311: Pulsed radiofrequency for managing lumbar facet joint-related chronic pain

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Developing methodology/technology, Non-pharmacological treatments, Treatment/management

Background and Aims: Low back pain (LBP) is a worldwide leading cause of disability, negatively impacting patients’ quality of life, social and health costs. Its management implies increased corticosteroid injections, opioid prescriptions, MRI use, and spinal surgery. The facet-joint impairment is a frequent pain generator of LBP. We aimed to assess the efficacy of pulsed radiofrequency (PRF) for managing lumbar facet joint-related chronic pain.

Methods: This observational study was conducted at the Pain Medicine Center of Bologna’s University Teaching Hospital. Between April and December 2025, n=12 adult patients with chronic LBP, compatible with facet joint origin, gave consent and thus were enrolled after a positive pain test and underwent ultrasound-guided PRF. Correct electrode placement was confirmed by impedance measurement (200-400 Ω) and by the patients’ sensory and motor stimulation response. PRF was delivered (T0) at 42°C and 50 V for 960 pulses (8-ms pulse duration; 5 Hz). Clinical outcomes were assessed at 7 (T1), 30 (T2), and 45 (T3) days after T0, using the Brief Pain Inventory (BPI) and PainDETECT (PD) questionnaires. Outcomes were thus compared between the four time points.

Results: The mean age in the sample was 68.0 ±14.1 years; 83.3% were females. All patients underwent a PRF procedure targeting the lumbar facet joints. The BPI outcomes’ longitudinal analysis revealed a progressive statistically significant reduction of all items. In particular, most items showed this reduction at T1, with consistent significance in the T0–T2 and T0–T3 comparisons. PD scores also showed, over time, a decrease in the neuropathic component, with its complete disappearance in the sample at T3. A progressive reduction in analgesic therapy was also observed from T0 to T3.

Conclusions: In routine clinical practice, identifying effective and safe chronic pain treatments is essential with the goal of reducing pain intensity and limiting adverse effects caused by multiple corticosteroid injections and long-term drug therapies. PRF, a minimally invasive technique with a favorable safety profile and neuromodulation effects, is emerging as a valid strategy for LBP treatment, to lower pain medication use, and to improve patients’ quality of life. This observational study provides clinical evidence for the use of the PRF in lumbar facet pain syndrome. Despite the limited sample size and short follow-up, the results showed an overall favorable trend in clinical outcomes.

References: 1. Manchikanti L, Boswell MV, Singh V, Pampati V, Damron KS, Beyer CD. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology. 2007;106(3):591–614.
2. Freynhagen R, Baron R, Gockel U, Tölle TR. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006;22(10):1911-1920.

Presenting Author: Boaz Samolsky Dekel
Submitting Author: Boaz Samolsky Dekel

Senior Author: Boaz Samolsky Dekel

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• luca Morini: MD - Anesthesiology, Intensive Care, and Pain Medicine Post-Graduate School, University of Bologna, Italy
• Martina Pardini: MD - Anesthesiology, Intensive Care, and Pain Medicine Post-Graduate School, University of Bologna, Italy
• Alessandro Trapani: MD - Anesthesiology, Intensive Care, and Pain Medicine Post-Graduate School, University of Bologna, Italy
• Galileo Vergari: MD - Anesthesiology, Intensive Care, and Pain Medicine Post-Graduate School, University of Bologna, Italy