Repeated medial branch blocks do not improve pain outcomes for thermal radiofrequency ablation

1. For patients with facet-mediated spine pain that achieve ≥80% pain relief after a medial branch block, a second diagnostic block does not improve post-radiofrequency ablation pain outcomes but may delay definitive treatment.

Evidence Rating Level: 2 (Good) 

This retrospective study examined whether receiving one versus two medial branch blocks (MBBs) prior to thermal radiofrequency ablation (tRFA) influenced pain outcomes in patients with facet-mediated spine pain. Existing guidelines often recommend dual MBBs before tRFA, though their necessity remains controversial. At a single academic center, 645 tRFA procedures performed between 2017 and 2021 were screened, yielding 312 cases with adequate follow-up data: 161 underwent one MBB and 151 received two. All patients had ≥80% pain relief after MBB, the center’s threshold for a positive diagnostic block. Pain outcomes at 3 months post-tRFA were assessed and compared using t-tests and χ² analyses. The average reported pain relief was 69.5%, with 85.3% of patients reporting ≥50% relief and 58.3% reporting ≥80% relief—no significant differences emerged between the one- and two-block groups. However, the time from the first MBB to tRFA was significantly longer in the two-block group (95.3 vs. 44.2 days, p<0.001). These findings align with prior research suggesting minimal added value of a second diagnostic block in predicting tRFA success and support recent guideline revisions discouraging routine use of dual MBBs. Limitations include the retrospective design, exclusion of many cases due to incomplete data, and reliance on self-reported pain outcomes.

Click to read the study in RAPM

Image: PD

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