Professional Statements and Societal Positions Guidelines
Practice Guidelines and Position Statements
Association of Neurological Surgeons and Congress of Neurological Surgeons
The American Association of Neurological Surgeons and the Congress of Neurological Surgeons (2014) updated their joint guidelines on the treatment of degenerative disease of the lumbar spine. The two groups provided grade B recommendations: (1) intra-articular injections of lumbar facet joints were not suggested for the treatment of facet-mediated chronic low back pain; (2) medial nerve blocks were suggested for the short-term relief of facet-mediated chronic low back pain; and (3) lumbar medial nerve ablation was suggested for the short-term (3- to 6-month) relief of facet-mediated pain in individuals who have chronic lower back pain without radiculopathy from degenerative disease of the lumbar spine.
American Society of Interventional Pain Physicians
Updated guidelines on interventional techniques for the management of chronic spinal pain from the American Society of Interventional Pain Physicians were published in 2013. Diagnostic lumbar facet joint nerve blocks were recommended in individuals with suspected facet joint pain, based on good evidence for diagnostic lumbar facet joint nerve blocks with 75% to 100% pain relief as the criterion standard. For the treatment of facet joint pain, evidence was considered good for conventional radiofrequency (RF), limited for pulsed RF, fair-to-good for lumbar facet joint nerve blocks, and limited for intra-articular injections. Based on the evidence review, the Society recommended treatment with conventional RF neurotomy or therapeutic facet joint nerve blocks.
American Society of Anesthesiologists et al
Practice guidelines on chronic pain management from the American Society of Anesthesiologists and the American Society of Regional Anesthesia and Pain Medicine were published in 2010. The guidelines included the following recommendations:
“Radiofrequency ablation: Conventional (e.g., 80°C) or thermal (e.g., 67°C) radiofrequency ablation of the medial branch nerves to the facet joint should be performed for low back (medial branch) pain when previous diagnostic or therapeutic injections of the joint or medial branch nerve have provided temporary relief.”
“Chemical denervation (e.g., alcohol, phenol, or high concentration local anesthetics) should not be used in the routine care of individuals with chronic noncancer pain.”
American Pain Society
The American Pain Society (2009) practice guidelines on nonsurgical interventions for low back pain stated that “there is insufficient (poor) evidence from randomized trials (conflicting trials, sparse and lower quality data, or no randomized trials) to reliably evaluate” a number of interventions including facet denervation.
National Institute for Health and Care Excellence
The NICE (2016) published guidance on the assessment and management of low back pain and sciatica in those over 16 years of age.The NICE recommended that RF denervation can be considered for individuals with chronic low back pain when "non-surgical treatment has not worked for them and the main source of pain is thought to come from structures supplied by the medial branch nerve and they have moderate or severe levels of localized back pain.” RF denervation should only be performed" after a positive response to a diagnostic medial branch block.” The NICE cautioned that the length of pain relief after RF denervation is uncertain, and that results from repeat RF denervation procedures are also uncertain.
California Technology Assessment Forum
The California Technology Assessment Forum (2001) published a review of the evidence for percutaneous RF neurotomy of cervical and lumbar zygapophyseal joints for chronic neck and low back pain; it concluded that the technology met its criteria for efficacy and safety for treatment of lower cervical (C3 and below) and for lumbar pain but not for treatment of upper (C2-3) levels.The Forum (2007) reviewed the evidence for treatment of C2-3 joints and did not reverse its position.