Professional Statements and Societal Positions Guidelines
American Society of Pain and Neuroscience (2021)
The American Society of Pain and Neuroscience (2021) issued consensus guidelines using U.S. Preventive Services Task Force (USPSTF) grading criteria on the use of RFA to treat various pain conditions. The guidelines stated that genicular RFA may be used for the treatment of osteoarthritis-related and post-surgical knee joint pain (Grade B) and may be selectively offered for the treatment of occipital neuralgia pain when greater or lesser nerves have been identified as the etiology of pain via diagnostic blocks (Grade C).
In 2021, the American Society of Pain and Neuroscience published practice a guideline on radiofrequency neurotomy.
All of the workgroup members utilized radiofrequency neurotomy in clinical practice. A consensus statement, based on Grade II-1 evidence (well-designed, controlled, nonrandomized clinical trial), was that 'lateral branch radiofrequency neurotomy may be used for the treatment of posterior sacral ligament and joint pain following positive response to appropriately placed diagnostic blocks.'
American Academy of Orthopaedic Surgeons (2021)
In 2021, the American Academy of Orthopaedic Surgeons published a clinical practice guideline, endorsed by the American Association of Hip and Knee Surgeons and the American Physical Therapy Association, on management of osteoarthritis (OA) of the knee. The guideline did not specifically address RFA or cryoneurolysis but did include a guideline statement on denervation therapy that included various ablation techniques (e.g., RFA, cryoneurolysis, thermal ablation and chemical ablation). The guideline stated, 'denervation therapy may reduce pain and improve function in individuals with symptomatic osteoarthritis of the knee' (strength of recommendation: limited).
Association of Extremity Nerve Surgeons (2020)
The Association of Extremity Nerve Surgeons issued practice guidelines in 2020 which drew the following conclusions:
We do not recommend ablation in the primary treatment of Intermetatarsal Nerve Entrapment ('Morton's Neuroma'). Radiofrequency ablation has use in the lower extremity but must be done with caution as this procedure has the potential for thermal necrosis of the adjacent tissues. Judicious use of fluoroscopy and other visualization techniques is advised while utilizing radiofrequency ablation...further research in this technique is needed.
Cryoablation (cryotherapy) should be used with extreme caution, as the amount of literature in the lower extremity is limited. If cryotherapy is used, it should ideally be performed with an open technique rather than percutaneously for optimal results.
