Study on Radiofrequency Ablation for Low Back Pain Receives $6.4 Million NIH Grant

A study on radiofrequency ablation for chronic low back pain has received a $6.4 million grant from the National Institute Of Arthritis And Musculoskeletal And Skin Diseases of the National Institutes of Health. The study, titled "A Superiority Trial of Radiofrequency Ablation for Low Back Pain (ASTRAL)," will be a large-scale, multi-center trial. Its goal is to evaluate the effectiveness of lumbar radiofrequency ablation (LRFA) in treating chronic low back pain (CLBP).

LRFA is a minimally invasive procedure that targets nerves in the lumbar spine to reduce pain. Although it shows promise, previous research on the procedure has produced mixed results, with some studies finding little benefit. Researchers believe these inconsistent findings may be due to variations in technique or inadequate patient selection. By adhering to the highest clinical and research standards, the ASTRAL trial aims to resolve these uncertainties and provide valuable insights into the role of LRFA in managing low back pain. 

In addition to providing clinical insights, this trial could have immediate financial implications. The need for spinal pain treatment grows by one percent a year, but the costs of such treatment are growing by seven percent annually. This is a significant increase, considering that spine pain spinal pain had the highest annual health care spending ($134 billion) of any condition. If ASTRAL shows that LRFA is effective, this would justify continued spending on this procedure. The reverse is also true—if the study shows it doesn’t help with spine pain, then resources may be better directed elsewhere. 

The trial will involve 300 participants who have already experienced significant pain relief from diagnostic nerve blocks. Participants will be randomly assigned to one of three groups: a conventional LRFA technique, an alternative LRFA method, or a simulated procedure that mimics LRFA but does not burn the nerve. The goal is to determine whether the two active LRFA methods offer greater improvement in back function compared to the placebo procedure.

Professors Janna Friedly, MD, MPH, and Pradeep Suri, MD, MSc, are co-principal investigators for the study.