Abstract
Objective: To evaluate the feasibility of sensory mapping of lumbar facet joint pain in patients scheduled to undergo radiofrequency denervation.
Design: Prospective cohort study.
Setting: University teaching hospital.
Subjects: 15 participants listed for radiofrequency denervation of lumbar facet joint.
Method: After written informed consent, participants were recruited to the study. Participants completed a pain diagram prior to their procedure. After successful image-guided placement of radiofrequency (RF) cannulas, the sensory detection threshold using 50 Hz stimulation was obtained, followed by application of suprathreshold stimulation. Participants mapped the stimulated area in comparison to their preprocedure pain diagram.
Results: All 15 participants had previously undergone diagnostic blocks. All participants were able to report either pain or paraesthesia during suprathreshold stimulation. Fourteen out of 15 participants reported complete coverage of their usual pain area with suprathreshold stimulation of nerves scheduled for RF denervation. In one of the participants, an area of upper lumbar pain was not covered during suprathreshold stimulation. Nearly two-thirds of the participants (n=9), reported either pain or paraesthesia, outside their normal painful area during suprathreshold stimulation. A total of 71 nerves were scheduled for RF denervation. Sensory electrical stimulation was successfully
achieved in 68 out of 71 nerves (96%).The average sensory detection threshold was found to be 0.3 V while the suprathreshold stimulation was 0.6 V.
Conclusion: Lumbar facet joint pain can be mapped using suprathreshold sensory stimulation, which has the potential to introduce objectivity during RF denervation.
Design: Prospective cohort study.
Setting: University teaching hospital.
Subjects: 15 participants listed for radiofrequency denervation of lumbar facet joint.
Method: After written informed consent, participants were recruited to the study. Participants completed a pain diagram prior to their procedure. After successful image-guided placement of radiofrequency (RF) cannulas, the sensory detection threshold using 50 Hz stimulation was obtained, followed by application of suprathreshold stimulation. Participants mapped the stimulated area in comparison to their preprocedure pain diagram.
Results: All 15 participants had previously undergone diagnostic blocks. All participants were able to report either pain or paraesthesia during suprathreshold stimulation. Fourteen out of 15 participants reported complete coverage of their usual pain area with suprathreshold stimulation of nerves scheduled for RF denervation. In one of the participants, an area of upper lumbar pain was not covered during suprathreshold stimulation. Nearly two-thirds of the participants (n=9), reported either pain or paraesthesia, outside their normal painful area during suprathreshold stimulation. A total of 71 nerves were scheduled for RF denervation. Sensory electrical stimulation was successfully
achieved in 68 out of 71 nerves (96%).The average sensory detection threshold was found to be 0.3 V while the suprathreshold stimulation was 0.6 V.
Conclusion: Lumbar facet joint pain can be mapped using suprathreshold sensory stimulation, which has the potential to introduce objectivity during RF denervation.
| Original language | English |
|---|---|
| Pages (from-to) | 64-68 |
| Number of pages | 5 |
| Journal | British Journal of Pain |
| Volume | 15 |
| Issue number | 1 |
| Early online date | 10 Nov 2019 |
| DOIs | |
| Publication status | Published - 1 Feb 2021 |
Bibliographical note
AcknowledgementsThe authors would like to thank Dr Jeremy Weinbren, Consultant Anaesthetist, The Hillingdon Hospitals NHS Foundation Trust for his statistical advice on this paper.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: K.F. received a John Snow Anaesthesia Intercalated BSc bursary. No funding was obtained for the running costs of the project.
Keywords
- low back pain
- Zygapophyseal joint
- denervation
- electric stimulation
- sensory threshold
- electrical stimulation
- nerve stimulation
- Low back pain
- radiofrequency neurotomy
- facet joint