A patient with chronic low back pain due to lumbar facet joint arthropathy has temporary relief from diagnostic medial branch blocks. The MOST appropriate next interventional step for longer-term pain relief is:
- A Epidural steroid injection targeting the L4-5 disc space
- B Intrathecal morphine pump insertion for chronic opioid delivery
- C Sacroiliac joint injection under fluoroscopic guidance
- D Radiofrequency ablation (RFA) of the medial branch nerves at the painful levels ✓
Explanation
When diagnostic medial branch blocks (targeting the small sensory nerves supplying facet joints) provide >50% temporary pain relief, radiofrequency ablation (RFA) of the medial branch nerves at corresponding levels is indicated for sustained analgesia (typically 6–18 months until nerve regeneration). The procedure uses high-frequency current to generate focal heat (80°C) causing controlled neuronal destruction. Epidural steroids target disc/nerve root pain, not facet arthropathy. Intrathecal pumps are reserved for intractable cancer or end-stage non-malignant pain. SIJ injection is for sacroiliac joint pain.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.