The Efficacy of Pulsed Radiofrequency Treatment of Cervical Radicular Pain Patients (original) (raw)
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Pain Practice, 2010
Cervical radicular pain is defined as pain perceived as arising in the arm caused by irritation of a cervical spinal nerve or its roots. Approximately 1 person in 1,000 suffers from cervical radicular pain. In the absence of a gold standard, the diagnosis is based on a combination of history, clinical examination, and (potentially) complementary examination. Medical imaging may show abnormalities, but those findings may not correlate with the patient's pain. Electrophysiologic testing may be requested when nerve damage is suspected but will not provide quantitative/ qualitative information about the pain. The presumed causative level may be confirmed by means of selective diagnostic blocks. Conservative treatment typically consists of medication and physical therapy. There are no studies assessing the effectiveness of different types of medication specifically in patients suffering cervical radicular pain. Cochrane reviews did not find sufficient proof of efficacy for either education or cervical traction. When conservative treatment fails, interventional treatment may be considered. For subacute cervical radicular pain, the available evidence on efficacy and safety supports a recommendation (2B+) of interlaminar cervical epidural corticosteroid administration. A recent negative randomized controlled trial of transforaminal cervical epidural corticosteroid administration, coupled with an increasing number of reports of serious adverse events, warrants a negative recommendation (2B-). Pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion is a recommended treatment for chronic cervical radicular pain (1B+). When its effect is insufficient or of short duration, conventional radiofrequency treatment is recommended (2B+). In selected patients with cervical radicular pain, refractory to other treatment options, spinal cord stimulation may be considered. This treatment should be performed in specialized centers, preferentially study related.
CASINO: Surgical or Nonsurgical Treatment for cervical radiculopathy, a randomised clinical trial
BMC Musculoskeletal Disorders, 2014
Background: Cervical radicular syndrome (CRS) due to a herniated disc can be safely treated by surgical decompression of the spinal root. In the vast majority of cases this relieves pain in the arm and restores function. However, conservative treatment also has a high chance on relieving symptoms. The objective of the present study is to evaluate the (cost-) effectiveness of surgery versus prolonged conservative care during one year of follow-up, and to evaluate the timing of surgery. Predisposing factors in favour of one of the two treatments will be evaluated.
The Effectiveness of Conservative Treatment for Patients With Cervical Radiculopathy
The Clinical Journal of Pain, 2013
Objectives: The aim of this systematic review is to assess the effectiveness of conservative treatments for patients with cervical radiculopathy, a term used to describe neck pain associated with pain radiating into the arm. Little is known about the effectiveness of conservative treatment for patients with cervical radiculopathy.
Clinics in Surgery
Background: Pulsed Radiofrequency (PRF) procedures are a minimally invasive and target-selective modality procedure. PRF procedure becoming an increasingly used treatment for chronic radicular pain and competitive with Transforaminal Epidural Steroid Injection (TFESI). Methods: A prospective randomized, blind study was performed to evaluate the therapeutic effect of lumbar Dorsal Root Ganglion (DRG) PRF treatment and lumbar TFESI and to compare efficacy of these two techniques, on the patient with chronic unilateral lumbosacral radicular pain with radiculopathy. The study included a total of 72 patients, of whom 35 were randomized to PRF group, 35 patients-to TFESI group, and 2 patients received placebo. The outcome of the treatment either by PRF or TFESI was evaluated by Global Perceiving Effect (GPE) and decrease in NRS and ODQ at day 30, 60 and 180. After 30 th day follow-up, patients with GPE Likert scores ≤ 5 had received the second, identical procedure. Results: GPE increased with time for both PRF and TFESI groups, reached at day 180 follow-up 6.2 for PRF and 6.3 for TFESI. Statistical comparison of improvements, caused by PRF and TFESI does not revealed significant difference in the treatment outcomes, i.e. generally values of GPE, decrease of NRS and decrease of ODQ was similar for PRF and TFESI treatments during entire follow up period. The only exception was decrease in ODQ scale at the day 30 that was higher for PRF treatment (P-value 0.02). Alongside, in PRF group there was only 9% of patients with less than 20% improvement in disability, as compared with 29% in TFESI group. But at the day 180, the proportion of patient with pain reduction more than 60% in TFESI group exceeded one for PRF group. Conclusion: The effectiveness of DRG PRF and TFESI by evaluation of three assessment's tools: GPE, NRS and ODQ demonstrates the efficiency of the PRF in short-term response (30 days followup) due to the notably higher decrease in ODQ scores in PRF than into the TFESI group, despite of similar GPE and NRS scores in both groups. TFESI procedure is more effective in long-term perspective, proved by slightly higher proportion of patients with pain reduction.
Novel technique of diagnosing and reducing pain in cervical radiculopathy
International Journal of Orthopaedics Sciences, 2018
Background: Neck pain with upper limb pain is a common complaint of patients seen in Out Patient Department (OPD). Such pain may be because of a pinched nerve. There is inflammation in the nerve which causes radicular symptoms. The available clinical tests for cervical radiculopathy are provocative tests, difficult to perform and techniques vary from author to author. The reliability of these tests is only when done in clusters. We devised a novel non-provocative clinical sign to diagnose cervical radiculopathy and a method to reduce upper limb radicular pain and thereby improving the function of the upper limb. Method: Patient’s bilateral pronated wrists were palpated dorsomedially on the ulnar styloid. This elicited tenderness over the Dorsal Cutaneous branch of Ulnar Nerve (DCU). The painless active degree of movement at shoulder and elbow joints was noted. Nerve block at the palpated tender point was given using 2% lignocaine in 95 patients. We used Visual Analogue Scale score t...
Medical research archives, 2021
Chronic cervical and lumbar radicular pain represents a very widespread neuropathic pain in the population with serious repercussions on the individual and social health. To date, we do not have sufficient evidence available to allow us to make recommendations on the optimal therapy, despite the fact that various ways of treating root pain have been described over the years. Currently, conservative treatment of radicular pain relies on combined therapeutic, pharmacological and physiotherapeutic management. Interventional therapeutic procedures are reserved for those patients with root pain refractory to conservative therapies. Radio frequency (RF) can provide a good treatment option with Pulsed Radio frequency (PRF) modality. We evaluate clinical and radiologic effects of the therapeutic outcome of pulsed radiofrequency (PRF) treatment adjacent to the dorsal root ganglion (DRG) for patients with chronic intractable lumbar and cervical radicular pain in this narrative minireview, des...
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2017
To summarise recommendations about 21 selected non-surgical interventions for recent onset (<12 weeks) non-specific neck pain (NP) and cervical radiculopathy (CR) based on two guidelines from the Danish Health Authority. Two multidisciplinary working groups formulated recommendations based on the GRADE approach. Twelve recommendations were based on evidence and nine on consensus. Management should include information about prognosis, warning signs, and advise to remain active. For treatment, guidelines suggest different types of supervised exercise and manual therapy; combinations of exercise and manual therapy before medicine for NP; acupuncture for NP but not CR; traction for CR; and oral NSAID (oral or topical) and Tramadol after careful consideration for NP and CR. Recommendations are based on low-quality evidence or on consensus, but are well aligned with recommendations from guidelines from North America. The working groups recommend intensifying research relating to all as...
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...
Hong Kong Physiotherapy Journal, 2018
Background: Radiating neck pain is one of the major symptoms of cervical radiculopathy (CR). Objective: This study compared the effects of cervical traction (CT) and transverse oscillatory pressure (TOP) in management of CR. Methods: Seventy-five participants with unilateral radiating neck pain were randomly allocated into three groups, 25 (14 males, 11 females) for CT, 25 (15 males and 10 females) for TOP and 25 (11 males and 14 females) control (Cnt) group. All participants received massage, cryotherapy and active exercises three times in a week for six weeks. CT was administered to CT group, TOP to TOP group while the third group served as control. Pain intensity (PI) and neck functional disability (NFD) were assessed pretreatment, 3rd and 6th week of intervention. Data were analyzed using descriptive and inferential statistics. Results: There was a significant reduction in PI and NFD between pretreatment and 6th week in all the groups ([Formula: see text]). The effect size of PI...