Connie Kurihara ◽  
...  
Keyword(s):  
Placebo Group ◽  
Radiofrequency Ablation ◽  
Pain Score ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Second Phase ◽  
Medial Branch ◽  
Numerical Rating ◽  
Medial Branch Block ◽  
Lumbar Facet

Abstract What We Already Know about This Topic What This Article Tells Us That Is New Background With facet interventions under scrutiny, the authors’ objectives were to determine the effectiveness of different lumbar facet blocks and their ability to predict radiofrequency ablation outcomes. Methods A total of 229 participants were randomized in a 2:2:1 ratio to receive intraarticular facet injections with bupivacaine and steroid, medial branch blocks, or saline. Those with a positive 1-month outcome (a 2-point or more reduction in average pain score) and score higher than 3 (positive satisfaction) on a 5-point satisfaction scale were followed up to 6 months. Participants in the intraarticular and medial branch block groups with a positive diagnostic block (50% or more relief) who experienced a negative outcome proceeded to the second phase and underwent radiofrequency ablation, while all saline group individuals underwent ablation. Coprimary outcome measures were average reduction in numerical rating scale pain score 1 month after the facet or saline blocks, and average numerical rating scale pain score 3 months after ablation. Results Mean reduction in average numerical rating scale pain score at 1 month was 0.7 ± 1.6 in the intraarticular group, 0.7 ± 1.8 in the medial branch block group, and 0.7 ± 1.5 in the placebo group; P = 0.993. The proportions of positive blocks were higher in the intraarticular (54%) and medial branch (55%) groups than in the placebo group (30%; P = 0.01). Radiofrequency ablation was performed on 135 patients (45, 48, and 42 patients from the intraarticular, medial branch, and saline groups, respectively). The average numerical rating scale pain score at 3 months was 3.0 ± 2.0 in the intraarticular, 3.2 ± 2.5 in the medial branch, and 3.5 ± 1.9 in the control group (P = 0.493). At 3 months, the proportions of positive responders in the intraarticular, medial branch block, and placebo groups were 51%, 56%, and 24% for the intraarticular, medial branch, and placebo groups, respectively (P = 0.005). Conclusions This study establishes that facet blocks are not therapeutic. The higher responder rates in the treatment groups suggest a hypothesis that facet blocks might provide prognostic value before radiofrequency ablation.

scholarly journals Resolution of Long Standing Tinnitus Following Radiofrequency Ablation of C2-C3 Medial Branches – A Case Report

2014 ◽  
Vol 17;1 (1;17) ◽  
pp. E95-E98
Author(s):  
Karina Gritsenko
Keyword(s):  
Neuropathic Pain ◽  
Radiofrequency Ablation ◽  
Care Physician ◽  
Dorsal Cochlear Nucleus ◽  
Electrolyte Imbalance ◽  
Medial Branch ◽  
Cervical Nerve ◽  
Upper Cervical ◽  
Medial Branch Block ◽  
One Year

Tinnitus is described as an auditory phantom perception analogous to central neuropathic pain. Despite the high prevalence of this debilitating symptom, no intervention is recognized that reliably eliminates tinnitus symptoms; a cause has yet to be determined. A 65-year-old healthy man presented with a 3 year history of left-sided tinnitus. Full workup performed by the primary care physician including blood tests for electrolyte imbalance, consultations by 2 independent otholaryngologists, and imaging did not reveal abnormalities to provide etiology of the tinnitus. No other complaints were noted except for occasional minimal left sided neck pain. Cervical spine x-ray showed degenerative changes with facet hypertrophy more pronounced on the left side. Subsequently, the patient underwent diagnostic left-sided C2-C3 medial branch block, resulting in complete resolution of tinnitus for more than 6 hours. After successful radiofrequency ablation of left C2-C3 medial branches, the patient became asymptomatic. At one year follow-up, he continued to be symptom free. Sparce studies have shown interaction between the somatosensory and auditory system at dorsal cochlear nucleus (DCN), inferior colliculus, and parietal association areas. Upper cervical nerve (C2) electrical stimulation evokes potentials in the DCN, eliciting strong patterns of inhibition and weak excitation of the DCN principal cells. New evidence demonstrated successful transcutaneous electrical nerve stimulation (TENS) of upper cervical nerve (C2) for treatment of somatic tinnitus in 240 patients. This case indicates that C2-C3 facet arthropathy may cause tinnitus and radiofrequency ablation of C2-C3 medial branches can provide an effective approach not previously considered. Key words: Radiofrequency ablation, tinnitus, neuropathic pain, cervical medial branch block, cervical pain, auditory phantom perception

scholarly journals Pulsed Dose Radiofrequency Before Ablation of Medial Branch of the Lumbar Dorsal Ramus for Zygapophyseal Joint Pain Reduces Postprocedural Pain

2016 ◽  
Vol 7;19 (7;9) ◽  
pp. 477-484 ◽  
Author(s):  
David Arsanious
Keyword(s):  
Radiofrequency Ablation ◽  
Joint Disease ◽  
Procedural Pain ◽  
Standard Group ◽  
Medial Branch ◽  
Zygapophyseal Joint ◽  
Oral Analgesic ◽  
Radiofrequency Neurotomy ◽  
Pain Scores ◽  
Medicine Physician

Background: One of the potential side effects with radiofrequency ablation (RFA) includes painful cutaneous dysesthesias and increased pain due to neuritis or neurogenic inflammation. This pain may require the prescription of opioids or non-opioid analgesics to control post-procedural pain and discomfort. Objectives: The goal of this study is to compare post-procedural pain scores and post-procedural oral analgesic use in patients receiving continuous thermal radiofrequency ablation versus patients receiving pulsed dose radiofrequency immediately followed by continuous thermal radiofrequency ablation for zygopophaseal joint disease. Study Design: This is a prospective, double-blinded, randomized, controlled trial. Patients who met all the inclusion criteria and were not subject to any of the exclusion criteria were required to have two positive diagnostic medial branch blocks prior to undergoing randomization, intervention, and analysis. Setting: University hospital. Methods: Eligible patients were randomized in a 1:1 ratio to either receive thermal radiofrequency ablation alone (standard group) or pulsed dose radiofrequency (PDRF) immediately followed by thermal radiofrequency ablation (investigational group), all of which were performed by a single Board Certified Pain Medicine physician. Post-procedural pain levels between the two groups were assessed using the numerical pain Scale (NPS), and patients were contacted by phone on postprocedural days 1 and 2 in the morning and afternoon regarding the amount of oral analgesic medications used in the first 48 hours following the procedure. Results: Patients who received pulsed dose radiofrequency followed by continuous radiofrequency neurotomy reported statistically significantly lower post-procedural pain scores in the first 24 hours compared to patients who received thermal radiofrequency neurotomy alone. These patients also used less oral analgesic medication in the post-procedural period. Limitations: These interventions were carried out by one board accredited pain physician at one center. The procedures were exclusively performed using one model of radiofrequency generator, at one setting for the PDRF and RFA. The difference in the number of levels of ablation was not considered in the analysis of the results. Conclusion: Treating patients with pulsed dose radiofrequency prior to continuous thermal radiofrequency ablation can provide patients with less post-procedural pain during the first 24 hours and also reduce analgesic requirements. Furthermore, the addition of PDRF to standard thermal RFA did not prolong the time of standard thermal radiofrequency ablation procedures, as it was performed during the typically allotted time for local anesthetic action. Key words: Low back pain, facet joint disease, medial branch block, Radiofrequency ablation, thermal radiofrequency, pulsed dose radiofrequency, PDRF, zygapophyseal joint

Sign in / Sign up

Export Citation Format

Share Document