Neck Pain, Zygapophyseal Joint Arthritis
Conditions
Keywords
Radiofrequency neurotomy, Cervical Medial Branch Nerves
Brief summary
Aim of the EndPaRL study is to compare the efficacy and effectiveness of the two techniques utilizing sharp straight conventional radiofrequency needle with a trident needle for radiofrequency neurotomy of Cervical Medial Branch Nerves (CMBNs), in patients presenting with chronic, moderate-to-severe, neck pain due to cervical zygapophyseal joint osteoarthritis, as diagnosed by positive responses to two consecutive diagnostic blocks with local anesthetic of the CMBN.
Interventions
PROCEDURERadiofrequency neurotomy (RFN) of Cervical Medial Branch Nerves (CMBNn) with parallel lesioning
Intervention type: RF nerve lesioning at 80-85 degree Celsius for 90 seconds Intervention name: Straight sharp conventional (SIS's technique) Intervention description: Technique as described in the SIS Practice Guidelines for parallel lesioning cannulae placement
PROCEDURERadiofrequency neurotomy (RFN) of Cervical Medial Branch Nerves (CMBNn) with end-on lesioning with multitined trident cannulae
Intervention type: RF nerve lesioning lesioning at 80-850 Celsius for 90 seconds Intervention name: End-on placement of the multitined trident cannulae Intervention description: Patient in lateral position, targeting joint position between the inferior C2 and superior C3 facets, the middle of the facet pillars for the third to fifth cervical levels, and the superior part of the sixth and seventh cervical facets.
Sponsors
University Health Network, Toronto
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
1. Adult patient of either gender aged 18-85 years 2. Predominant axial (non-radicular) neck pain for at least 3 months 3. 7-day average NRS score for neck pain ≥ 5/10 at baseline evaluation 4. Moderate or greater functional impairment due to pain, defined as NDI Questionnaire raw score of 15 out of 50 (≥30% )e Failure to respond to conservative medical management (pharmacologic, physical therapy) for at least 3 months; f) Positive response to two consecutive diagnostic blocks of the CMBN with a short and long-acting anesthetic
Exclusion criteria
1. Participants with financial incentives or litigation associated with ongoing pain 2. Inability to complete assessment instruments 3. Chronic widespread pain 4. Prior RFN of the CMBN; 5. Severe mental health issues 6. Pregnancy or other reason that precludes the use of fluoroscopy 7. Untreated coagulopathy 8. Systemic or local infection at the time of screening.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Difference in mean Numerical Rating Scale (NRS) for pain scores | 3 months | Difference in the mean pain scores before and after procedure. Scale from 0 to 10, where higher scores mean worse outcome |
| Proportion of patients with positive analgesic response | 3 months | Proportion of patients with positive analgesic response (≥50% reduction in the NRS score for neck pain compared to baseline) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Difference in the mean Numerical Rating Scale (NRS) for pain scores | at 1, 6 and 12 months | Difference in mean NRS for pain scores at 1, 6 and 12 months after the RFA procedure. Scale from 0 to 10, where higher scores mean worse outcome |
| Proportion of patients with positive analgesic response | at 1,3, 6 and 12 months | Proportion of patients with positive analgesic response (≥50% reduction in the NRS score for neck pain compared to baseline) at 1,3, 6 \& 12 months |
| Proportion of patients with reduction in the Neck Disability Index (NDI) score | at 1, 3, 6, and 12 months | Proportion of patients with ≥10% reduction in the NDI score at 1, 3, 6, and 12 months. Scale from 0 to 50, where higher scores mean worse outcome |
| Proportion of participants reporting improvement in the Patient Global Impression of Change (PGIC) scale | at 1, 3, 6, and 12 months | PGIC score is a 7 point scale depicting a patient's subjective rating of overall improvement over time, as proportion of participants reporting improvement in the PGIC scale at 1, 3, 6, and 12 months |
| Difference in mean Pittsburgh Sleep Quality Index (PSQI) scores for sleep quality | at 1, 3, 6, and 12 months | Difference in mean PSQI scores scores at 1, 3, 6, and 12 months. It has a range of 0-21; higher scores indicate worse sleep quality. |
| Difference in mean European Quality of Life (EQ-5D-5L score), a self-assessed, health related, quality of life questionnaire. It ranges from 5 to 25, where higher scores indicate worse outcome. | at 1, 3, 6, and 12 months | Difference in mean EQ-5D-5L scores at 3, 6, and 12 months |
| Differences in duration of procedure between 2 groups | day of procedure | Differences in duration of procedure in two groups |
| Differences in discomfort procedure between 2 groups | day of procedure | Differences in patient discomfort of procedure |
| Differences in radiation dose of procedure between 2 groups | day of procedure | Differences in radiation dose of procedure |
| Differences in cost of procedure between 2 groups | day of procedure | Differences in cost of the procedures |
| Difference in opioid requirements in daily oral morphine equivalents between the groups | at 3, 6, and 12 months follow-ups after the procedure | Difference in opioid requirements in daily oral morphine equivalents in mg averaged over the 1 week before and at 3, 6, and 12 months follow-ups after the procedure |
| Difference in average physical activity and sleep duration | 1 week before the procedure and 1 month after the procedure | Difference in average physical activity and sleep duration as measured by wrist-worn actigraphy worn for 1 week before the procedure and 1 month after the procedure |
| Difference in incidence of peri-procedural complications and post-procedural adverse effects following the RFN procedure | at 1, 3, 6, and 12 months after the procedures | Difference in incidence of peri-procedural complications and post-procedural adverse effects following the RFN procedure in the two groups during and at 1, 3, 6, and 12 months after the procedures |
| Patient assumption of the group assigned | at 3 months after procedure | Patient assumption of the group assigned at 3 months after the RFN procedure |
Countries
Canada, Spain
Contacts
CONTACTDanielle Alvares, PhD
PRINCIPAL_INVESTIGATORAnuj Bhatia, MD, PhD
Department of Anesthesia and Pain Management, University Health Network, Toronto
Outcome results
None listed