***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background No proof of efficacy , in the form of a r and omized controlled trial ( RCT ) , exists to support pulsed radiofrequency ( PRF ) treatment of the dorsal root ganglion ( DRG ) for chronic lumbar radicular ( CLR ) pain . We determined the feasibility of a larger trial ( primary objective ) , and also explored the efficacy of PRF in decreasing pain on a visual analog scale ( VAS ) and improving the Oswestry Disability Index . Methods This was a single-center , placebo-controlled , triple-blinded RCT . Patients were r and omized  to a placebo group ( needle placement ) or a treatment group ( PRF at 42 ° C for 120 seconds to the DRG ) . Patients were followed up for 3 months post procedure . Outcomes with regard to pain , Oswestry Disability Index score , and side effects were analyzed on an intention-to-treat basis . Results Over 15 months , 350 potential patients were identified and 56 were assessed for eligibility . Fifteen of them did not meet the selection criteria . Of the 41 eligible patients , 32 ( 78 % ) were recruited . One patient opted out before intervention . Three patients were lost to follow-up at 3 months . Mean VAS differences were not significantly different at 4 weeks ( −0.36 , 95 % confidence interval [ CI ] , −2.29 , 1.57 ) or at 3 months ( −0.76 , 95 % CI , −3.14 , 1.61 ) . The difference in mean Oswestry Disability Index score was also not significantly different at 4 weeks ( −2 % , 95 % CI , −14 % , 10 % ) or 3 months ( −7 % , 95 % CI , −21 % , 6 % ) . There were no major side effects . Six of 16 patients in the PRF group and three of 15 in the placebo group showed a > 50 % decrease in VAS score . Conclusion The recruitment rate was partially successful . At 3 months , the relative success of PRF-DRG was small . A large-scale trial to establish efficacy is not practically feasible considering the small effect size , which would necessitate recruitment of a challengingly large number of participants over a number of years . Until clear parameters for application of PRF are established , clinicians will need to use their individual judgment regarding its clinical applicability , given the present evidence Study Design . A prospect i ve double-blind r and omized trial in 28 patients . Objectives . To assess the clinical effect of percutaneous intradiscal radiofrequency thermocoagulation for reducing pain , functional disability , and physical impairment in patients with chronic discogenic low back pain . Summary of Background Data . Chronic discogenic low back pain is a challenging problem in western countries . A treatment option is radiofrequency heating of the affected disc . Its clinical efficacy has never been formally tested in a controlled trial . Methods . Twenty-eight patients with a history of at least 1 year of chronic low back pain were selected on the basis of a diagnostic anesthetization of the lower intervertebral discs . Only patients with one putative painful level were selected and r and omly assigned to one of two treatment groups . Each patient in the radiofrequency treatment group ( n = 13 ) received a 90-second 70 C lesion of the intervertebral disc . Patients in the control group ( n = 15 ) underwent the same procedure , but without use of radiofrequency current . Both the treating physician and the patients were blinded to the group assignment . Before treatment , physical impairment , rating of pain , the degree of disability , and quality of life were assessed by a blinded investigator . Results . Eight weeks after treatment , there was one success in the radiofrequency group ( n = 13 ) and two in the control group ( n = 15 ) . The adjusted and unadjusted odds ratio was 0.5 and 1.1 , respectively ( not significant ) . Also , visual analog scores for pain , global perceived effect , and the Oswestry disability scale showed no differences between the two groups . Conclusions . Percutaneous intradiscal radiofrequency thermocoagulation ( 90 seconds , 70 C ) is not effective in reducing chronic discogenic low back pain Background and aims Facet joint denervation is a frequently performed technique to treat facet joint syndrome . Most often this technique is used under fluoroscopic guidance implicating high radiation doses for both patients and surgeons . This prospect i ve study was performed to evaluate the effectiveness in reducing radiation dose during radiofrequency ablation therapy of the lumbar facet joints and to evaluate the feasibility and possibilities of the new real time image guidance system Sabre Source ™ . Material s and methods As much as 20 consecutive patients with radiofrequency ablation therapy of the facet joints L4 to S1 were included . Ten patients were treated by fluoroscopic control alone ; the following 10 patients were treated with the Sabre Source ™ image guidance system . A total of 40 thermal ablations to the facet joints were performed . Each patient was given one thermal ablation on both sides of the vertebral segment , either to the facet joints of L4–L5 or of L5–S1 . Pain , according to the visual analogue scale ( VAS ) , was documented before and 6 h after the intervention . Radiation dose , time of radiation and the number of shots needed to place the radiofrequency cannula were recorded . Results No complications occurred . Before therapy , the mean VAS in all patients was 7.6 ( range 6–10 ) . After therapy the mean VAS in all patients was 3.4 ( range 0–5 ) . Compared to the fluoroscopy-guided thermal ablation therapy the Sabre Source ™ system significantly reduced the number of fluoroscopy exposures ( reduction 23.53 % , p = 0.02 ) , the time of radiation exposure ( reduction 21.2 % , p = 0.03 ) and the mean entrance surface dose ( reduction 30.46 % , p = 0.01 ) . Conclusion The Sabre Source System reduces radiation exposure and radiation dose in the radiofrequency denervation therapy of the lumbar facet joints and can be applied for other minimally invasive techniques Research suggests that clinical examination of the lumbar spine and pelvis is unable to predict the results of diagnostic injections used as reference st and ards . The purpose of this study was to assess the diagnostic accuracy of a clinical examination in identifying symptomatic and asymptomatic sacroiliac joints using double diagnostic injections as the reference st and ard . In a blinded concurrent criterion-related validity design study , 48 patients with chronic lumbopelvic pain referred for diagnostic spinal injection procedures  were examined using a specific clinical examination and received diagnostic intraarticular sacroiliac joint injections . The central isation and peripheralisation phenomena were used to identify possible discogenic pain and the results from provocation sacroiliac joint tests were used as part of the clinical reasoning process . Eleven patients had sacroiliac joint pain confirmed by double diagnostic injection . Ten of the 11 sacroiliac joint patients met clinical examination criteria for having sacroiliac joint pain . In the primary subset analysis of 34 patients , sensitivity , specificity and positive likelihood ratio ( 95 % confidence intervals ) of the clinical evaluation were 91 % ( 62 to 98 ) , 83 % ( 68 to 96 ) and 6.97(2.70 to 20.27 ) respectively . The diagnostic accuracy of the clinical examination and clinical reasoning process was superior to the sacroiliac joint pain provocation tests alone . A specific clinical examination and reasoning process can differentiate between symptomatic and asymptomatic sacroiliac Background : Sacroiliac joint pain is a challenging condition accounting for approximately 20 % of cases of chronic low back pain . Currently , there are no effective long-term treatment options for sacroiliac joint pain . Methods : A r and omized placebo-controlled study was conducted in 28 patients with injection-diagnosed sacroiliac joint pain . Fourteen patients received L4–L5 primary dorsal rami and S1–S3 lateral branch radiofrequency denervation using cooling-probe technology after a local anesthetic block , and 14 patients received the local anesthetic block followed by placebo denervation . Patients who did not respond to placebo injections crossed over and were treated with radiofrequency denervation using conventional technology . Results : One , 3 , and 6 months after the procedure , 11 ( 79 % ) , 9 ( 64 % ) , and 8 ( 57 % ) radiofrequency-treated patients experienced pain relief of 50 % or greater and significant functional improvement . In contrast , only 2 patients ( 14 % ) in the placebo group experienced significant improvement at their 1-month follow-up , and none experienced benefit 3 months after the procedure . In the crossover group ( n = 11 ) , 7 ( 64 % ) , 6 ( 55 % ) , and 4 ( 36 % ) experienced improvement 1 , 3 , and 6 months after the procedure . One year after treatment , only 2 patients ( 14 % ) in the treatment group continued to demonstrate persistent pain relief . Conclusions : These results provide preliminary evidence that L4 and L5 primary dorsal rami and S1–S3 lateral branch radiofrequency denervation may provide intermediate-term pain relief and functional benefit in selected patients with suspected sacroiliac joint pain . Larger studies are needed to confirm these results and to determine the optimal c and i date s and treatment parameters for this poorly understood disorder In this study two strategies in the treatment of Mechanical Spinal Discogenic Pain have been compared : Disc Coablation and Epidural Injection of Steroids . In 2003 50 patients treated with one or two epidural injections have been selected " ad r and om " and 50 patients treated with disc coablation .  Comparison of the data indicated an improvement of average VAS when relaxed for both groups ( p < 0.01 ) , while after slight-moderate strain , this value was significant only after coablation ( p < 0.001 ) . Finally , average VAS was clearly lower ( p < 0.01 ) after coablation as compared to epidural injections STUDY DESIGN A prospect i ve audit . OBJECTIVE To establish the efficacy of lumbar medial branch neurotomy under optimum conditions . SUMMARY OF BACKGROUND DATA Previous reports of the efficacy of lumbar medial branch neurotomy have been confounded by poor patient selection , inaccurate surgical technique , and inadequate assessment of outcome . METHODS Fifteen patients with chronic low back pain whose pain was relieved by controlled , diagnostic medial branch blocks of the lumbar zygapophysial joints , underwent lumbar medial branch neurotomy .  Before surgery , all were evaluated by visual analog scale and a variety of vali date d measures of pain , disability , and treatment satisfaction .  Electromyography of the multifidus muscle was performed before and after surgery to ensure accuracy of the neurotomy . All outcome measures were repeated at 6 weeks , and 3 , 6 , and 12 months after surgery . RESULTS Some 60 % of the patients obtained at least 90 % relief of pain at 12 months , and 87 % obtained at least 60 % relief . Relief was associated with denervation of the multifidus in those segments in which the medial branches had been coagulated . Prelesion electrical stimulation of the medial branch nerve with measurement of impedance was not associated with outcome . CONCLUSIONS Lumbar medial branch neurotomy is an effective means of reducing pain in patients carefully selected on the basis of controlled diagnostic blocks . Adequate coagulation of the target nerves can be achieved by carefully placing the electrode in correct position as judged radiologically . Electrical stimulation before lesioning is superfluous in assuring correct placement of the electrode Objective To evaluate the effectiveness of an integrated care programme , combining a patient directed and a workplace directed intervention , for patients with chronic low back pain . Design Population based r and omised controlled trial . Setting Primary care ( 10 physiotherapy practice s , one occupational health service , one occupational therapy practice ) and secondary care ( five hospitals ) . Participants 134 adults aged 18 - 65 sick listed for at least 12 weeks owing to low back pain . Intervention Patients were r and omly assigned to usual care ( n=68 ) or integrated care ( n=66 ) . Integrated care consisted of a workplace intervention based on participatory ergonomics , involving a supervisor , and a grade d activity programme based on cognitive behavioural principles . Main outcome measures The primary outcome was the duration of time off work ( work disability ) due to low back pain until full sustainable return to work . Secondary outcome measures were intensity of pain and functional status . Results The median duration until sustainable return to work was 88 days in the integrated care group compared with 208 days in the usual care group ( P=0.003 ) . Integrated care was effective on return to work ( hazard ratio 1.9 , 95 % confidence interval 1.2 to 2.8 , P=0.004 ) . After 12 months , patients in the integrated care group improved significantly more on functional status compared with patients in the usual care group ( P=0.01 ) . Improvement of pain between the groups did not differ significantly . Conclusion The integrated care programme substantially reduced disability due to chronic low back pain in private and working life . Trial registration Current Controlled Trials IS RCT N28478651 OBJECTIVES We aim ed to prospect ively evaluate the response and safety of pulsed and continuous radiofrequecy lesioning of the dorsal root ganglion/segmental nerves in patients with chronic lumbosacral radicular pain . METHODS Seventy-six patients with chronic lumbosacral radicular pain refractory to conventional therapy met the inclusion criteria and were r and omly assigned to one of 2 types of treatment , pulsed radiofrequency lesioning of the dorsal root ganglion/segmental nerve or pulsed radiofrequency followed immediately by continuous radiofrequency . Patients were carefully evaluated for neurologic deficits and side effects 
    Output:
    
The review authors found no high- quality evidence suggesting that RF denervation provides pain relief for patients with CLBP .
Similarly , we identified no convincing evidence to show that this treatment improves function .