Approximately 60 patients with cervical facet arthropathy who are undergoing cervical
radiofrequency ablation (RFA) will be recruited for this study. Only patients who have
already been deemed candidates by their primary pain physician for cervical RFA (e.g. >
50% relief from a diagnostic cervical medial branch block) will be recruited. During the
cervical RFA procedure, all patients will undergo sensory and motor stimulation testing
prior to receiving radiofrequency lesioning, which is a standard and recommended
practice. The investigators will align the electrodes to optimize sensory testing.
During the motor stimulation testing step, the pain physicians performing the procedure
(e.g. attending, fellows, residents, etc.) will assess the presence or absence of
cervical paraspinal muscle twitching by using a standardized grading scale (per
radiofrequency electrode: 0 = no twitches observed or palpated; 1 = twitches palpated but
not observed; 2 = twitches observed and palpated at 1-2 levels; 3 = twitches observed at
> 2 levels). A total score and a weighted score (total score divided by the number of
radiofrequency lesion sites), will be recorded for each patient, and the RFA procedure
will be completed per usual practice.
The interventional procedure used in this study (radiofrequency ablation) will be
performed in the usual manner and as per "standard of care." The use of the grading scale
described above to assess the presence/absence and magnitude of cervical paraspinal
muscle twitching will be unique to this research study.
The investigators will also obtain the following data immediately pre-procedurally, from
electronic health record review and also a standardized set of questionnaires provided to
study participants:
Information routinely obtained as standard practice: age, sex, average and worst
neck pain score over the past week on numeric rating scale (NRS), percent pain
relief from diagnostic block, duration of pain, inciting event, MRI findings if
available, obesity (defined as BMI > 30), smoking, co-existing pain conditions,
co-existing psychiatric conditions, and potential sources of secondary gain (e.g.
worker's compensation claim, ongoing litigation, etc.)
Information obtained as part of the research study: Neck Disability Index (NDI)
score, Athens Insomnia Scale (AIS) score, Hospital Anxiety and Depression Scale
(HADS) scores.
At a 1-month post-procedural follow-up timepoint, the investigators will obtain the
following data, from electronic health record review and also a standardized set of
questionnaires provided to study participants:
Information routinely obtained as standard practice: categorical binary outcome
(positive outcome defined as >/= 2-point decrease in average neck pain score coupled
with PGIC score >/= 5/7) analgesic medications and doses; status of medication
reduction (yes or no); average and worst NRS pain score over the past week;
description of any procedural complications
Information obtained as part of the research study: NDI, AIS, and HADS scores;
Patient Global Impression of Change Scale (PGIC) score
Exiting the trial: patients may choose to exit the study at any time for any reason.
A patient will exit the study to receive alternative care if the patient reports a
PGIC score <5 or < 2-point reduction in average NRS pain score. This would indicate
that the RFA treatment was unsuccessful.
At a 3-month post-procedural follow-up timepoint, the investigators will obtain the
following data, from electronic health record review and also a standardized set of
questionnaires provided to study participants:
Information routinely obtained as standard practice: categorical binary outcome,
analgesic medications and doses; status of medication reduction (yes or no); average
and worst NRS pain score over the past week; description of any procedural
complications
Information obtained as part of the research study: NDI, AIS, and HADS scores;
Patient Global Impression of Change Scale (PGIC) score on 7-point Likert scale
Exiting the trial: patients may choose to exit the study at any time for any reason.
A patient will exit the study to receive alternative treatment if the patient
reports a PGIC score <5 or < 2-point reduction in average NRS pain score. This would
indicate that the analgesic and functional benefit of the RFA procedure has now been
exhausted.
At a 6-month post-procedural follow-up timepoint, the investigators will obtain the
following data, from electronic health record review and also a standardized set of
questionnaires provided to study participants:
Information routinely obtained as standard practice: binary categorical outcome,
analgesic medications and doses; status of medication reduction (yes or no); average
and worst NRS pain score over the past week; description of any procedural
complications
Information obtained as part of the research study: NDI, AIS, and HADS scores;
Patient Global Impression of Change Scale (PGIC) score
Exiting the trial: All patients who remain in the study will exit at 6 months.