Comparison of the Efficacy of Conventional Radiofrequency, Pulse Radiofrequency, and TENS Therapies for Lumbar Facet Joint Pain: A Single-blind Randomized Controlled Trial

Patient selection

The study included patients who presented to the outpatient clinics of these units with the complaint of chronic low back pain prevailing for at least 3 months that had not responded to previous medical treatment. Medical history were obtained from the patients and their low back and lower extremity musculoskeletal systems and neurologic systems were examined. Patients were assessed using their two-way lumbar X-rays taken within the last 1 year and lumbar magnetic resonance imaging outcomes. After all these examinations and assessments, the patients who were excluded from the study consisted of those who had a coagulation disorder, a history of malignity, a mental disorder, a psychiatric disorder, pregnancy, prior low back surgery, a history of TENS or radiofrequency procedure at their low back region within the last 1 year, an advanced (grade 3-4) spondylolisthesis defect in their lumbar vertebrae, an extruded and sequestrated disk hernia or a spinal narrow canal in their magnetic resonance imaging, a cauda equine syndrome or advanced paresis, an examination finding suggesting radiculopathy with pain noticeably extending under the knee, a history of systemic inflammatory disease, an advanced cardiac deficiency and a diagnosis of pulmonary disease. In the light of the medical history, examination findings and other tests, the patients who were thought to have facet joint syndrome and who did not meet any of the exclusion criteria above were informed about the study and treatment procedures.

The patients who agreed to receive the treatment based on the information given to them were administered a diagnostic test dose at the operating room of the Algology Division to confirm whether the present pain was associated with the facet syndrome meeting the inclusion criteria. This diagnostic procedure involved injection of 0.4 cc of bupivacaine under fluoroscopy to the median of dorsal ramus that enable innervation of lumbar facet joints. The patients whose pain receded more than 50% after this administration of a test dose and who met the other two inclusion criteria, visual analogue scale pain level >3 and 18-75 years of age, were included in the study.

The patients included in the study were informed both in writing and verbally about the purpose and length of the study, the way of implementing it, and possible side effects and problems that can arise. Patients signed the "subject informed consent form" and local ethics committee approval was obtained.

Intervention