Can Cooled Radiofrequency Ablation Provide Relief for Patients With Sacroiliac Joint Pain?

In a comparative effectiveness study involving 210 patients with sacroiliac (SI) joint pain, cooled radiofrequency ablation (RFA) demonstrated a greater reduction in pain scores than standard medical management.

Low back pain is a leading cause of disability globally, with SI joint pain accounting for as much as 30% of all cases of axial low back pain. Conventional therapies often offer limited relief, underscoring the need for more effective treatment options. Placebo-controlled trials suggest that sacral lateral branch cooled RFA can be beneficial. This study aimed to assess its efficacy against standard medical management for SI joint pain.

This multicenter, randomized trial assigned patients with suspected SI joint pain who had shown short-term pain relief following diagnostic SI joint injections and lateral branch blocks to receive either cooled RFA of the L5 dorsal ramus and S1-S3 lateral branches or a standard medical management protocol. The primary outcome was the reduction in low back pain as measured by the NRS at the 3-month follow-up. Secondary outcomes included assessments of quality of life and functional improvement.

The study found that patients receiving cooled RFA reported a mean Numeric Rating Scale (NRS) pain score of 3.8±2.4 at 3 months post-treatment, reflecting a mean reduction of 2.5±2.5 points. This reduction is larger than that seen in the standard medical management group, which reported a post-treatment NRS score of 5.9±1.7 and a mean reduction of only 0.4±1.7 points (P < .0001).

In addition to greater reductions in NRS pain scores, 52.3% of patients in the cooled RFA group achieved either a ≥ 2-point reduction or at least 30% pain relief, qualifying them as responders. This contrasted with only 4.3% in the standard management group (P < .0001). Functional improvement was similar; the mean Oswestry Disability Index (ODI) score decreased to 29.7±15.2 in the RFA group, as compared to 41.5±13.6 in the standard management group (P < .0001). Quality of life, as measured by the EuroQoL-5D (EQ-5D) score, was also significantly higher in the RFA group (mean score of 0.68±0.22) versus the standard management group (mean score of 0.47±0.29, P < .0001).

One limitation of the study is the relatively short follow-up period of 3 months, which limits understanding of long-term efficacy. The study also relies on patient-reported outcomes, which may be subject to recall bias or variability in subjective pain perception.

“In patients with sacroiliac joint pain, cooled radiofrequency ablation provided statistically superior improvements across the spectrum of patient outcomes compared with standard medical management,” the study authors concluded.

Reference

Cohen SP, Kapural L, Kohan L, et al. Cooled radiofrequency ablation versus standard medical management for chronic sacroiliac joint pain. Reg Anesth Pain Med.2024 Mar;49(3):184-191. doi:10.1136/rapm-2023-104568.