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Cryoneurolysis versus radiofrequency ablation outcome on pain experience in chronic low back pain (COPE): a single-blinded randomised controlled trial
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  • Published on:
    Letter to the editor regarding non validated patient and radiofrequency technique for facet pain: re: Truong K. et al.
    • Koen Van Boxem, Pain therapist Pain Center, Ziekenhuis Oost-Limburg, Belgium
    • Other Contributors:
      • Steven P.C Cohen, Pain therapist
      • Javier De Andrès-Ares, Pain therapist
      • Sandra van den Heuvel, Pain therapist
      • Jan Van Zundert, Pain therapist

    We congratulate Truong et al. for performing an RCT with long-term follow-up of patients with chronic low back pain. We do, however, have major concerns regarding significant methodological flaws in this study.
    Patient selection is critical in determining outcomes after interventional pain treatments and image guidance is regarded an essential component of performing procedures for pain management. 1 This is in sharp contrast with the present study: the method used to select the target facet joints wasn’t described and patients were diagnosed with facet joint pain based on a blind injection of local anesthetic around the facet joint. This was performed by a single physician using spinous processes as landmarks. Although there is ongoing debate regarding the sensitivity and specificity of diagnostic blocks, this technique lacks validity. 2 Studies have also shown a higher predictive value when medial branch blocks (vs. facet joint blocks) are used as diagnostic tools.
    As a result, the percentage of patients with a positive response after their diagnostic block was extraordinarily high, much higher than the prevalence rate as determined by high-quality studies using rigorous selection criteria. Only 14 out of 261 patients reported a negative test block.2
    Furthermore, studies have shown that even small volumes (< 0.5 mL) of local anesthetic injected under fluoroscopic guidance can lead to false-positive results via the spread of the injectate into pain-...

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    Conflict of Interest:
    None declared.