BACKGROUND: Chronic neck pain is often multifactorial and is a leading cause of pain and disability. Cervical facet joint pain is a common cause of neck pain and, in addition to more conservative modalities, can be treated with radiofrequency ablation (RFA) of the respective medial branch nerves. Cervicogenic headaches are a frequent complaint in pain clinics in the United States and can be targeted via a similar procedural approach.
OBJECTIVES: We evaluated randomized controlled trials of cervical facet joint pain and cervicogenic headaches with the goal of establishing a current level of evidence for treating these etiologies of pain with RFA.
STUDY DESIGN: Systematic review.
METHODS: Database search, from inception through July 2021, was performed identifying randomized controlled trials for cervical medial branch RFA. Two reviewers independently evaluated the studies to identify those meeting criteria. Primary outcome measures included pain relief and duration of pain relief. Secondary outcome measures included function, sleep, mood, return to work, additional treatments, and complications.
RESULTS: Four randomized controlled studies met inclusion criteria and were selected for this review, each demonstrated low risk of bias. Of these studies, 3 were unique with the fourth being a subgroup analysis. Primary outcome measures of pain relief and duration of relief were variable with successful relief ranging from 30% to 50% and median duration of pain relief also demonstrating a wide variety. Function and psychological distress were also variably reported and found variable relief to treatment with no difference between groups in 2 of the studies.
LIMITATIONS: Primary limitations of the review are the paucity of randomized controlled trials and the variability in measured outcome measures.
CONCLUSIONS: Based on this systematic review, efficacy of cervical facet RFA in treatment of chronic neck pain has Level II evidence.
|Rehab Clinician (OT/PT)|
Only 4 trials reviewed. That’s not a lot. Based on that, probably not surprising that RFA is only level II evidence for efficacy. As per usual, more studies needed.
Careful with the interpretation of the results. There are no indications. Also it is missing a Prospero registration. The search string does not involve cervicogenic headache.
This is really interesting as, in my clinical practise, I have patients with chronic debilitating neck pain and high irritability. Thus, it is good to learn about that this option exists. However, the accessibility to radiofrequency ablation is still limited.