Journal
CLINICAL JOURNAL OF PAIN
Volume 29, Issue 5, Pages 382-391Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/AJP.0b013e31825f53bf
Keywords
facet joint; low back pain; predictive value; radiofrequency; specificity; zygapophysial
Categories
Funding
- John P. Murtha Neuroscience and Pain Institute, Johnstown, PA
- US Army
- Army Regional Anesthesia & Pain Medicine Initiative, Washington, DC
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Objectives: Diagnostic medial branch blocks (MBB) are considered the reference standard for diagnosing facetogenic pain and selecting patients for radiofrequency (RF) denervation. Great controversy exists regarding the ideal cutoff for designating a block as positive. The purpose of this study is to determine the optimal pain relief threshold for selecting patients for RF denervation after diagnostic MBB. Methods: In this multicenter, prospective correlational study, 61 consecutive patients undergoing lumbar facet RF denervation after experiencing significant pain relief after MBB were enrolled. A positive outcome was defined as a >= 50% reduction in back pain at rest or with activity coupled with a positive satisfaction score lasting longer than 3 months. The relationship between pain relief after the blocks and denervation outcomes was evaluated by pairwise correlation matrix, receiver's operating characteristic curve, and stratifying outcomes based on 10- and 17-percentage point intervals for MBB. Results: There were no significant differences in RF outcomes based on any MBB pain relief cutoff over 50%. A trend was noted whereby those patients who obtained <50% pain relief reported poorer outcomes. No optimal threshold for designating a diagnostic block as positive, above 50% pain relief, could be calculated. Conclusion: Employing more stringent selection criteria for lumbar facet RF is likely to result in withholding a beneficial procedure from a substantial number of patients, without improving success rates.
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