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Background The past two decades have witnessed a surge in the use of cervical spine joint procedures including joint injections, nerve blocks and radiofrequency ablation to treat chronic neck pain, yet many aspects of the procedures remain controversial. Methods In August 2020, the American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine approved and charged the Cervical Joint Working Group to develop neck pain guidelines. Eighteen stakeholder societies were identified, and formal request-for-participation and member nomination letters were sent to those organizations. Participating entities selected panel members and an ad hoc steering committee selected preliminary questions, which were then revised by the full committee. Each question was assigned to a module composed of 4–5 members, who worked with the Subcommittee Lead and the Committee Chairs on preliminary versions, which were sent to the full committee after revisions. We used a modified Delphi method whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chairs, who incorporated the comments and sent out revised versions until consensus was reached. Before commencing, it was agreed that a recommendation would be noted with >50% agreement among committee members, but a consensus recommendation would require ≥75% agreement. Results Twenty questions were selected, with 100% consensus achieved in committee on 17 topics. Among participating organizations, 14 of 15 that voted approved or supported the guidelines en bloc, with 14 questions being approved with no dissensions or abstentions. Specific questions addressed included the value of clinical presentation and imaging in selecting patients for procedures, whether conservative treatment should be used before injections, whether imaging is necessary for blocks, diagnostic and prognostic value of medial branch blocks and intra-articular joint injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for designating a block as positive, how many blocks should be performed before radiofrequency ablation, the orientation of electrodes, whether larger lesions translate into higher success rates, whether stimulation should be used before radiofrequency ablation, how best to mitigate complication risks, if different standards should be applied to clinical practice and trials, and the indications for repeating radiofrequency ablation. Conclusions Cervical medial branch radiofrequency ablation may provide benefit to well-selected individuals, with medial branch blocks being more predictive than intra-articular injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of false-negatives (ie, lower overall success rate). Clinical trials should be tailored based on objectives, and selection criteria for some may be more stringent than what is ideal in clinical practice. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effectiveness and safety of radiofrequency (RF) ablation and neuromodulation modalities for knee osteoarthritis (OA). Methods The Pubmed, Medline, Embase, and Cochrane Library databases were searched from inception to August 2018. All comparative and noncomparative studies that reported clinical outcome measures and adverse events related to RF modalities for knee OA were included. Pain scores, physical function measures, quality of life (QOL), patient satisfaction, and adverse events for three months and beyond of postprocedure follow-up were analyzed qualitatively. Results Thirty-three studies, including 13 randomized controlled trials (RCTs), two nonrandomized comparative studies, and 18 noncomparative cohort studies, were identified, with 1,512 patients (mean age = 64.3 years, 32.5% males). All 33 studies were considered to be of moderate or high methodological quality. All 33/33 (100%) studies reported alleviation of OA-related knee pain from baseline until three to 12 months with RF modalities, with six comparative studies reporting 194/296 (65.5%) and 29/150 (19.3%) RF and control patients achieving >50% pain relief, respectively. Three of the 33 studies reported QOL, with three of three studies (100%) achieving improvements in disease-specific QOL from baseline until three to 12 months. Twenty-eight of the 33 studies reported functional outcomes, with 27/28 (96%) studies obtaining enhanced functionality from baseline up until three to 12 months. Ten of the 33 studies reported patient satisfaction, with eight of 10 studies (80%) indicating that patients were significantly satisfied after RF procedures, and from these eight studies, four were comparative studies that indicated that 86/154 (56%) and 33/104 (32%) RF and control patients were extremely satisfied or satisfied, respectively. Regarding adverse events (AEs), 29 of the 33 studies reported AEs, with 20/29 (69%) studies indicating no AEs related to the RF modalities and the remaining nine studies only indicating minor localized AEs. Twenty-nine of the 33 studies indicated no serious knee-related AEs pertaining to RF modalities. Conclusions Current evidence substantiates that RF modalities for knee OA potentially improve pain, functionality, and disease-specific QOL for up to three to 12 months with minimal localized complications. This suggests that RF modalities are perhaps an effective adjunct therapy for patients with knee OA who are unresponsive to conservative therapies. Further RCTs with larger sample sizes and long-term follow-up that directly compare the three primary RF modalities are warranted to confirm the clinical efficaciousness and superiority of these RF modalities for knee OA. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to a paper by K. Van Boxem et al on the results of pulsed radiofrequency (PRF) for chronic intractable pain.