|Principal Investigator: Zachary McCormick|
|Keywords: Medial Branch Block , Facet Joint Injection , Prospective trial , Radiofrequency Ablation , Low back pain , Lumbar Facet Joint Pain||Department: Physical Medicine & Rehab|
|IRB Number: 00111315||Co Investigator: Nick Monson|
|Specialty: Physical Medicine and Rehabilitation|
|Sub Specialties: Back|
|Recruitment Status: Recruiting|
Determine if individuals with lumbar facet syndrome who are treated with C-RFA of the MBNs compared to facet joint injection of corticosteroid have a greater likelihood of experiencing meaningful relief of low back pain symptoms, functional improvement, and reduction of analgesic medication use at both short and long-term follow-up.
- Adult patients aged > 21 capable of understanding and providing consent in English and capable of complying with the outcome instruments used.
- Axial (non-radicular) back pain for at least 3 months (ie Chronic Low Back Pain), with pain lasting at least half of the days within those 3 months, that did not respond to conventional treatment such as physical therapy, oral analgesic agents, and non-invasive adjunctive treatments. The pain can be unilateral or bilateral. The pain can also include referred lower limb pain.
- 7-day worst numeric pain rating score (NPRS) for back pain of 5/10 or greater at baseline evaluation.
- Positive responses to dual comparative diagnostic MBN blocks using 0.5mL of 0.5% bupivacaine and 4% lidocaine, on respective encounters on separate days, at each of the appropriate MBNs. The blocks are administered in a double-blind fashion so that neither the subject nor the independent assessor is aware of the local anesthetic used.
- Focal neurologic signs or symptoms.
- Radiologic evidence of a symptomatic herniated disc or nerve root impingement related to spinal stenosis.
- Active systemic or local infections at the site of proposed needle and electrode placement.
- Coagulopathy or other bleeding disorder.
- Receipt of remuneration for their pain treatment (e.g. disability, worker’s compensation, auto injury in litigation or pending litigation).
- History of any lumbar or lower thoracic fusion surgery or placement of other hardware.
- Grade 2 Spondylolisthesis at an affected or adjacent level.
- Cobb angle >10 degrees.
- Sagittal vertical axis angle >5 degrees.
- BMI >40.
- Cognitive deficit affecting ability to complete the assessment instruments.
- Inability to read English and complete the assessment instruments.
- Allergy to local anesthetics.
- Chronic widespread pain or somatoform disorder (e.g. fibromyalgia).
- Prior lumbar MBN radiofrequency neurotomy.
- Addictive behavior, severe clinical depression, anxiety, or any mental health condition with psychotic features.
- Possible pregnancy or other reason that precludes the use of fluoroscopy.
- Daily chronic opiate use of >50 morphine equivalents.
No reimbursement but there is compensation.Participants will receive three $50 Amazon gift cards if they complete all surveys. Gift cards will be distributed upon completion at the 3-month, 1-year, and 2-year survey time. Gift cards will be mailed 1-2 weeks after completion at those time periods.