The impact of emotional distress on response to radiofrequency ablation

Radiofrequency ablation (RFA) is commonly performed for facet-mediated cervical, thoracic, and lumbar spine pain. Inadequate relief from RFA may be because of biopsychosocial factors not addressed with RFA.

To investigate the effects of baseline emotional distress on RFA treatment response.

Patients who completed self-reported surveys, Patient-Reported Outcomes Measurement System (PROMIS), from January 2021 through July 2023 were included. Additional baseline information was obtained by retrospective review. The primary outcome was PROMIS Pain Intensity T-scores at 6 weeks, 3 months, and 6 months after RFA. The main predictor of interest was emotional distress, computed as average baseline PROMIS T-scores for depression and anxiety. Interaction terms tested how the influence of baseline emotional distress and pain intensity changed over the follow-up period.

Data were available for 154, 101, 91, and 83 participants at baseline, 6 weeks, 3 months, and 6 months post-RFA, respectively. Baseline emotional distress (P = 0.04) and baseline pain intensity (P = 0.01) were both associated with worse pain intensity at follow-up, controlling for each other. Interaction terms were not significant, though visual inspection of trends suggested that the influence of baseline emotional distress may increase as the follow-up period lengthens.

Patients reporting higher levels of baseline emotional distress experience less pain reduction after RFA, controlling for baseline pain intensity. Patients with greater emotional distress may benefit from treatments addressing emotional distress, in addition to or instead of RFA.