Xu Bo, Zhao Xudong, Zhang Lei, Feng Shouhan, Li Jinxia, Xu Ye
Acupuncture and Rehabilitation Department, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou, Zhejiang, People's Republic of China.
Physical Therapy Center, Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Huzhou, Zhejiang, People's Republic of China.
J Pain Res. 2024 Sep 4;17:2903-2916. doi: 10.2147/JPR.S469615. eCollection 2024.
Pain management for spinal facet joint (SFJ) and sacroiliac joint (SIJ) pain is challenging, often requiring interventions like radiofrequency ablation (RFA) or corticosteroid injections (CI). This study aims to assess and compare the effectiveness of CI and RFA in treating SFJ and SIJ pain. We combine these treatments due to their shared pathophysiology, similar therapeutic interventions, and the necessity for an integrated approach to spinal pain management.
Literature search from PubMed, Scopus, CENTRAL and Google Scholar for published studies upto 31 December 2023, and reporting data of patients who were treated using CI of RFA for SFJ and SIJ pain. Pooled standardized mean difference (SMD) with a 95% Confidence Interval (CI) was calculated.
Our meta-analysis incorporated thirteen studies. Overall, patients, treated with CI had a higher pain intensity score compared to patients treated with RFA (SMD=0.92; 95% CI: 0.19 to 1.65) at 3 months, and at 6 months (SMD=1.53; 95% CI: 0.66 to 2.40) after the treatment. No significant association was reported at 12 months (SMD=1.47; 95% CI: -0.03 to 2.97). Subgroup analysis based on joint types revealed increased pain intensity scores in patients who were treated with CI for SIJ (SMD=1.25; 95% CI: 0.39 to 2.11) and SFJ (SMD=1.33; 95% CI: 0.09 to 2.57) pain. A negative but not significant effect was detected in patients, treated with CI for cervical joint pain (SMD=-0.40; 95% CI: -0.90 to 0.10). Patients treated with CI exhibited higher functional disability score compared to patients treated with RFA at 3 months (SMD=1.28; 95% CI: 0.20 to 2.35) post-treatment.
This study suggests that RFA may offer superior pain relief with longer duration compared to steroid injections for spinal facet and sacroiliac joint pain. Decision regarding specific interventions should be individualized and consider patient preferences, clinical context, and potential risks.
脊柱小关节（SFJ）和骶髂关节（SIJ）疼痛的疼痛管理具有挑战性，通常需要进行射频消融（RFA）或皮质类固醇注射（CI）等干预措施。本研究旨在评估和比较CI和RFA治疗SFJ和SIJ疼痛的有效性。我们将这两种治疗方法结合起来，因为它们具有共同的病理生理学、相似的治疗干预措施，以及采用综合方法进行脊柱疼痛管理的必要性。
从PubMed、Scopus、CENTRAL和谷歌学术搜索截至2023年12月31日发表的研究，并报告使用CI或RFA治疗SFJ和SIJ疼痛的患者数据。计算合并标准化均数差（SMD）及95%置信区间（CI）。
我们的荟萃分析纳入了13项研究。总体而言，治疗后3个月和6个月时，接受CI治疗的患者的疼痛强度评分高于接受RFA治疗的患者（SMD = 0.92；95% CI：0.19至1.65）以及（SMD = 1.53；95% CI：0.66至2.40）。12个月时未报告显著相关性（SMD = 1.47；95% CI：-0.03至2.97）。基于关节类型的亚组分析显示，接受CI治疗的SIJ（SMD = 1.25；95% CI：0.39至2.11）和SFJ（SMD = 1.33；95% CI：0.09至2.57）疼痛患者的疼痛强度评分增加。在接受CI治疗的颈椎关节疼痛患者中检测到负性但不显著的效应（SMD = -0.40；95% CI：-0.90至0.10）。治疗后3个月时，接受CI治疗的患者的功能障碍评分高于接受RFA治疗的患者（SMD = 1.28；95% CI：0.20至2.35）。
本研究表明，对于脊柱小关节和骶髂关节疼痛，与类固醇注射相比，RFA可能提供更好的疼痛缓解且持续时间更长。关于具体干预措施的决策应个体化，并考虑患者偏好、临床情况和潜在风险。
