Newly Published
Pain Medicine  |   May 2018
Effectiveness of Lumbar Facet Joint Blocks and Predictive Value before Radiofrequency Denervation: The Facet Treatment Study (FACTS), a Randomized, Controlled Clinical Trial
Author Notes
  • Submitted for publication October 21, 2017. Accepted for publication May 1, 2018. From the Department of Anesthesiology and Critical Care Medicine (S.P.C., T.L.D., M.A.-W.) and the Department of Neurology and Physical Medicine and Rehabilitation (S.P.C.), The Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Anesthesiology (S.P.C., S.R.G.) and Department of Physical Medicine and Rehabilitation (S.P.C., M.B.J., W.J.K., P.F.P.), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Surgery, Landstuhl Regional Medical Center, Landstuhl, Germany (O.C.C.); Department of Neurology, District of Columbia Veterans Affairs Hospital, Washington, District of Columbia (Z.Z.); Physical Medicine and Rehabilitation Service, Department of Orthopedic Surgery (P.F.P.), and Pain Treatment Center, Anesthesia Service, Department of Surgery (A.J.V., C.K., D.E.J., S.R.G.), Walter Reed National Military Medical Center, Bethesda, Maryland; Parkway Neuroscience and Spine Institute, Hagerstown, Maryland (T.M.L., S.E.S.); Puget Sound Veteran’s Hospital, Seattle, Washington (T.C.D.); Department of Pain Medicine, David Grant U.S. Air Force Medical Center, Travis Air Force Base, California (R.L.W.); Pain Medicine Center, Department of Anesthesiology, Naval Medical Center-San Diego, San Diego, California (I.M.F.); and Department of Anesthesiology, University of Washington, Seattle, Washington (T.C.D.).
  • Submitted for publication October 21, 2017. Accepted for publication May 1, 2018.
    Submitted for publication October 21, 2017. Accepted for publication May 1, 2018.×
  • Research Support: This research was funded by the Center for Rehabilitation Sciences Research, Bethesda, Maryland. This trial was registered in 2013 on clinicaltrials.gov: NCT02002429.
    Research Support: This research was funded by the Center for Rehabilitation Sciences Research, Bethesda, Maryland. This trial was registered in 2013 on clinicaltrials.gov: NCT02002429.×
  • Competing Interests: Dr. Cohen has served as a consultant to Halyard, Alpharetta, Georgia, Boston Scientific, Natick, Massachusetts, and Abbott, Abbott Park, Illinois, within the past 3 yr. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the U.S. Department of Defense.
    Competing Interests: Dr. Cohen has served as a consultant to Halyard, Alpharetta, Georgia, Boston Scientific, Natick, Massachusetts, and Abbott, Abbott Park, Illinois, within the past 3 yr. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the U.S. Department of Defense.×
  • Reproducible Science: Full protocol available at: scohen40@jhmi.edu. Raw data available at: scohen40@jhmi.edu.
    Reproducible Science: Full protocol available at: scohen40@jhmi.edu. Raw data available at: scohen40@jhmi.edu.×
  • Correspondence: Address correspondence to Dr. Cohen: 550 North Broadway, Suite 301, Baltimore, Maryland 21029. scohen40@jhmi.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Pain Medicine / Neurosurgical Anesthesia / Pain Medicine / Regional Anesthesia
Pain Medicine   |   May 2018
Effectiveness of Lumbar Facet Joint Blocks and Predictive Value before Radiofrequency Denervation: The Facet Treatment Study (FACTS), a Randomized, Controlled Clinical Trial
Anesthesiology Newly Published on May 29, 2018. doi:10.1097/ALN.0000000000002274
Anesthesiology Newly Published on May 29, 2018. doi:10.1097/ALN.0000000000002274
Abstract

Background: With facet interventions under scrutiny, the authors’ objectives were to determine the effectiveness of different lumbar facet blocks and their ability to predict radiofrequency ablation outcomes.

Methods: A total of 229 participants were randomized in a 2:2:1 ratio to receive intraarticular facet injections with bupivacaine and steroid, medial branch blocks, or saline. Those with a positive 1-month outcome (a 2-point or more reduction in average pain score) and score higher than 3 (positive satisfaction) on a 5-point satisfaction scale were followed up to 6 months. Participants in the intraarticular and medial branch block groups with a positive diagnostic block (50% or more relief) who experienced a negative outcome proceeded to the second phase and underwent radiofrequency ablation, while all saline group individuals underwent ablation. Coprimary outcome measures were average numerical rating scale pain scores 1 month after the facet or saline blocks and 3 months after ablation.

Results: Mean reduction in average numerical rating scale pain score at 1 month was 0.7 ± 1.6 in the intraarticular group, 0.7 ± 1.8 in the medial branch block group, and 0.7 ± 1.5 in the placebo group; P = 0.993. The proportions of positive blocks were higher in the intraarticular (54%) and medial branch (55%) groups than in the placebo group (30%; P = 0.01). Radiofrequency ablation was performed on 135 patients (45, 48, and 42 patients from the intraarticular, medial branch, and saline groups, respectively). The average numerical rating scale pain score at 3 months was 3.0 ± 2.0 in the intraarticular, 3.2 ± 2.5 in the medial branch, and 3.5 ± 1.9 in the control group (P = 0.493). At 3 months, the proportions of positive responders in the intraarticular, medial branch block, and placebo groups were 51%, 56%, and 24% for the intraarticular, medial branch, and placebo groups, respectively (P = 0.005).

Conclusions: This study establishes that facet blocks are not therapeutic. The higher responder rates in the treatment groups suggest a hypothesis that facet blocks might provide prognostic value before radiofrequency ablation.