Radiofrequency ablation should only be used to treat chronic neck pain of patients who meet specific criteria, says new guidelines published today.
Evidence-based consensus guidelines, published in Regional Anesthesia & Pain Medicine, have been agreed by an international panel of 22 experts from 18 professional societies and government bodies.
The guidelines say while nerve blocks are likely to be more useful in identifying the patients with chronic neck pain than steroid injections into the joints, only one block rather than the mandated two is required.
The report also says that while dual blocks increase the success rate of radiofrequency ablation, the evidence indicates that doubling up leads to more unnecessary procedures and higher costs.
The cervical facet joints are believed to be the primary source of the pain in about 40% of patients with chronic neck pain and in more than half of those with neck pain after whiplash injury.
While procedures, such as joint injections, nerve blocks and radiofrequency ablation to ease chronic neck pain, have increased considerably over the past 20 years, there has been doubt over their diagnostic and therapeutic effectiveness.
Clinicians have not been clear which patients benefit the most from the procedures, which has led to inconsistencies in clinical practice, patient safety concerns, and, in the USA, disputes with medical insurers.
Experts from The American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine convened an international panel of experts to draw up consensus guidelines based on the best available evidence.
They drew on more than 400 publications to conclude that radiofrequency ablation may be helpful for easing chronic neck pain, but only in patients whose pain corresponds to the joints being treated; those whose signs and symptoms don’t emanate from a nerve root; and those who obtain meaningful pain relief from properly performed diagnostic nerve blocks.
The guidelines also conclude that more stringent selection criteria, such as requiring nearly total pain relief from diagnostic blocks, might improve the level of pain relief for individual patients after radiofrequency ablation.
Other key recommendations include the use of only soluble, short-acting steroids when injecting into the upper neck joints or after radiofrequency ablation; using smaller needles and electrodes than those used for the lower back; using nerve and muscle stimulation to improve effectiveness and reduce the risk of complications; and taking steps to minimise interference with implanted electrical devices, such as pacemakers.
“These multi-society guidelines have been developed to serve as a roadmap to improve outcomes, enhance safety, and minimize unnecessary tests and procedures,” conclude the authors.
Hurley RW, Adams MCB, Barad M et al. Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group. Regional Anesthesia & Pain Medicine 12 November 2021; doi:10.1136/rapm-2021-103031
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