***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: Study Design . The efficacy of radiofrequency medial branch neurotomy to treat cervical zygapophysial joint pain from whiplash was compared prospect ively in litigants and nonlitigants . Objectives . 1 ) To assess the effect of monetary gain on treatment of zygapophysial joint pain in cervical whiplash . 2 ) To determine whether radiofrequency medial branch neurotomy is effective treatment for whiplash . Summary of Background Data . The influence of litigation on treatment outcome is a subject of controversy in both the medical and legal professions . This is the first study to examine this issue in a prospect i ve manner using a previously proven diagnostic and therapeutic method . Methods . Sixty patients with cervical whiplash who remained symptomatic after 20 weeks of conservative management were referred for radiofrequency cervical medial neurotomy .  The patients were classified as litigant or nonlitigant based on whether the potential for monetary gain via litigation existed . Each group underwent identical evaluation and treatment . Patients were observed for 1 year . Visual analogue scores and self-reported improvement were obtained before , immediately after , and 1 year after radiofrequency cervical medial neurotomy . Results . Forty-six patients completed the study . The overall reduction in cervical whiplash symptoms and visual analogue pain scores were significant immediately after treatment ( nonlitigants vs. litigants : 2.0 vs. 2.5 , P = 0.36 ) and at 1 year ( nonlitigants vs. litigants : 2.9 vs. 4.0 , P = 0.05 ) . One-year follow-up scores were higher than immediate post-treatment scores ( nonlitigants vs. litigants : 2.5 vs. 3.6 ) . The difference between litigants and nonlitigants in the degree of symptomatology or response to treatment did not reach significance . Conclusions . These results demonstrate that the potential for secondary gain in patients who have cervical facet arthropathy as a result of a whiplash injury does not influence response to treatment . These data contradict the common notion that litigation promotes malingering . This study also confirms the efficacy of radiofrequency medial branch neurotomy in the treatment of traumatic cervical facet arthropathy 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 BACKGROUND Chronic pain in the cervical zygapohyseal joints is a common problem after whiplash injury , but treatment is difficult . Percutaneous radiofrequency neurotomy can relieve the pain by denaturing the nerves innervating the painful joint , but the efficacy of this treatment has not been established . METHODS In a r and omized , double-blind trial , we compared percutaneous radio-frequency neurotomy in which multiple lesions were made and the temperature of the electrode making the lesions was raised to 80 degrees C with a control treatment using an identical procedure except that the radio-frequency current was not turned on . We studied 24 patients ( 9 men and 15 women ; mean age , 43 years ) who had pain in one or more cervical zygapophyseal joints after an automobile accident ( median duration of pain , 34 months ) . The source of their pain had been identified with the use of double-blind , placebo-controlled local anesthesia . Twelve patients received each treatment . The patients were followed by telephone interviews and clinic visits until they reported that their pain had returned to 50 percent of the preoperative level . RESULTS The median time that elapsed before the pain returned to at least 50 percent of the preoperative level was 263 days in the active-treatment group and 8 days in the control group ( P=0.04 ) . At 27 weeks , seven patients in the active-treatment group and one patient in the control group were free of pain . Five patients in the active-treatment group had numbness in the territory of the treated nerves , but none considered it troubling . CONCLUSIONS In patients with chronic cervical zygapophyseal-joint pain confirmed with double-blind , placebo-controlled local anesthesia , percutaneous radio-frequency neurotomy with multiple lesions of target nerves can provide lasting relief STUDY DESIGN A prospect i ve double-blind r and omized trial in 31 patients . OBJECTIVES To assess the clinical efficacy of percutaneous radiofrequency denervation of the lumbar zygapophysial joints in reducing pain , functional disability , and physical impairment in patients with back pain originating from the lumbar zygapophysial joints . SUMMARY OF BACKGROUND DATA Chronic low back pain is a major health problem in the industrialized world . A treatment option is percutaneous radiofrequency denervation of the lumbar zygapophysial joints . Its clinical efficacy has never been formally tested in a controlled trial . METHODS Thirty-one patients with a history of at least 1 year of chronic low back pain were selected on the basis of a positive response to a diagnostic nerve blockade and subsequently r and omly assigned to one of two treatment groups . Each patient in the radiofrequency treatment group ( 15 patients ) received an 80 C radiofrequency lesion of the dorsal ramus of the segmental nerve roots L3 , L4 , and L5 . Patients in the  control group ( n = 16 ) underwent an the same procedure but without use of a 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 were 10 success patients in the radiofrequency group ( n = 15 ) and 6 in the sham group ( n = 16 ) . The unadjusted odds ratio was 3.3 ( P = 0.05 , not significant ) , and the adjusted odds ratio was 4.8 ( P < 0.05 , significant ) . The differences in effect on the visual analog scale scores , global perceived effect , and the Oswestry disability scale were statistically significant . Three , 6 , and 12 months after treatment , there were significantly more success patients in the radiofrequency group compared with the sham group . CONCLUSIONS Radiofrequency lumbar zygapophysial joint denervation results in a significant alleviation of pain and functional disability in a select group of patients with chronic low back pain , both on a short-term and a long-term basis OBJECTIVE The objective of this study was to determine the effectiveness of cervical medial branch radiofrequency neurotomy ( RFN ) performed by two practitioners trained according to rigorous guidelines . DESIGN The study was design ed as a prospect i ve , outcome study of consecutive patients with chronic neck pain treated in a community setting . INTERVENTIONS A total of 104 patients , selected on the basis of complete relief of pain following controlled , diagnostic , medial branch blocks , were treated with RFN according to the guidelines of the International Spine Intervention Society . OUTCOME MEASURES Successful outcome was defined as complete relief of pain , or at least 80 % relief , for at least 6 months , with complete restoration of activities of daily living , no need for any further health care , and return to work . Patients who failed to meet any of these criteria were deemed to have failed treatment . RESULTS In the two practice s , 74 % and 61 % of patients achieved a successful outcome . Relief lasted 17 - 20 months from the first RFN , and 15 months for repeat treatments . Allowing for repeat treatment , patients maintained relief for a median duration of 20 - 26 months , with some 60 % still having relief at follow-up . CONCLUSION Cervical RFN can be very effective when performed in a rigorous manner in appropriately selected patients . Chronic neck pain , mediated by the cervical medial branches , can be temporarily , but completely , relieved and patients fully restored to desired activities of daily living , if treated with RFN Facet joint pain is an important aspect of degenerative lumbar spine disease , and radiofrequency medial branch neurotomy remains an established therapy , while cryodenervation has still been poorly examined . This study was undertaken to examine the effects of medial branch cryodenervation in the treatment of lumbar facet joint pain .  This was a prospect i ve clinical case series . Patient selection was based on the history , physical examination and positive medial branch blocks .  Percutaneous medial branch cryodenervation was performed using a Lloyd Neurostat 2000 . Target parameters were low back pain ( VAS ) , limitation of activity ( McNab ) and overall satisfaction .  Fifty patients were recruited , and 46 completed the study . The follow-up time was 1 year . At 6 weeks , 33 patients ( 72 % ) were pain free or had major improvement of low back pain ; 13 ( 28 % ) had no or little improvement . Including failures , mean low back pain decreased significantly from 7.7 preoperatively to 3.2 at 6 weeks , 3.3 at 3 months , 3.0 at 6 months and 4.2 at 12 months ( P<0.0001 ) . Limitation of the activities of daily living improved parallel to reduced pain . Our results suggest that medial branch cryodenervation is a safe and effective treatment for lumbar facet joint pain . RésuméBut de l’étude : les douleurs facétaires articulaires sont un élément important de la pathologie dégénérative de la colonne lombaire et la neurotomie par radio fréquence de la branche médiale est un traitement classique , alors que les résultats de la cryodénervation ne sont pas considérés comme évidents . Cette étude a pour but d’examiner les effets de la cryodénervation des rameaux médians dans le traitement des douleurs facétaires . L’étude a été menée de façon prospect i ve . Les patients ont été sélectionnés selon leur histoire , l’examen physique et la positivité de la réalisation d’une infiltration des rameaux médians . La cryodénervation par voie percutanée a été réalisée par un appareil Lyod Neurostat 2000 . Les paramètres étudiés ont été les lombalgies ( VAS ) , la limitation d’activité ( McNab ) et la satisfaction . Cinquante patients ont été recrutés pour ce traitement , 46 sujets ont été spécialement étudiés et suivis pendant au moins un an . Résultats : à 6 semaines , 33 patients ( 72 % ) ne présentent aucune douleur et ont une gr and e amélioration de leur lombalgie , 13 ( 28 % ) n’ont pas ou simplement ont une petite amélioration . Malgré les échecs , les douleurs lombaires diminuent de façon significative avec une échelle de 7.7 préopératoire à 3.2 à 6 semaines , de 3.3 à 3 mois , de 3.0 à 6 mois et 4.2 à 12 mois ( P<0.0001 ) . En conclusion , nous pouvons affirmer , aux vues de nos résultats que la cryodénervation des rameaux médians est un procédé donnant de bons résultats réguliers dans le traitement des syndromes facétaires douloureux Radiofrequency neurolysis of lumbar medial branch is currently the only proven way to treat patients with chronic lumbar zygapophysial joint pain , however , in some patients it can cause transient postoperative pain due to an inflammation caused by trauma of the electrode insertion and the thermal lesion around the target nerves . The aim of this study was to assess the effectiveness of intraoperative injection of methylprednisolone or pentoxifylline in comparison with placebo ( saline ) to prevent this process . 45 consecutive patients seen by one physician at one pain management clinic were included . Patients were r and omly assigned to 3 groups of 15 patients treated with radiofrequency neurotomy procedure with an addition of methylprednisolone , pentoxifylline or saline , respectively , and were observed for 6 months . Pain intensity , summed pain intensity difference , minimum 50 % reduction of pain intensity , Patients Satisfaction Score , and local tenderness were determined . The 50 % reduction of pain intensity was achieved in 80 % of patients one week after the procedure , and at 6 months such results were reported by 60 % of patients . There was a significant reduction of pain intensity in all three groups at 
    Output:
    
Apart from soreness of the paravertebral muscles no severe side effects were encountered .
Conclusion This is the first report of cryoneurolysis for the treatment of cervical facet joint pain .