Health insurers and the government should not be funding an invasive procedure for chronic back pain for which there is now evidence of no benefit, according to a leading back pain researcher.
Professor Chris Maher, director of musculoskeletal health research in the University of Sydney’s School of Public Health, said the findings from the MINT trials recently published in JAMA should shut down any remaining debate about radiofrequency denervation.
“I think it’s pretty clear that radiofrequency denervation doesn’t work. If you cherry pick the results you might find a statistically significant benefit at one time-point for one outcome, but when you look at the whole picture from the MINT trials, it doesn’t seem to work.”
The suite of three trials in the Netherlands compared radiofrequency denervation and exercise with exercise alone in patients with chronic low back pain originating from either the facet joint, the sacroiliac joint or a combined source including facet and sacroiliac joints and intravertebral discs.
The trials found the intervention provided either no statistically significant benefit in terms of a reduction in pain intensity after three months, or none that met a pre-determined threshold for clinical significance (2 points on an 11 point numerical rating scale).
Professor Maher told the limbic the procedure was readily available for back and neck pain at clinics around the country – with many making misleading claims about its evidence base.
“It’s based on an old fashioned idea of pain; but managing chronic pain is much more complex than turning off one isolated nerve.”
Professor Maher said the Netherlands study was designed to provide the definitive evidence on which to base funding decisions by government and insurers.
“Clinicians, funders and researchers agreed to the protocol and they expected the trial to be a fair test of the treatment,” he said.
“Now is the time to stop. As per vertebroplasty, we need to remove the MBS item number for this procedure.”