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  • Recent data from radiofrequency denervation trials further emphasise that treating nociception is not the same as treating pain

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Recent data from radiofrequency denervation trials further emphasise that treating nociception is not the same as treating pain
  1. Matthew K Bagg1,2,3,
  2. James H McAuley1,2,
  3. G Lorimer Moseley1,4,
  4. Benedict Martin Wand5
  1. 1 Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
  2. 2 Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
  3. 3 New College Village, University of New South Wales, Sydney, New South Wales, Australia
  4. 4 Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
  5. 5 School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
  1. Correspondence to Matthew K Bagg, Neuroscience Research Australia, 139 Barker St Randwick, NSW 2031, Australia; m.bagg{at}neura.edu.au

https://doi.org/10.1136/bjsports-2017-098510

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    Persistent low back pain (LBP) is the leading cause of disability globally, for which ever-larger increases in healthcare expenditure have not made a difference in terms of prevalence or burden.1 It is unquestionable that current healthcare is failing individuals with chronic LBP, and we contend that recent evidence from the interventional pain medicine field points clearly to what these failings are.

    Radiofrequency denervation does not work for LBP

    There has been remarkable growth in the use of interventional pain medicine procedures to manage chronic LBP, particularly radiofrequency denervation.2 In this approach, various diagnostic practices are used to identify a peripheral ‘nociceptive driver’, with the presumption that denervation of the peripheral structure will eradicate or significantly reduce pain and improve function.3 The growth in the use of radiofrequency denervation is surprising given that, until recently, the evidence base was equivocal2 and based on conflicting results from a limited number of small trials.

    A welcome addition to the field was recently provided by Juch et al,2 who reported on the outcome of three large clinical trials of neuroablative procedures in chronic LBP. All three trials compared guideline-based physical rehabilitation to rehabilitation with the addition of radiofrequency denervation. Despite employing a …

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    Footnotes

    • Contributors MKB and BMW wrote the first draft of the manuscript. GLM and JHM contributed importantly to the manuscript for intellectual content and style. All authors read and approved the final version of the manuscript.

    • Funding MKB is supported by an Australian Research Training Program Scholarship, a UNSW Research Excellence Award and a NeuRA PhD Candidature Supplementary Scholarship. JHM is supported by the National Health and Medical Research Council (NHMRC) of Australia project grants ID1087045 and ID1047827. GLM is supported by an NHMRC Principal Research Fellowship, ID1061279. The aforementioned funding bodies and organisations had no role in the conception or writing of the manuscript.

    • Competing interests MKB received conference travel support from the Chiropractors' Association of Australia to speak about pain neuroscience and rehabilitation. GLM receives speaker’s fees for lectures on pain and rehabilitation. GLM received payment for contributions to Pfizer’s web-based pain education strategy; and has received support from Kaiser Permanente (USA), workers’ compensation boards in Australia, North America and Europe, Noigroup Australasia, Agile Physiotherapy (USA), Results Physiotherapy (USA), the IOC, the Arsenal Football Club, and the Port Adelaide Football Club. GLM receives royalties for books about pain and rehabilitation.

    • Provenance and peer review Not commissioned; externally peer reviewed.