Treatments for Facet Arthritis: Radiofrequency Ablation vs Platelet Rich Plasma

Imagine this: Your chronic lower back pain is getting worse. You have been diagnosed with arthritis affecting the facet joints, paired joints on either side of the spine. Advanced imaging with an MRI confirms you have spondylosis or facet arthropathy, terms used to describe wear-and-tear changes of the spine. You have tried treatments, including a healthy diet, spine-focused physical therapy, home exercise, and over-the-counter medications, but you still have pain that is functionally limiting.  

Diagnostic injections known as medial branch blocks can be administered to determine if the facet joints are causing your pain. Under fluoroscopic (x-ray) guidance, a numbing agent temporarily blocks the nerves called medial branches, which are responsible for carrying pain sensation from the facet joints to the brain. 

If these tests relieve pain by at least 80% for the duration of the anesthetic, confirming facet joint arthritis as the source of pain, your provider will then discuss different treatment options, including radiofrequency ablation (RFA) or platelet-rich plasma (PRP) therapy, to help reduce your pain and improve your function.

What is RFA, and How Does it Work?  

RFA is a minimally invasive procedure using radiofrequency energy or heat delivered via a needle under fluoroscopic guidance to ablate (“burn”) the medial branch nerves transmitting pain from the facet joints. This safe and effective procedure can produce long-term pain relief from facet arthritis. 

Notably, studies have shown that RFA can provide significant pain relief, with 60% of patients experiencing a 90% reduction in pain and 87% experiencing at least a 60% reduction in pain lasting up to 12 months. These studies also demonstrate that most patients receive substantial relief without complications following an RFA. 

However, some patients may experience inadequate pain relief from RFA. For those with persistent pain and functional limitation or those hesitant about ablation, PRP therapy presents a viable alternative or complementary option. 

What is PRP, and How Does it Work?

PRP is an effective and safe treatment used for various painful conditions, such as joint osteoarthritis, chronic tendon injuries, and nerve injuries. PRP therapy utilizes concentrated growth factors and immune modulators derived from the patient’s own platelets (obtained through a simple blood draw) to promote healing and tissue regeneration. It has shown benefits in accelerating healing and providing long-lasting pain relief and recovery. Notably, unlike steroid injections, PRP therapy is not associated with cartilage breakdown, which is a significant risk factor for the progression of arthritis.

Could PRP Help Alleviate My Facet Joint Pain?

Given PRP’s efficacy and safety profile in treating aches and pains throughout the body, patients often wonder if PRP could help them alleviate their spine pain related to arthritis. Several studies have shed light on the answer to this question.

For instance, a 2016 study by Wu et al. comparing PRP to steroid injections of the facet joints found that 79% of patients receiving PRP reported pain relief at the 3-month follow-up. 

Moreover, a 2017 study found PRP to be superior to steroid injections, with 81% of participants experiencing at least 50% pain relief. The study also highlighted PRP’s longer-term pain relief when compared to steroids, with improved pain scores at both three and six months. 

Given the need for further high-quality research, in 2022, researchers published a triple-blinded randomized control trial that compared facet joint injections with PRP to steroids. This study compared pain and function at one, three, and six months post injection. Compared to PRP, steroid injections led to faster improvement and better pain scores at one month; the PRP group also demonstrated reduced pain and increased function at this time point. By three months, pain and function were similar between the PRP and steroid groups. Most notably, PRP demonstrated significantly improved outcomes at six months, indicating its superiority as a long-term treatment.

Finally, a 2023 study from the Journal of Orthopaedics, Trauma, and Rehabilitation studied facet injections administered with an RFA procedure. In the study, RFAs were performed with either saline, steroid, or PRP injected into the facet joints. At one month, the steroid group outperformed the PRP group in pain reduction. However, researchers found that the PRP group had significantly decreased pain scores, increased functional scores, and reduced non-steroidal anti-inflammatory medication use at three and six months. 

Get Pain Relief with RFA or PRP Today

Collectively, these studies suggest that while steroids offer short-term pain relief, PRP therapy is associated with significantly more sustained pain alleviation in patients with spinal arthritis. This illustrates that PRP is a worthwhile treatment for facet joint pain, both alone and as an adjuvant to RFA. 

Considering RFA or PRP for your back pain? Reach out to one of our Board-Certified Physiatrists today, who are fellowship-trained in Interventional Spine and Musculoskeletal Medicine. Together, we’ll help find the right treatment plan for you. 

References: 

1. Dreyfuss, Paul MD*; Halbrook, Bobby MS†; Pauza, Kevin MD*; Joshi, Anand MD‡; McLarty, Jerry PhD§; Bogduk, Nikolai MD, PhD∥. Efficacy and Validity of Radiofrequency Neurotomy for Chronic Lumbar Zygapophysial Joint Pain. Spine 25(10):p 1270-1277, May 15, 2000.
2. Patel A, Koushik S, Schwartz R, Gritsenko K, Farah F, Urits I, Varrassi G, Viswanath O, Shaparin N. Platelet-Rich Plasma in the Treatment of Facet Mediated Low Back Pain: A Comprehensive Review. Orthop Rev (Pavia). 2022 Jul 27;14(4):37076. doi: 10.52965/001c.37076. PMID: 35910548; PMCID: PMC9329057.
3. Wu J, Du Z, Lv Y, et al.. A New Technique for the Treatment of Lumbar Facet Joint Syndrome Using Intra-articular Injection with Autologous Platelet Rich Plasma. Pain Phys. 2016;8;19(8;11):617-625. doi:10.36076/ppj/2016.19.617
4. Wu J, Zhou J, Liu C, Zhang J, Xiong W, Lv Y, Liu R, Wang R, Du Z, Zhang G, Liu Q. A Prospective Study Comparing Platelet-Rich Plasma and Local Anesthetic (LA)/Corticosteroid in Intra-Articular Injection for the Treatment of Lumbar Facet Joint Syndrome. Pain Pract. 2017 Sep;17(7):914-924. doi: 10.1111/papr.12544. Epub 2017 Feb 22. PMID: 27989008.
5. Cauchon AM, Mares C, Fan XY, Bois MC, Hagemeister N, Noiseux N, Roy A. Comparing the efficacy of intra-articular injection of Platelet Rich Plasma (PRP) with corticosteroids (CS) in patients with chronic zygapophyseal joint low back pain confirmed by double intra-articular diagnostic blocks: A triple-blinded randomized multicentric controlled trial with a 6-month follow-up. Interv Pain Med. 2024 Dec 3;3(4):100525. doi: 10.1016/j.inpm.2024.100525. PMID: 39717452; PMCID: PMC11665351.