Current evidence on radiofrequency denervation for chronic low back pain: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract; statistical significance implied but clinical significance explicitly negated by MCID analysis

• Effect Size: Small improvements in pain and function with RF denervation versus sham/comparator across all subtypes; specific standardised mean differences not reported in abstract

• Primary Outcome: Pain intensity and functional disability at short-, medium-, and long-term follow-up across four chronic LBP subtypes (facet joint, sacroiliac joint, discogenic, non-specific)

• Nnt Or Sensitivity: No NNT reported; MCID thresholds were not exceeded for any outcome or subtype, indicating that statistically significant effects lack clinical meaningfulness. Certainty of evidence: very low to moderate (GRADE)

• Confidence Interval: Not reported in abstract; full paper required for specific estimates

Clinical Application

RF denervation is a specialist procedural intervention requiring fluoroscopic or ultrasound guidance, available in pain medicine, interventional radiology, and neurosurgery settings. Procedural costs, access inequity (particularly in rural and regional Australia), and the need for repeat procedures (nerve regeneration typically occurs within 6–12 months) are significant feasibility considerations. The lack of MCID-exceeding effects raises questions about cost-effectiveness at a health system level. In Australia, RF denervation for chronic LBP is performed under Medicare Benefits Schedule (MBS) item numbers for percutaneous procedures (e.g., MBS 39115 for facet joint denervation). The Therapeutic Goods Administration (TGA) has approved RF devices used in these procedures. The RACGP and Spine Society of Australia guidelines recommend RF denervation only after failure of conservative management and positive diagnostic block response. This meta-analysis — finding no MCID-exceeding benefit — aligns with the cautious, stepwise approach recommended in Australian musculoskeletal guidelines and supports ongoing scrutiny of MBS-funded procedural indications. The findings are relevant to current MBS Review Taskforce deliberations on interventional pain procedures. PBS listing of pharmacological alternatives (e.g., duloxetine, pregabalin) should be considered in the context of this evidence. Adults with chronic LBP (>3 months duration) attributed to facet joint, sacroiliac joint, discogenic, or non-specific sources who have not responded adequately to conservative management. Most applicable to patients who have demonstrated a positive response to diagnostic medial branch or lateral branch blocks prior to RF denervation consideration.

Abstract

OBJECTIVE: To assess the effects of radiofrequency (RF) denervation for chronic low back pain (LBP) from facet joint, sacroiliac joint, discogenic and non-specific pain. DESIGN: Systematic review and meta-analysis. DATA SOURCES: We searched Medline, Embase, Cochrane Library, CINAHL, PsycINFO, ClinicalTrials.gov and WHO ICTRP up to 18 February 2025 for randomised controlled trials (RCTs). STUDY SELECTION, DATA EXTRACTION AND SYNTHESIS: Pairs of reviewers independently selected studies, extracted data and assessed risk of bias (Cochrane RoB 2). Meta-analyses with clinically homogeneous studies were performed and certainty of evidence was assessed using Grades of Recommendation, Assessment, Development and Evaluation. RESULTS: 55 RCTs (n=4394) were included; many outcomes were at some risk of bias. Low to moderate certainty evidence suggested small improvements in pain and function with RF denervation versus sham for facet joint pain, sacroiliac, discogenic and non-specific chronic LBP. None exceeded predefined minimally clinically important between-group differences, suggesting limited clinical relevance. CONCLUSIONS: RF denervation showed small improvements in pain and function compared with sham, steroid injection or standard care, but the effects did not reach clinically meaningful thresholds and the certainty of evidence was very low to moderate. Additional research is needed to clarify the effects of RF denervation and guide clinical decision-making. PROSPERO REGISTRATION NUMBER: CRD42023460743.

References

1. 1.Truong, K. M. T. L., Maas, E., Rasmussen, M. M., Ostelo, R., Hurri, H., & van Tulder, M. W. (2026). Current evidence on radiofrequency denervation for chronic low back pain: a systematic review and meta-analysis. BMJ Open. https://doi.org/10.1136/bmjopen-2025-105106