Journal of Pain Research (Jul 2021)

Sensory Stimulation Threshold: A Viable Tool to Improve the Outcome of Lumbar Facet Radiofrequency Denervation?

  • Shi W,
  • Rudra R,
  • Vu TN,
  • Gordin Y,
  • Smith R,
  • Kunselman AR

Journal volume & issue
Vol. Volume 14
pp. 2113 – 2119

Abstract

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Weibin Shi,1,2 Renuka Rudra,1,2 To-Nhu Vu,3 Yuri Gordin,1,2 Ryan Smith,1,2 Allen R Kunselman4 1Department of Physical Medicine and Rehabilitation, Penn State Health Milton S Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA; 2Penn State Hershey Rehabilitation Hospital, Hummelstown, PA, USA; 3Department of Anesthesiology & Perioperative Medicine, Penn State Health Milton S Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA; 4Department of Public Health Sciences, Penn State Hershey College of Medicine, Hershey, PA, USACorrespondence: Weibin Shi; To-Nhu Vu Email [email protected]; [email protected]: Sensory stimulation threshold (SST) has been used as a surrogate marker to target a nerve branch for radiofrequency (RF) denervation; however, the validity of SST as a prognostic marker is still under debate.Objective: To assess whether lower SST values correlate with better outcomes of radiofrequency denervation for facetogenic low back pain.Design: Prospective cohort study.Patients: Sixty-seven patients who underwent radiofrequency denervation for low back pain.Methods: Correlations, between the average percentage of pain relief from diagnostic medial branch block (MBB) and RF denervation procedure outcome, and between SST and RF denervation procedure outcome, were analyzed using Spearman correlation coefficient (rs). Wilcoxon rank sum test was performed to assess whether magnitude and duration of pain relief following RF denervation differed by the levels of SST (< 0.5 and ≥ 0.5) or pain relief (< 80% and ≥ 80%) from diagnostic MBB.Results: There was a positive correlation between pain relief after diagnostic MBB and pain relief 2 weeks after denervation (rs 0.31, 95% CI 0.08 to 0.51, p < 0.01), but not between pain relief after MBB and pain relief 6 months after denervation, nor pain relief duration after denervation. There was a negative correlation between SST and pain relief 6 months after denervation (rs − 0.41, 95% CI − 0.59 to − 0.18, p < 0.001). There was also a negative correlation between SST and pain relief duration after denervation (rs − 0.33, 95% CI − 0.53 to − 0.09, p < 0.01).Conclusion: SST is a viable measurement with which to guide needle placement during RF denervation for lumbar facet pain, and enhances pain relief outcomes.Keywords: sensory stimulation threshold, radiofrequency ablation, lower back pain, lumbar facet arthropathy, outcome

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