Authors' objectives

To determine the efficacy of radiofrequency (RF) procedures for spinal pain.

Searching

MEDLINE (from 1966 to 2000), EMBASE (from 1989 to 2000), the Cochrane Library, the Dutch Central Catalogue of theses (from 1988 to 1999) and Current Contents (from 1999 to 2000) were searched; the search terms were reported. In addition, the references in relevant RCTs were screened. The review was limited to studies reported in the English language. Conference proceedings, abstracts and letters were excluded.

Study selection

Assessment of study quality

Studies were assessed for quality using the Jadad scale. Studies scoring at least 3 out of a possible 5 were considered to be of a high quality, while those scoring 2 or less were considered to be of a low quality. The studies were also scored for the following items: the avoidance of cointerventions; the reporting of whether patients were compliant with the study protocol; the inclusion of data proving that pain conditions had similar aetiologies; and whether the therapeutic times between the control and treatment groups were equivalent.

Since the reporting of the methods of patient selection and technical aspects of RF was poor, additional evaluation criteria were developed. These assessed the studies for the following: description of baseline psychological profile of included patients; description of clinical tests used to circumscribe patients' pain syndrome; description of method of selection by diagnostic blocks; accurate description of needle positions; specification of number of lesions per treated level; specification of treated levels; specification of applied RF lesions, regarding temperature or voltage and time; description of sensory or motor stimulation criteria; and description of needle used and technical details.

Three reviewers independently assessed the studies and resolved any disagreements through discussion.

Data extraction

The authors did not state how the data were extracted for the review, or how many reviewers performed the data extraction.

The primary outcome was judged to be: positive if it was reported that the RF intervention was statistically significantly more effective than the comparator treatment (P<0.05); neutral if the RF intervention was not significantly different from the comparator; and negative if the RF intervention was significantly less effective than the comparator treatment (P<0.05).

Methods of synthesis

Results of the review

Six RCTs were included. The total number of patients was 211.

There was moderate evidence for the efficacy of RF denervation of cervical zygapophyseal joints for facetal pain in the lumbar region. There was limited evidence that cervical RF treatment of the dorsal root ganglion for cervicobrachialgia will result in adequate pain relief. There was also limited evidence that pain complaints in patients with whiplash can be treated by RF denervation of cervical zygapophyseal joints.

Authors' conclusions

There was moderate evidence that RF lumbar facet denervation is more effective for chronic low-back pain than placebo. In addition, there was limited evidence for the efficacy of RF neurotomy in chronic cervical zygapophyseal joint pain after flexion-extension injury. Finally, there was limited evidence that RF heating of the dorsal root ganglion is more effective than placebo in chronic cervicobrachialgia.

CRD commentary

The review addressed a clear question and defined the inclusion criteria. The literature search covered several relevant sources, but the restriction to studies reported in English might have introduced language bias. The possibility of publication bias also cannot be ruled out. The extensive quality assessment was incorporated into the synthesis of the results, but it was difficult to distinguish between the quality of reporting and the potential for study bias. Insufficient details of the included studies were presented to enable an independent affirmation of the authors' evaluations. The assessment of efficacy in the review was simplistic and the individual study results were not shown. The authors' conclusions were based on a very small number of small trials and, as they pointed out, may be too optimistic.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors recommended the systematic application of their additional parameter assessments (see quality criteria) in future evaluations of RF studies. They also recommended that future RCTs include sufficiently homogeneous patient populations, and that reports provide a meticulous description of the RF technique used.

Bibliographic details

Geurts J W, van Wijk R M, Stolker R J, Groen G J. Efficacy of radiofrequency procedures for the treatment of spinal pain: a systematic review of randomized clinical trials. Regional Anesthesia and Pain Medicine 2001; 26(5): 394-400. [PubMed: 11561257]

Other publications of related interest

Slavin RE. Best evidence synthesis: An intelligent alternative to meta-analysis. J Clin Epidemiol 1995;48:9-18.

Indexing Status

Subject indexing assigned by NLM

MeSH

Chronic Disease; Humans; Low Back Pain /radiotherapy; Neck Pain /radiotherapy; Radio Waves /therapeutic use; Randomized Controlled Trials as Topic

AccessionNumber

12001002285

Database entry date

30/11/2004

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.