Response to Pulsed and Continuous Radiofrequency Lesioning of the Dorsal Root Ganglion and Segmental Nerves in Patients with Chronic Lumbar Radicular Pain (original) (raw)
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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...
Pulsed Radiofrequency for Chronic Intractable Lumbosacral Radicular Pain: A Six-Month Cohort Study
Pain medicine (Malden, Mass.), 2015
There is little evidence concerning the medical management of lumbosacral radicular pain. The prognosis for patients suffering pain for more than 3 months is poor. Pulsed radiofrequency (PRF) treatment of the dorsal root ganglion (DRG) has been suggested as a minimally invasive treatment. We studied the effect on pain and quality of life of PRF treatment of the DRG in patients with chronic, severe lumbosacral radicular pain. Patients with lumbosacral radicular pain were screened to select a homogeneous population. PRF treatment of the DRG was performed at L5 or S1. Evaluation was carried out at 6 weeks, 3 months, and 6 months. Pain reduction and "fully recovered" or "much improvement," in terms of the global perceived effect, were the primary outcomes. Quality of life (RAND-36), disability (Oswestry Disability Index), and the neuropathic pain scales leeds assessment of neuropathic symptoms and signs (LANSS) and DN4 were registered at each time point. Medication u...
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...
Pulsed Radiofrequency Dorsal Root Ganglion-Fluoroscopy Guide for Lumbar Radicular Pain
Journal of Anaesthesia and Pain, 2021
Background: Lumbosacral radicular pain is the most common neuropathic pain. Pulsed Radio Frequency (PRF) is a method that believes to be safe and effective for reducing pain. Case: A 43-year-old woman experiences chronic right lumbar radiculopathy due to Herniated nucleus pulposus (HNP) L4-5. Anamnesis and physical examination show a sign of neuropathic pain. The MRI examination shows a paracentral disc protrusion L4-5 that compresses the transversing nerve L5. The conservative management did not produce a satisfying result indicated by the patient still experience pain with the Numeric Rating Scale (NRS) 4-5. Patient unable to do activity properly. We perform pain management using the dorsal root ganglion L5 pulsed radiofrequency-fluoroscopy (PRF) and producing a positive outcome. Patients experience a decrease in pain intensity with NRS 1. The examination on one and two months post-intervention show an improvement. Patient able to do the daily activity with NRS 1-2. Conclusion: Pu...
The Clinical Journal of Pain, 2019
Objectives: Despite the interest in scientific community, there is still poor evidence about pulsed radiofrequency (PRF) efficacy in the treatment of neuropathic pain. In order to determine whether highvoltage PRF and epidural adhesiolysis (PRF-EA) showed better results than epidural adhesiolysis alone (EA), a randomized, doubleblind, comparative-effectiveness study was conducted in patients with chronic lumbosacral radiating pain and neuropathic features. Materials and Methods: A total of 41 patients were randomly allocated to 2 groups. Twenty-one patients were randomized to receive 2 cycles of 240 seconds high-voltage PRF followed by the injection of local anesthetics, hyaluronidase, and betamethasone, whereas 20 patients underwent sham stimulation followed by adhesiolysis. The treatment was delivered at the affected lumbosacral roots and patients, treating physicians and assessors were blinded to intervention. Results: A significant reduction of radiating pain was observed in mean Numeric Rating Scale score at follow-up. A change of −3.43 versus −1.75 (P = 0.031) after 1 month and −3.34 versus −0.80 (P = 0.005) after 6 months was reported in patients undergoing PRF-EA in comparison with EA, respectively. After 1 month, 57% of patients in the PRF-EA group experienced a pain reduction of ≥ 50% versus only 25% of patients allocated to EA (P = 0.037). Improvement decreased to 48% in the PRF-EA group whereas only 10% of EA reported significant pain relief after 6 months (P = 0.008). Discussion: High-voltage PRF of dorsal root ganglion delivered through multifunctional electrode provided significant pain relief and may be considered a valuable treatment in chronic lumbosacral radicular pain with neuropathic features.
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.
BJA: British Journal of Anaesthesia, 2017
Background. Quantitative sensory testing (QST) has been used to predict the outcome of epidural steroid injections in lumbosacral radicular pain and has the potential to be an important tool in the selection of appropriate treatment (such as epidural steroid injections vs surgery) for patients with chronic radicular pain. In addition, QST assists in identification of the pain pathways of peripheral and central sensitization in selected groups of patients. Methods. Twenty-three patients were given dorsal root ganglion (DRG) infiltration with local anaesthesia and steroid ('DRG block'), and those who demonstrated at least 50% pain relief were offered pulsed radiofrequency (PRF) to the DRG. Questionnaires and QST scores were measured before the DRG blocks and at 1 week and 3 months after their procedure. Those who received PRF also answered questionnaires and underwent QST measurements at 1 week and 3 months after their procedure. Results. There was a significant increase in pressure pain threshold scores after DRG blocks. A reduced conditioned pain modulation response was seen before DRG, which increased after the procedure. Ten out of 23 patients underwent PRF to the DRG, and an increase in pressure pain threshold scores after PRF was observed. The conditioned pain modulation response was maintained in this group and increased after PRF. Conclusions. The study demonstrates that patients with unilateral radicular low back pain who receive dorsal root ganglion interventions show changes in pressure pain thresholds and conditioned pain modulation that are consistent with a 'normalization' of peripheral and central sensitization.