Ablation Could Alleviate Back Pain When Steroids Fail

Patients with lower back pain who do not respond to intra-articular steroid injections may still be candidates for treatment with radiofrequency ablation (RFA), according to a new study.

Researchers at the Cleveland Clinic (OH, USA) conducted a retrospective study of 80 patients who underwent preoperative intraarticular steroid injections from January 2006 to June 2009. The researchers related that traditionally, the degree of pain relief from steroid injections has been used to determine if patients would be good candidates for RFA of the lateral branches that innervate the sacroiliac joint. In these cases, RFA of the lateral branches is often considered only if the patient had more than 50% pain reduction from the intraarticular steroid injection.

The researchers found that after adjusting for variables such as age, modes of pain onset, multiple pain complaints, and responses to extension or axial rotation of the lumbar spine in the multivariable proportional hazards model, the difference in duration of post-RFA pain relief between the groups was not significant, and was independent of the degree of pain relief within the range of 25%-100% after steroid injections. The study was presented at the American Academy of Pain Medicine annual meeting, held during February 2012 in Palm Springs (FL, USA).

“The duration of pain relief after radiofrequency ablation ... is independent of the degree of pain relief within the range of 25% to 100% after sacroiliac intraarticular steroid injections,” said lead author and study presenter Jianguo Cheng, MD, PhD. “Don't disqualify a patient from radiofrequency ablation if they only achieved 25% to 49% relief from steroid injections.”

The researchers noted that patients with the more robust responses to intraarticular steroid injections were older, were more likely to have pain radiating to the leg, more likely to have gradual onset pain, and were less likely to have pain with extension or axial rotation.

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