A new study by Italian researchers investigated whether the use of pulsed radiofrequency can help relieve lower back pain and sciatica.
Lower back pain can be excruciating and debilitating. One of the most common causes of lower back pain is lumbar disc herniation. Discs are like cushions that sit in between vertebrae and act as shock absorbers to allow you to bend and move without your bones rubbing together. They consist of a soft jelly-like center known as the nucleus and a tough exterior known as the annulus.
A herniated disc occurs when a portion of the nucleus pushes through a tear or crack in the annulus (ruptured disc), putting pressure on nearby nerves. This is often the source of sciatica back pain, as the pain spreads down the sciatic nerve which branches from the lower back and down the back of each leg.
Current treatments for herniated discs are quite conservative and include over-the-counter pain medications to injections of corticosteroids such as cortisone, which provide pain relief for inflamed areas of the body. The injections are given directly into the area of the spine affected. However, there are many patients who do not respond to these conservative treatments. Some may, therefore, require surgery, with some requiring the disc to be removed.
However, researchers in Italy have investigated an alternative minimally invasive procedure as a potential alternative for people who have not responded to conservative treatments. The study was presented at the annual meeting of the Radiological Society of North America in November 2018.
New technique applies pulses of energy directly to the nerve roots
The technique, CT-guided pulsed radiofrequency, involves applying pulses of energy from a probe under CT guidance directly to nerve roots near the spine, which are the portions responsible for sending pain signals. The pulsed radiofrequency causes stimulation of the nerves, reducing inflammation significantly and subsequently resulting in pain relief.
The study included two groups to compare the alternative method to a more conservative treatment approach. One group included 128 patients with lower back pain caused by lumbar disc herniation who were not responding to conservative treatment for a prolonged period. The technique was done under CT guidance and applied for ten minutes. The second group included 120 patients, with the same condition. However, they received CT-guided steroid injections to the same target, three times. They did not receive any pulsed radiofrequency.
Greater overall improvement in pain compared to steroid injections
After one year, patients who received the CT-guided pulsed radiofrequency saw a greater overall improvement in pain compared to those only received the steroid injections. The results also showed patients who had the pulsed radiofrequency treatment had faster relief of leg pain and faster rate of perceived recovery. The probability of perceived recovery was 95% in this group, compared to only 61% in the group who received the steroid injection only.
The study also showed that the combination of the pulsed radiofrequency treatment followed by a steroid injection was more effective than either treatment alone. The results, such as pain relief and reduction in inflammation were longer lasting.
A minimally invasive and safe procedure
These findings show this alternative treatment is significantly superior compared to conservative treatments given to patients suffering from lower back pain due to a herniated disc or sciatica. Pulsed radiofrequency is a fast and effective treatment that does not have the same adverse events associated with it, like the use of pain medications and steroids. Only one 10-minute treatment was needed to be effective in a large number of patients.
This minimally invasive and safe procedure is now being offered to patients suffering from herniated discs and sciatica who are not responding to the typical treatments offered. This could also help a number of patients avoid surgery, which is often the only other option.
Written by Lacey Hizartzidis, PhD
- Pulsed radiofrequency relieves acute back pain and sciatica. EurekAlert website https://www.eurekalert.org/pub_releases/2018-11/rson-prr111318.php. Accessed January 25, 2019.
- Photo credit: Radiological Society of North America https://www.eurekalert.org/multimedia/pub/185960.php?from=412249