Portal de Periódicos da CAPES

Letters

2010; Lippincott Williams & Wilkins; Volume: 35; Issue: 7 Linguagem: Inglês

10.1097/brs.0b013e3181d2ad36

1528-1159

Jan Van Zundert, Pascal Vanelderen, Alfons G.H. Kessels,

Pain Management and Treatment

To the Editor: Re: Chou R, Atlas SJ, Stanos SP, et al. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine (Phila Pa 1976) 2009;34:1078–93. In a systematic review, Chou et al1 assessed the benefits and harms of different forms of nonsurgical intervention therapy for low back pain. With respect to radiofrequency denervation of the facet joint, they came to the conclusion that there is insufficient (poor) evidence from randomized trials to reliably evaluate this therapy. Unfortunately, they did not comply with general guidelines of writing a systematic review of randomized controlled trials (Quality of Reporting of Meta-Analyses [QUOROM] and now Preferred Reporting Items for Systematic Reviews and Meta-analyses [PRISMA]).2,3 Because they did not present the outcomes of the trials in a structured way, it is rather a narrative review. This also applied to the 6 trials4–9 on which they concluded that there was poor evidence for radiofrequency denervation of the facet joint. Indeed, several of these 6 trials have shortcomings. Three studies did not report the standard errors of the change in time.4,6,9 One study did not do an intention-to-treat analysis,4 and in another study flaws were detected in the assessment of the diagnostic block.7 To analyze the effect of the intervention, we performed a meta-analysis including all these 6 trials, which showed a significantly better effect of radiofrequency compared with placebo: 95% confidence interval was 0.6 to 1.5 on a 10-point scale, P < 0.001. Furthermore, if we included only the trials without shortcomings,5,8 the analysis even showed a significantly better result for radiofrequency: 95% confidence interval was 0.7 to 3.1 on a 10-point scale, P = 0.002. The results of these 2 different analyses indicate that radiofrequency treatment of the facet joint is significantly more effective than placebo. Jan Van Zundert, MD, PhD Department of Anesthesiology and Multidisciplinary Pain Centre Ziekenhuis Oost-Limburg Genk, Belgium Department of Anesthesiology and Pain Therapy Maastricht University Medical Centre Maastricht, The Netherlands Pascal Vanelderen, MD Department of Anesthesiology and Multidisciplinary Pain Centre Ziekenhuis Oost-Limburg Genk, Belgium Alfons G. H. Kessels, MD, MSc Department of Clinical Epidemiology and Medical Technology Assessment University Hospital Maastricht Maastricht, The Netherlands