Would Pulsed Radiofrequency applied to different anatomical regions have effective results for chronic pain treatment (original) (raw)
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Radiofrequency and pulsed radiofrequency treatment of chronic pain syndromes: the available evidence
Pain practice : the official journal of World Institute of Pain
There are currently 6 reviews on (pulsed) radiofrequency (RF) for the management of spinal pain. Two reviews on interventional pain management techniques in general also discuss RF. The outcomes of those reviews depend on the type of studies included and the opinion of the reviewers, which may result in different evidence levels. Radiofrequency denervation at the cervical and lumbar level has produced the most solid evidence. The differences in treatment outcome registered in the 5 randomized controlled trials (RCTs) regarding lumbar facet denervation can be attributed to differences in patient selection and/or inappropriate technique. There is not sufficient evidence supporting the use of RF facet denervation for the management of cervicogenic headache. The studies examining the management of cervical radicular pain suggest a comparable efficacy for RF and pulsed RF (PRF). The PRF treatment is supposed to be safer and therefore should be preferred. The superiority of RF treatment a...
Pulsed radiofrequency application in the treatment of chronic pain
Pain …, 2007
The efficacy of pulsed radiofrequency (PRF) in the treatment of painful lumbosacral spondylosis has been reported. This case series reviews 22 consecutive patients presenting to clinic who had been previously treated with PRF with good results. Patients being prescribed opioids were excluded. During the PRF application, tissue temperature was limited to 43°C. A minimum of 200 mA of current was delivered in each case. The minimum current (at 50 Hz) necessary to stimulate the involved nerve was recorded. The duration of time from PRF treatment until the patient requested a subsequent application was documented. The effective duration of PRF in patients treated for lumbosacral spondylosis ranged from 5 to 18 months (mean ± SD: 9 ± 3.7 months; n = 16). PRF applications to dorsal root ganglia were effective from 2 to 12 months (7 ± 3.8 months; n = 8). Similar results were observed when PRF was applied to cervical medial branch nerves, one suprascapular nerve, and one stellate ganglion. The mean (50 Hz) sensory stimulation thresholds obtained before treatment ranged from 0.08 V to 0.14 V. In this select population of patients not receiving controlled substances, who had a favorable response to a previous PRF application, the duration of pain relief supports the use of PRF as an effective pain treatment.
Acta Neurochirurgica, 2011
Background The objective of this review is to evaluate the efficacy of Pulsed Radiofrequency (PRF) treatment in chronic pain management in randomized clinical trials (RCTs) and well-designed observational studies. The physics, mechanisms of action, and biological effects are discussed to provide the scientific basis for this promising modality. Methods We systematically searched for clinical studies on PRF. We searched the MEDLINE (PubMed) and EMBASE database, using the free text terms: pulsed radiofrequency, radio frequency, radiation, isothermal radiofrequency, and combination of these. We classified the information in two tables, one focusing only on RCTs, and another, containing prospective studies. Date of last electronic search was 30 May 2010. The methodological quality of the presented reports was scored using the original criteria proposed by Jadad et al. Findings We found six RCTs that evaluated the efficacy of PRF, one against corticosteroid injection, one against sham intervention, and the rest against conventional RF thermocoagulation. Two trials were conducted in patients with lower back pain due to lumbar zygapophyseal joint pain, one in cervical radicular pain, one in lumbosacral radicular pain, one in trigeminal neuralgia, and another in chronic shoulder pain. Conclusion From the available evidence, the use of PRF to the dorsal root ganglion in cervical radicular pain is compelling. With regards to its lumbosacral counterpart, the use of PRF cannot be similarly advocated in view of the methodological quality of the included study. PRF application to the supracapular nerve was found to be as efficacious as intra-articular corticosteroid in patients with chronic shoulder pain. The use of PRF in lumbar facet arthropathy and trigeminal neuralgia was found to be less effective than conventional RF thermocoagulation techniques.
The British journal of radiology, 2017
The objective of this review was to evaluate the efficacy of pulsed radiofrequency (PRF) treatment of pain associated with different spinal conditions. The mechanisms of action and biological effects are shortly discussed to provide the scientific basis for this radiofrequency modality. We systematically searched for clinical studies on spinal clinical conditions using PRF. We searched the MEDLINE (PubMed) database. We classified the information in one table focusing on randomized controlled trials (RCTs) and other types of studies. Date of last electronic search was October 2016. We found four RCTs that evaluated the efficacy of PRF on cervical radicular pain and five observational studies. Two trials and three observational studies were conducted in patients with facet pain. For disc-related pathology, we found one RCT with PRF applied intradiscally and three RCTs for dorsal root ganglia PRF modulation lumbosacral radicular pain. For sacroiliac joint pain, spondylolisthesis, malig...
Radiofrequency procedures in chronic pain
Best Practice & Research Clinical Anaesthesiology, 2002
Radiofrequency current is simply a tool used for creating discrete thermal lesions in neural pathways in order to interrupt transmission. In pain medicine, radiofrequency lesions have been used to interrupt nociceptive pathways at various sites. This is a palliative treatment not without complications, so its use should be limited to those patients with cancer pain or chronic non-cancer pain for whom conservative non-surgical therapies have been ineective or intolerable. With the development of alternatives such as intrathecal opioid infusion and neuromodulation technologies, the number of patients considered for neuroablative therapy may dwindle. Nevertheless, there is evidence that radiofrequency neurotomy has an important role in the management of trigeminal neuralgia, nerve root avulsion and spinal pain. In this chapter the evidence for ecacy and safety is reviewed and interrogated with special emphasis on the available randomized controlled trails and systematic review.
Efficacy of Radiofrequency Ablation in Chronic Pain Management
Nepal Journal of Neuroscience
The aim of this study is to determine the efficacy of radiofrequency ablation in management of chronic pain. Radiofrequency ablation in pain management was done in 21 patients who were experiencing chronic pain in different regions of the body. Patients were divided into three groups according to region of pain i.e. chronic lower back pain, trigeminal neuralgia, and osteoarthritis. Pre-treatment and Post-treatment pain score were taken with numeric rating scale (NRS). Denervation was achieved in the pain originating region with the help of Cosman RFG-1A radiofrequency generator under fluoroscopy obtained from Axiom Artis U. The comparison between pre pain score and post pain score revealed the pain was almost nullified in 52% of the patients whereas in 33% it was reduced to tolerable levels and 15% still had some trouble, though pain was slightly reduced as compared before ablation. Radiofrequency ablation alleviated the pain in cases where oral medications were not enough and surgi...
Pain Medicine, 2006
Background. Intradiscal radiofrequency, with the electrode placed in the center of the nucleus pulposus, has been a controversial procedure in patients with discogenic pain. Possibly the effect has not been due to the production of heat, but to exposure to electric fields. Design. We have investigated the effect of high-voltage, long-duration intradiscal pulsed radiofrequency in patients with one-level discogenic low back pain, as confirmed by discography. Outcome Measure. The pain intensity score on a 0-10 numeric rating scale (NRS) was taken as outcome measure. Patients. Eight patients were reported. The mean duration of pain was 6.3 years (range 0.5-16, median 4). The mean NRS score was 7.75 (range 5-9). Disc height was reduced 60% in one patient and up to 30% in the others. Intervention. A 15-cm, 20-gauge needle with a 15-mm active tip was placed centrally in the disc. Pulsed radiofrequency was applied for 20 min at a setting of 2 × 20 ms/s and 60 V. Results. There was a very significant fall in the NRS scores over the first 3 months (P < 0.0001). On an individual basis, all patients had a fall of the NRS score of at least 4 points at the 3-month follow-up. A follow-up of 12.8 months (range 6-25, median 9) was available for five patients. All these patients are now pain free, except for one patient with an NRS score of 2. Conclusion. It is concluded that this method merits a controlled, prospective study.
January 2018, 2018
Background: Pulsed radiofrequency (PRF) is increasingly used in clinical practice, especially in neuropathic pain disorders. Although PRF is not new to clinical use, there are significant gaps in knowledge regarding its effectiveness. Objectives: The current study was conducted to evaluate the effect of duration of application of PRF on its analgesic efficacy in improvement of neuropathic pain. Study Design: A randomized experimental trial. Setting: An animal research facility at the College of Veterinary Medicine at Mansoura University in Egypt. Methods: Chronic constriction of the sciatic nerve of 36 male Sprague-Dawley rats was performed to induce neuropathic pain. The rats were divided into 6 groups (6 rats each) in which PRF was applied for 2, 4, 6, or 8 minutes or not at all. In one group, RF cannula was applied without performing PRF intervention. The pain was assessed through observation of resting paw posture (RPP) at 3, 10, and 21 days. Nerve damage was assessed by histopa...
Effectiveness of pulsed radiofrequency in chronic lumbosacral radicular pain
Background: Lumbosacral radicular pain is one of the most common clinical features which accounts for more than 10% of the hospital visits annually. Multiple treatment strategies have been in use to manage it. This study aimed to assess the efficacy of pulsed radiofrequency (PRF) in treating pain and physical disturbances in chronic lumbosacral radicular pain. Methodology: Forty patients, suffering from lumbosacral neuropathic pain were treated by PRF at the corresponding level (ranging from L3 to S1). Outcome measures included the pain intensity score on a 0-10 numeric rating scale (NRS) at pretreatment, after two months and six months post-treatment. Results: A significant reduction in pain scores was observed in mean NRS at two and six month duration (p < 0.001). The NRS after treatment with PRF was significantly reduced compared to that before PRF treatment (3.28 vs. 8.38 and 4.25 vs. 8.38 respectively) after two and six months. Conclusion: The PRF is effective in the treatment of chronic lumbosacral radicular pain of neuropathic features.
Pulsed radiofrequency in lumbar radicular pain: clinical effects in various etiological groups
Pain practice : the official journal of World Institute of Pain, 2007
The purpose of this study was to evaluate the effectiveness of pulsed radiofrequency (PRF) applied to the lumbar dorsal root ganglion (DRG). A retrospective analysis of 54 consecutive patients who underwent 75 PRF procedures was performed. The patients were divided into three groups according to the etiology of the lesion (herniated disc [HD], spinal stenosis [SS], and failed back surgery syndrome [FBSS]). The analgesic efficacy of the technique was assessed using a 10-point Numeric Rating Scale (NRS) at baseline and, along with the Global Perceived Effect (GPE), at 30, 60, 90, and 180 days. The reduction in medications and the number of complications associated with the technique were assessed. A decrease in the NRS score was observed in patients with HD (P < 0.05) and SS (P < 0.001), but not in those with FBSS. The GPE scores confirmed this finding. No complications were noted. We observed that PRF of the DRG was significantly more efficacious in HD and SS than in FBSS patie...