Long-term Follow-up of Patients Treated with Cervical Radiofrequency Neurotomy for Chronic Neck Pain

To the Editor: I am concerned about the conclusions expressed in the article by McDonald et al. (1) regarding the use of radiofrequency neurotomy for 28 patients with chronic neck pain. They have described a procedure that has no permanent benefit in a group of patients whose treatment is frequently very difficult. The use of this procedure could interfere with the more functional aspects of rehabilitation usually needed in this condition. In my opinion, giving patients a few months of false hope by relieving symptoms temporarily cannot reasonably be construed as being “satisfying.” Some 25 years ago, our medical practice asked a physician who was not affiliated with our group to evaluate the patients on whom we had performed lumbar facet neurotomy for chronic low back pain. After approximately 6 months of follow-up, the remarkably beneficial immediate effects had all but dissipated. We concluded that the procedure did not work to provide any real benefit, and we stopped using it. It seems that a new generation cannot admit to the failure of a procedure, even when their own data indicate it. The complexity of the situation of a patient with chronic neck pain is commonly epitomized by the description of “biopsychosocial problems.” A procedure that produces only a short-term benefit with known late failure has to be justified in its global value to the patient before it can be accepted as anything more than a gimmick. A more reasonable conclusion would be that this procedure fails to provide long-term benefits. Therefore, indications for its use must be developed before it can be recommended. It is important to note that the dashed hopes created by an only brief period of relief in the patient with chronic pain can have disastrous effects on the patient’s psyche and on his or her level of participation in rehabilitation. Joel L. Seres