The comparison of effectiveness of transcutaneous electrical nerve stimülation, conventionel radiofrequency and pulse radiofrequency treatment methods in patients with lumbar faset joint pain syndrome

Aim: In this prospective, randomized, single blind study, we aimed to compare the effectiveness of TENS ( transcutaneous electrical nevre stimulation) which is used in physical therapy departments and conventional radiofrequency (RF), thermocoagulation and pulse radiofrequency (RF) which ise used in algology departments in patients whithlumbar facet syndrome. Materials and methods: Subjects were selected from patients with chronic lower back pain visiting outpatient clinics of physical therapy and algology departments of Ege University School of Medicine and whose pain was refractory to medical treatment of at least 3 months. Patients who met the inclusion criteria and who were responsive to the diagnostic test intervention in the algology department were enrolled in the study. Subjects were randomized into 3 groups. A total of 60 patients, 20 patients in each group were enrolled. Patients in the first group received one time conventional RF thermocoagulation. Patients in the second group received conventional TENS 30 minutes a day for 15 days. Patients in the third group received pulse RF. Also all subjects were given a home exercise program consisting of lumbar range of motion and isometric exercises with limited lumbar extension and rotation, for the whole follow up period of six months, at least 2 times a week. Patients were assessed at baseline, at the end of first and sixth months for a total of three times. Findings: For the first group which received conventional RF, we detected a significant improvement from the baseline to both first and sixth month assessments in fingertip to floor distance, VAS pain score, Oswestry disability score, Beck depression score and physical role, pain, mental health subscores of SF-36 (p<0,05). For the second group which received TENS, we detected significant intragroup improvement for 20 m walk distance, VAS pain score, Oswestry score, physical role, pain, vitality subgroups of SF-36 between baseline and first and sixth month visits (p<0,05). In the third group which received pulse RF, we detected significant improvement in fingertip to floor distance, six minute walk test, VAS pain score, Oswestry score, Oswesr disability score, Beck depression score, physical role, pain, phsical function subscores of SF-36 (p<0.05). In the intergroup comparison of the groups, no significant superiority was detected among the 3 groups in any of the parameters (p>0,05) Discussion: Currently, TENS which is a physical therapy modality and conventional RF and pulse RF which are algological treatment modalities are successfully applied to patients with lumbar facet syndrome and previous studies have proven their effectiveness. But there are no studies comparing the effectivenes of TENS which is a noninvasive treatment to that of RF treatments which are invasive modalities. In our study, we found that TENS treatment is as effective as conventional and pulse RF in improving pain, lumbar movement and quality of life, both short and long term. We suggest it might be more appropriate to use TENS which is a non-invasive treatment before trying more invasive procedures like conventional and pulse RF in these patients. There is still a need for more high quality studies enrolling larger samples of patients.