Low back pain is one of the leading causes of disability worldwide, affecting 10-15 per cent of adults. One type of low back pain is caused by the small joints between the bones in the lower back. Treatments include painkillers, exercise and talking therapies. However, if people do not get better with these treatments, they can be offered radiofrequency denervation.

Radiofrequency denervation involves placing a needle in the nerve to the painful joint, which is heated up to cause a break in the nerve. The purpose of this is to stop the nerve sending pain messages to the brain. Radiofrequency denervation is low risk and is used widely in the NHS, with around 13,000 procedures performed each year. Despite its widespread use in the NHS, it is not known how well this procedure works for reducing pain or whether it is a good way to spend NHS money.

To answer this question, the RADICAL trial will recruit 250 patients from pain management and spinal centres across the UK. Half the participants will be randomised to receive ‘real’ denervation and half to receive ‘placebo’ radiofrequency denervation. The placebo treatment will involve placement of the needle in the nerve but without heating it up, so the nerve is not affected. Participants will then be asked to complete questions over the following two years to monitor symptoms, general health and use of health services. This trial will provide important evidence to inform the provision of services and ensure that people with long-term and disabling low back pain receive the best care.

For further information about the study please contact Dr Vikki Wylde at the Bristol Medical School.