Background and objectives We hypothesized that patients with characteristics of centralized pain (fibromyalgia (FM)-like phenotype) would be less likely to respond to radiofrequency ablation (RFA), which may explain some of the failures of this peripherally directed therapy.
Methods We conducted a prospective, observational study of patients undergoing RFA using a number of validated self-report measures of pain, mood and function. The 2011 Fibromyalgia Survey Criteria were used to assess for symptoms of centralized pain and was the primary predictor of interest. We constructed multivariable linear regression models to evaluate covariates independently associated with change in pain 3 months after RFA.
Results 141 patients scheduled for medial branch blocks were enrolled in the study; 55 underwent RFA (51 with complete 3 months’ follow-up). Patients with higher FM scores had less improvement in overall body pain; however, this was not statistically significant (adjusted mean change in pain FM+0.41, FM−1.11, p=0.396). In a secondary analysis, the FM score was not associated with change in back pain (p=0.720), with both groups improving equally. This cohort also reported significant improvement in anxiety, physical function, catastrophizing, and sleep disturbance at 3 months after RFA.
Conclusions Although patients with high baseline centralized pain exhibited less improvement in overall pain, this trend was not statistically significant, possibly due to insufficient power. The same trend was not seen with change in spine pain with both groups improving equally. Centralized pain patients may have less improvement in overall pain but may have equal improvement in their site-specific pain levels after localized interventions.
- radiofrequency ablation
- pain medicine
- chronic pain: central pain syndromes
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Contributors Each author contributed significantly in the study and manuscript. DM took part in the reporting, conduct, analysis of data, interpretation of data, manuscript preparation, and review of final manuscript. DBL participated in reporting, interpretation of data, manuscript preparation, and review of final manuscript. JG took part in the planning, conduct, reporting, interpretation of data, manuscript preparation, and review of final manuscript. ALH took part in the planning, conduct, reporting, conception and design, interpretation of data, and review of final manuscript. CMB and SEM were involved in all aspects of the study, including conception and design, planning, conduct, reporting, analysis and interpretation of data, manuscript preparation, and review of final manuscript.
Funding This study has been funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (P50 AR070600 R01, AR060392) and the American Society of Regional Anesthesia and Pain Medicine.
Competing interests CMB is a consultant for Recro Pharma (Malvern, PA) and Heron Therapeutics (San Diego, CA); not related to the present work. CMB receives research funding from Neuros Medical (Willoughby Hills, Ohio); also not related to present work. ALH is a consultant for AbbVie Pharmaceutical Research and Development–not related to present work.
Patient consent for publication Not required.
Ethics approval University of Michigan Institutional Review Board (Ann Arbor, MI)
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.