Cryoneurolysis versus radiofrequency ablation outcome on pain experience in chronic low back pain (COPE): a single-blinded randomised controlled trial

Kamilla Truong, Kaare Meier, Lasse Cramer Ahrens, Thea Overgaard Wichmann, Hamed Zaer, Lasse Hubertus Tiroke, Simon Arvin, Mindaugas Bazys, Peter Duel, Gudrun Gudmundsdottir, Jakob Gram Carlsen, Lone Nikolajsen, Maurits van Tulder, Jens Christian Hedemann Sørensen, Mikkel Mylius Rasmussen

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review


OBJECTIVE: A comparison of cryoneurolysis or radio frequency (RF) with placebo in patients with facetogenic chronic low back pain (LBP) for patient global impression of change (PGIC), pain intensity, function and quality of life, with 1-year follow-up.

DESIGN: Single-centre, single-blinded placebo-controlled randomised controlled trial.

SETTING: Single-centre study.

PARTICIPANTS: Inclusion from March 2020 to September 2022: consenting adults over 18 years of age, LBP>3 months, average Numeric Rating Scale LBP≥4 average last 14 days and a positive response to a diagnostic medial branch block ( >50% pain reduction after 60 min).

INTERVENTIONS: 120 patients were block randomised 1:1:1 to cryoneurolysis, RF or placebo of the medial branch nerves. Physical therapy was added after 4 weeks for all groups.

MAIN OUTCOME MEASURES: Primary outcome was PGIC 4 weeks after the intervention. Secondary outcomes included pain intensity (Numeric Rating Scale, NRS), quality of life (Short Form 36, EQ-5D-5L), disability (Oswestry Disability Index), depression (Major Depression Inventory) and catastrophising (Pain Catastrophising Scale). Outcomes were measured at 4 weeks, 3, 6 and 12 months.

RESULTS: There was no statistically significant difference in PGIC at 4 weeks between cryoneurolysis and placebo (risk ratio (RR) 2; 95% CI 0.75 to 5.33, p=0.17) and RF and placebo (RR 1.6; 95% CI 0.57 to 4.49, p=0.37), except PGIC for cryoneurolysis at 6-month follow-up (RR 5.1; 95% CI 1.20 to 22.03, p=0.03). No statistically significant differences were found in secondary follow-up endpoints.

CONCLUSIONS: Denervation of the medial branch nerve by either cryoneurolysis or RF compared with placebo did not demonstrate significant improvement in PGIC, pain intensity, function and quality of life in patients with facetogenic chronic LBP at short-term or long-term follow-up.


Original languageEnglish
Article numbere004196
JournalRMD Open
Number of pages10
Publication statusPublished - May 2024


  • Humans
  • Low Back Pain/therapy
  • Male
  • Female
  • Middle Aged
  • Quality of Life
  • Radiofrequency Ablation/methods
  • Chronic Pain/therapy
  • Treatment Outcome
  • Pain Measurement
  • Adult
  • Single-Blind Method
  • Cryosurgery/methods
  • Aged
  • Pain Management/methods


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