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      Radiofrequency ablation for chronic low back pain: A systematic review of randomized controlled trials

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          Abstract

          Low back pain affects a considerable proportion of the population and can significantly decrease quality of life. Radiofrequency ablation is an emerging technique that may offer relief from pain for patients experiencing chronic low back pain. This systematic review of the procedure aimed to summarize its efficacy in the treatment of pain in different regions of the low back.

          Abstract

          BACKGROUND:

          Radiofrequency ablation (RFA), a procedure using heat to interrupt pain signals in spinal nerves, is an emerging treatment option for chronic low back pain. Its clinical efficacy has not yet been established.

          OBJECTIVE:

          To determine the efficacy of RFA for chronic low back pain associated with lumbar facet joints, sacroiliac joints, discogenic low back pain and the coccyx.

          METHODS:

          A systematic review was conducted. Medline, EMBASE, PubMed, SPORTDiscus, CINAHL and the Cochrane Library were searched up to August 2013. Abstracts and full-text articles were reviewed in duplicate. Included articles were sham-controlled randomized controlled trials (RCTs), assessed the efficacy of RFA, reported at least one month of follow-up and included participants who had experienced back pain for at least three months. Data were extracted in duplicate and quality was assessed using the Cochrane Risk of Bias tool. Due to heterogeneity, as well as a lack of reported mean differences and SDs, meta-analysis was not possible using these data.

          RESULTS:

          The present systematic review retrieved 1063 abstracts. Eleven sham-controlled RCTs were included: three studies involving discogenic back pain; six studies involving lumbar facet joint pain; and two studies involving sacroiliac joint pain. No studies were identified assessing the coccyx. The evidence supports RFA as an efficacious treatment for lumbar facet joint and sacroiliac joint pain, with five of six and both of the RCTs demonstrating statistically significant pain reductions, respectively. The evidence supporting RFA for the treatment of discogenic pain is mixed.

          CONCLUSIONS:

          While the majority of the studies focusing on lumbar facet joints and sacroiliac joints suggest that RFA significantly reduces pain in short-term follow-up, the evidence base for discogenic low back pain is mixed. There is no RCT evidence for RFA for the coccyx. Future studies should examine the clinical significance of the achieved pain reduction and the long-term efficacy of RFA.

          Translated abstract

          HISTORIQUE :

          L’ablation par radiofréquence (ARF), une intervention faisant appel à la chaleur pour interrompre les signaux de douleur dans les nerfs rachidiens, est un traitement émergent dont l’efficacité n’est pas encore établie pour soulager les douleurs lombaires chroniques.

          OBJECTIF :

          Déterminer l’efficacité de l’ARF pour soulager les douleurs lombaires chroniques associées aux facettes articulaires lombaires, aux articulations sacro-iliaques, aux articulations discales et au coccyx.

          MÉTHODOLOGIE :

          Les chercheurs ont effectué une analyse systématique dans Medline, EMBASE, PubMed, SPORTDiscus, CINAHL et la Bibliothèque Cochrane jusqu’en août 2013. Ils ont examiné deux fois les résumés et les articles intégraux. Ils ont inclus les essais aléatoires et contrôlés (EAC) contre placebo, évalué l’efficacité de l’ARF, rendu compte d’au moins un mois de suivi et inclus les participants qui avaient souffert de douleurs lombaires pendant au moins trois mois. Ils ont extrait les données deux fois et évalué la qualité au moyen de l’outil de risque de biais de Cochrane. En raison de l’hétérogénéité et du manque de différences moyennes et d’ÉT déclarés, il n’a pas été possible d’effectuer de méta-analyse.

          RÉSULTATS :

          La présente analyse systématique a permis d’extraire 1 063 résumés. Onze EAC contre placebo ont été conservés : trois sur les douleurs aux articulations discales dorsales, six sur les douleurs aux facettes articulaires lombaires et deux sur les articulations sacro-iliaques. Aucune ne portait sur le coccyx. Cinq des six EAC sur les facettes articulaires lombaires et les deux EAC sur les articulations sacro-iliaques démontraient une réduction statistiquement significative de la douleur grâce à l’ARF. Les données probantes en appui à l’ARF pour traiter les douleurs discales sont mitigées.

          CONCLUSIONS :

          D’après la majorité des études sur les facettes articulaires lombaires et les articulations sacro-iliaques, l’ARF réduit considérablement la douleur au suivi à court terme, mais les données probantes sont mitigées à l’égard des douleurs des disques lombaires. Aucun EAC ne présente de résultats sur l’ARF appliqué au coccyx. D’autres études devraient porter sur l’importance clinique de la réduction de la douleur obtenue et sur l’efficacité à long terme de l’ARF.

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          Most cited references 22

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          Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: a systematic review of the literature.

          The percentages of patients with acute low back pain (LBP) that go on to a chronic state varies between studies from 2% to 34%. In some of these cases low back pain leads to great costs. To evaluate the evidence for prognostic factors for return to work among workers sick listed with acute LBP. Systematic literature search with a quality assessment of studies, assessment of levels of evidence for all factors, and pooling of effect sizes. Inclusion of studies in the review was restricted to inception cohort studies of workers with LBP on sick leave for less than six weeks, with the outcome measured in absolute terms, relative terms, survival curve, or duration of sick leave. Of the studies, 18 publications (14 cohorts) fulfilled all inclusion criteria. One low quality study, four moderate quality studies, and nine high quality studies were identified; 79 prognostic factors were studied and grouped in eight categories for which the evidence was assessed. Specific LBP, higher disability levels, older age, female gender, more social dysfunction and more social isolation, heavier work, and receiving higher compensation were identified as predictors for a longer duration of sick leave. A history of LBP, job satisfaction, educational level, marital status, number of dependants, smoking, working more than 8 hour shifts, occupation, and size of industry or company do not influence duration of sick leave due to LBP. Many different constructs were measured to identify psychosocial predictors of long term sick leave, which made it impossible to determine the role of these factors.
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            Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions.

            A systematic review of randomized controlled trials. To assess the effectiveness of the most common conservative types of treatment for patients with acute and chronic nonspecific low back pain. Many treatment options for acute and chronic low back pain are available, but little is known about the optimal treatment strategy. A rating system was used to assess the strength of the evidence, based on the methodologic quality of the randomized controlled trials, the relevance of the outcome measures, and the consistency of the results. The number of randomized controlled trials identified varied widely with regard to the interventions involved. The scores ranged from 20 to 79 points for acute low back pain and from 19 to 79 points for chronic low back pain on a 100-point scale, indicating the overall poor quality of the trials. Overall, only 28 (35%) randomized controlled trials on acute low back pain and 20 (25%) on chronic low back pain had a methodologic score of 50 or more points, and were considered to be of high quality. Various methodologic flaws were identified. Strong evidence was found for the effectiveness of muscle relaxants and nonsteroidal anti-inflammatory drugs and the ineffectiveness of exercise therapy for acute low back pain; strong evidence also was found for the effectiveness of manipulation, back schools, and exercise therapy for chronic low back pain, especially for short-term effects. The quality of the design, execution, and reporting of randomized controlled trials should be improved, to establish strong evidence for the effectiveness of the various therapeutic interventions for acute and chronic low back pain.
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              Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain.

              A prospective double-blind randomized trial in 31 patients. To assess the clinical efficacy of percutaneous radiofrequency denervation of the lumbar zygapophysial joints in reducing pain, functional disability, and physical impairment in patients with back pain originating from the lumbar zygapophysial joints. Chronic low back pain is a major health problem in the industrialized world. A treatment option is percutaneous radiofrequency denervation of the lumbar zygapophysial joints. Its clinical efficacy has never been formally tested in a controlled trial. Thirty-one patients with a history of at least 1 year of chronic low back pain were selected on the basis of a positive response to a diagnostic nerve blockade and subsequently randomly assigned to one of two treatment groups. Each patient in the radiofrequency treatment group (15 patients) received an 80 C radiofrequency lesion of the dorsal ramus of the segmental nerve roots L3, L4, and L5. Patients in the control group (n = 16) underwent an the same procedure but without use of a radiofrequency current. Both the treating physician and the patients were blinded to the group assignment. Before treatment, physical impairment, rating of pain, the degree of disability, and quality of life were assessed by a blinded investigator. Eight weeks after treatment, there were 10 success patients in the radiofrequency group (n = 15) and 6 in the sham group (n = 16). The unadjusted odds ratio was 3.3 (P = 0.05, not significant), and the adjusted odds ratio was 4.8 (P < 0.05, significant). The differences in effect on the visual analog scale scores, global perceived effect, and the Oswestry disability scale were statistically significant. Three, 6, and 12 months after treatment, there were significantly more success patients in the radiofrequency group compared with the sham group. Radiofrequency lumbar zygapophysial joint denervation results in a significant alleviation of pain and functional disability in a select group of patients with chronic low back pain, both on a short-term and a long-term basis.
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                Author and article information

                Journal
                Pain Res Manag
                Pain Res Manag
                PGI
                Pain Research & Management : The Journal of the Canadian Pain Society
                Pulsus Group Inc
                1203-6765
                1918-1523
                Sep-Oct 2014
                : 19
                : 5
                : e146-e153
                Affiliations
                [1 ]The Department Community Health Sciences, Teaching Research and Wellness Building, Calgary;
                [2 ]Institute of Health Economics, Edmonton;
                [3 ]Institute for Public Health, Teaching Research and Wellness Building, Calgary, Alberta
                Author notes
                Correspondence: Dr Fiona Clement, 3D18, Teaching Research and Wellness Building, 3280 Hospital Drive Northwest, Calgary, Alberta T2N 4N1. Telephone 403-210-9373, fax 403-270-7307, e-mail fclement@ 123456ucalgary.ca
                Article
                prm-19-e146
                4197759
                25068973
                © 2014, Pulsus Group Inc. All rights reserved

                This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) ( http://creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes. For commercial reuse, contact support@ 123456pulsus.com

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