Effectiveness of Radiofrequency Ablation for Chronic Low Back Pain: A Systematic Review of Sham-Controlled Randomized Controlled Trials

Abstract

Background: Radiofrequency ablation (RFA) is widely used as an interventional treatment for chronic low back pain; however, its clinical effectiveness across different pain generators remains uncertain, particularly when evaluated in rigorously controlled trials.

Objective: To systematically review randomized controlled trials assessing the effectiveness of RFA for chronic low back pain, stratified by pain generator and radiofrequency technique.

Methods: A systematic search of PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov was conducted to identify randomized controlled trials evaluating RFA for chronic low back pain. Trials employing sham or active comparator interventions were included. Study selection, data extraction, and risk of bias assessment were performed independently by two reviewers.

Results: Six randomized controlled trials involving different pain generators were included. For discogenic low back pain, RFA of the ramus communicans did not demonstrate superiority over sham treatment, with pain reduction observed over time in both groups. Similarly, for facet joint pain, medial branch RFA was not superior to sham procedures within the studied follow-up period. For sacroiliac joint pain, results were heterogeneous. Sham-controlled trials evaluating conventional lateral branch RFA did not demonstrate a specific treatment effect, whereas studies employing alternative techniques, including strip-lesion, capsular, or cooled RFA, were associated with greater and more sustained pain reduction, with statistically significant between-group differences reported at up to 12 months in selected trials.

Conclusion: Based on a limited number of randomized controlled trials, RFA does not consistently demonstrate superiority over sham treatment for discogenic or facet joint-related chronic low back pain. For sacroiliac joint pain, selected RFA techniques may offer benefit in appropriately selected patients; however, conclusions remain constrained by heterogeneity and small sample sizes. Further high-quality, sham-controlled trials are required before definitive clinical recommendations can be made.

Keywords: chronic low back pain; facet joint; radiofrequency ablation; randomized controlled trials; sacroiliac joint; sham-controlled trials.