Radiofrequency denervation of lumbar facet joints: A clinical audit

Saravanakumar Kanakarajan, Colin Patterson

Research output: Contribution to journalAbstract

Abstract

Background
Chronic lower back pain is a common condition in the developed world. Back pain can be very difficult to manage successfully, and so the condition carries a large socio-economic burden. In a number of patients, the Zygapophyseal (or Facet) joint acts as the pain generating site. Alongside a multi-modal approach, many of these patients can be helped with specific denervation of the medial branch of the dorsal rami that innervates the Zygapophyseal joint. However data from the literature has shown conflicting outcomes. Medial Branch denervation is routinely carried out in our centre, but data on the patients outcomes has not been audited. We report our local findings on the outcomes of patients with chronic Zygapophyseal joint pain.
Methods
Following approval from the local Clinical Effectiveness department, patients were identified through theatre lists. Data was collected from hospital notes, specific chronic pain notes and a database held and maintained by the local chronic pain services (data on attendances, procedures, pain scores and follow up). Retrospective data was extracted on the patients demographics, duration of symptoms, timing of diagnostic blocks, Brief Pain Inventory (BPI) scores (before and after procedure), the procedure carried out and levels involved. The data was recorded and analysed using a Excel spreadsheet. We defined ‘success’ as a patient who reported 50% reduction in pain eight weeks after the procedure.
Results
33 radiofrequency denervations were identified, carried out by one clinician over a 34 month period. There were 26 unique patients (seven patients having 2 procedures), all of whom had two sets of diagnostic blocks. Ages ranged from 33 to 79, with patients reporting a mean duration of symptoms of seven years. There were no recorded complications. 24 of the 33 cases (73%) fitted our criteria for ‘success’ (50% improvement in pain at eight weeks post denervation), although an additional 3 (9%) did not attend for follow-up. In the ‘success’ group’s follow-up BPI there a improvement in pain scores (2 point median improvement in ‘maximum’, 1 point median improvement in ‘average’ and 1.5 point median improvement in
‘current’ pain scores, with a larger improvement in the physical (9 point median improvement), psychological (8 point median improvement) and sleep (3 point median improvement) segments of the BPI noted.
Conclusion
Although denervation of the Medial Branch Block is commonly performed for chronic lower back pain originating from the Zygapophyseal joint, there is conflicting evidence regarding the
efficacy of this treatment. This audit demonstrated good pain relief in the majority of patients eight weeks post procedure, adding to the evidence in support of the treatment. The patients reported not only an improvement in pain symptoms, but also an improvement in physical, psychological and sleep interference
Original languageEnglish
Pages (from-to)S50-51
Number of pages2
JournalBritish Journal of Pain
Volume6
Issue number2 Supplement
DOIs
Publication statusPublished - 2012

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Clinical Audit
Zygapophyseal Joint
Denervation
Pain
Low Back Pain
Chronic Pain
Equipment and Supplies
Sleep
Psychology
Arthralgia
Back Pain

Cite this

Radiofrequency denervation of lumbar facet joints: A clinical audit. / Kanakarajan, Saravanakumar; Patterson, Colin.

In: British Journal of Pain, Vol. 6, No. 2 Supplement, 2012, p. S50-51.

Research output: Contribution to journalAbstract

Kanakarajan, Saravanakumar ; Patterson, Colin. / Radiofrequency denervation of lumbar facet joints: A clinical audit. In: British Journal of Pain. 2012 ; Vol. 6, No. 2 Supplement. pp. S50-51.
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title = "Radiofrequency denervation of lumbar facet joints: A clinical audit",
abstract = "BackgroundChronic lower back pain is a common condition in the developed world. Back pain can be very difficult to manage successfully, and so the condition carries a large socio-economic burden. In a number of patients, the Zygapophyseal (or Facet) joint acts as the pain generating site. Alongside a multi-modal approach, many of these patients can be helped with specific denervation of the medial branch of the dorsal rami that innervates the Zygapophyseal joint. However data from the literature has shown conflicting outcomes. Medial Branch denervation is routinely carried out in our centre, but data on the patients outcomes has not been audited. We report our local findings on the outcomes of patients with chronic Zygapophyseal joint pain.MethodsFollowing approval from the local Clinical Effectiveness department, patients were identified through theatre lists. Data was collected from hospital notes, specific chronic pain notes and a database held and maintained by the local chronic pain services (data on attendances, procedures, pain scores and follow up). Retrospective data was extracted on the patients demographics, duration of symptoms, timing of diagnostic blocks, Brief Pain Inventory (BPI) scores (before and after procedure), the procedure carried out and levels involved. The data was recorded and analysed using a Excel spreadsheet. We defined ‘success’ as a patient who reported 50{\%} reduction in pain eight weeks after the procedure.Results33 radiofrequency denervations were identified, carried out by one clinician over a 34 month period. There were 26 unique patients (seven patients having 2 procedures), all of whom had two sets of diagnostic blocks. Ages ranged from 33 to 79, with patients reporting a mean duration of symptoms of seven years. There were no recorded complications. 24 of the 33 cases (73{\%}) fitted our criteria for ‘success’ (50{\%} improvement in pain at eight weeks post denervation), although an additional 3 (9{\%}) did not attend for follow-up. In the ‘success’ group’s follow-up BPI there a improvement in pain scores (2 point median improvement in ‘maximum’, 1 point median improvement in ‘average’ and 1.5 point median improvement in‘current’ pain scores, with a larger improvement in the physical (9 point median improvement), psychological (8 point median improvement) and sleep (3 point median improvement) segments of the BPI noted.ConclusionAlthough denervation of the Medial Branch Block is commonly performed for chronic lower back pain originating from the Zygapophyseal joint, there is conflicting evidence regarding theefficacy of this treatment. This audit demonstrated good pain relief in the majority of patients eight weeks post procedure, adding to the evidence in support of the treatment. The patients reported not only an improvement in pain symptoms, but also an improvement in physical, psychological and sleep interference",
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AU - Kanakarajan, Saravanakumar

AU - Patterson, Colin

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N2 - BackgroundChronic lower back pain is a common condition in the developed world. Back pain can be very difficult to manage successfully, and so the condition carries a large socio-economic burden. In a number of patients, the Zygapophyseal (or Facet) joint acts as the pain generating site. Alongside a multi-modal approach, many of these patients can be helped with specific denervation of the medial branch of the dorsal rami that innervates the Zygapophyseal joint. However data from the literature has shown conflicting outcomes. Medial Branch denervation is routinely carried out in our centre, but data on the patients outcomes has not been audited. We report our local findings on the outcomes of patients with chronic Zygapophyseal joint pain.MethodsFollowing approval from the local Clinical Effectiveness department, patients were identified through theatre lists. Data was collected from hospital notes, specific chronic pain notes and a database held and maintained by the local chronic pain services (data on attendances, procedures, pain scores and follow up). Retrospective data was extracted on the patients demographics, duration of symptoms, timing of diagnostic blocks, Brief Pain Inventory (BPI) scores (before and after procedure), the procedure carried out and levels involved. The data was recorded and analysed using a Excel spreadsheet. We defined ‘success’ as a patient who reported 50% reduction in pain eight weeks after the procedure.Results33 radiofrequency denervations were identified, carried out by one clinician over a 34 month period. There were 26 unique patients (seven patients having 2 procedures), all of whom had two sets of diagnostic blocks. Ages ranged from 33 to 79, with patients reporting a mean duration of symptoms of seven years. There were no recorded complications. 24 of the 33 cases (73%) fitted our criteria for ‘success’ (50% improvement in pain at eight weeks post denervation), although an additional 3 (9%) did not attend for follow-up. In the ‘success’ group’s follow-up BPI there a improvement in pain scores (2 point median improvement in ‘maximum’, 1 point median improvement in ‘average’ and 1.5 point median improvement in‘current’ pain scores, with a larger improvement in the physical (9 point median improvement), psychological (8 point median improvement) and sleep (3 point median improvement) segments of the BPI noted.ConclusionAlthough denervation of the Medial Branch Block is commonly performed for chronic lower back pain originating from the Zygapophyseal joint, there is conflicting evidence regarding theefficacy of this treatment. This audit demonstrated good pain relief in the majority of patients eight weeks post procedure, adding to the evidence in support of the treatment. The patients reported not only an improvement in pain symptoms, but also an improvement in physical, psychological and sleep interference

AB - BackgroundChronic lower back pain is a common condition in the developed world. Back pain can be very difficult to manage successfully, and so the condition carries a large socio-economic burden. In a number of patients, the Zygapophyseal (or Facet) joint acts as the pain generating site. Alongside a multi-modal approach, many of these patients can be helped with specific denervation of the medial branch of the dorsal rami that innervates the Zygapophyseal joint. However data from the literature has shown conflicting outcomes. Medial Branch denervation is routinely carried out in our centre, but data on the patients outcomes has not been audited. We report our local findings on the outcomes of patients with chronic Zygapophyseal joint pain.MethodsFollowing approval from the local Clinical Effectiveness department, patients were identified through theatre lists. Data was collected from hospital notes, specific chronic pain notes and a database held and maintained by the local chronic pain services (data on attendances, procedures, pain scores and follow up). Retrospective data was extracted on the patients demographics, duration of symptoms, timing of diagnostic blocks, Brief Pain Inventory (BPI) scores (before and after procedure), the procedure carried out and levels involved. The data was recorded and analysed using a Excel spreadsheet. We defined ‘success’ as a patient who reported 50% reduction in pain eight weeks after the procedure.Results33 radiofrequency denervations were identified, carried out by one clinician over a 34 month period. There were 26 unique patients (seven patients having 2 procedures), all of whom had two sets of diagnostic blocks. Ages ranged from 33 to 79, with patients reporting a mean duration of symptoms of seven years. There were no recorded complications. 24 of the 33 cases (73%) fitted our criteria for ‘success’ (50% improvement in pain at eight weeks post denervation), although an additional 3 (9%) did not attend for follow-up. In the ‘success’ group’s follow-up BPI there a improvement in pain scores (2 point median improvement in ‘maximum’, 1 point median improvement in ‘average’ and 1.5 point median improvement in‘current’ pain scores, with a larger improvement in the physical (9 point median improvement), psychological (8 point median improvement) and sleep (3 point median improvement) segments of the BPI noted.ConclusionAlthough denervation of the Medial Branch Block is commonly performed for chronic lower back pain originating from the Zygapophyseal joint, there is conflicting evidence regarding theefficacy of this treatment. This audit demonstrated good pain relief in the majority of patients eight weeks post procedure, adding to the evidence in support of the treatment. The patients reported not only an improvement in pain symptoms, but also an improvement in physical, psychological and sleep interference

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DO - 10.1177/2049463712444183

M3 - Abstract

VL - 6

SP - S50-51

JO - British Journal of Pain

JF - British Journal of Pain

SN - 2049-4637

IS - 2 Supplement

ER -