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Yan Q, Zhong X, Li J, Zhao L, Niu J, Song D, Wang J, Teng Y, Wu T, Sun X, Chen R, Wang S, Zou J. Modified transforaminal epidural steroid injection combined with pulsed radiofrequency: an effective treatment measure for lumbar radiculopathy. Front Surg 2025; 12:1566661. [PMID: 40352305 PMCID: PMC12062145 DOI: 10.3389/fsurg.2025.1566661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2025] [Accepted: 04/09/2025] [Indexed: 05/14/2025] Open
Abstract
Background Lumbar disc herniation (LDH) is a prevalent condition encountered in the clinical diagnosis and management of spinal surgery. Certain people may experience excruciating radicular pain in the lower extremities. If these symptoms are not promptly alleviated, they may progressively deteriorate, ultimately resulting in radiating pain in the lower extremities, advancing neurological impairments, and potential trouble in standing, significantly impairing the patient's quality of life. Consequently, clinicians require an expedited and efficacious approach to address radicular discomfort resulting from lumbar radiculopathy and promptly reinstate the patient's normal functionality. Objectives This study seeks to assess the effectiveness of a modified transforaminal epidural steroid injection (TFESI) in conjunction with pulsed radiofrequency (PRF) for treating lumbar radiculopathy using a retrospective analysis. Methods Our study examined patients with unilateral lower limb radicular pain persisting for three months or more due to LDH, in whom conservative therapies were ineffective, from January 1, 2023, to October 31, 2023. This trial comprised 106 patients who received modified TFESI alongside PRF. We evaluated clinical efficacy and follow-up at baseline and at 1 week, 1 month, 3 months, 6 months, and 12 months post-surgery primarily using the Visual Analog Scale (VAS), Oswestry disability index (ODI), and modified MacNab score. Results Patients who received modified TFESI in conjunction with PRF exhibited substantial enhancements across all three assessment instruments (VAS, ODI, MacNab) when compared to pre-treatment evaluations (p < 0.0001). The alleviation of radicular discomfort was notably enduring, meeting the patients' expectations. At the 12-month follow-up, we noted that patients often achieved substantial pain alleviation within 6 months, and only a minor proportion of patients encountered pain recurrence by the 12th month, with no notable problems detected. Conclusions The modified TFESI in conjunction with PRF is a safe, cost-efficient, and successful therapy modality. Our findings indicated that this method can efficiently and swiftly relieve patients' radicular discomfort and produce enduring therapeutic effects.
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Affiliation(s)
- Qi Yan
- Department of Orthopedics Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xianggu Zhong
- Department of Orthopedics Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiarong Li
- Department of Orthopedics Surgery, Wuzhong People’s Hospital, Suzhou, Jiangsu, China
| | - Leyu Zhao
- Department of Orthopedics Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Junjie Niu
- Department of Orthopedics Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Dawei Song
- Department of Orthopedics Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jinning Wang
- Department of Orthopedics Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yun Teng
- Department of Orthopedics Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Tianyi Wu
- Department of Orthopedics Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiao Sun
- Department of Orthopedics Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Rui Chen
- Department of Orthopedics Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shuangfei Wang
- Department of Orthopedics Surgery, Chenghang Hospital, Zhangjiagang, Jiangsu, China
| | - Jun Zou
- Department of Orthopedics Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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Gónima Valero E, Rodríguez Miranda CD, Contreras Arrieta S, Daza Morelli MI, Seija Butnaru D, Reyes Carrillo M, Aponte Camacho LD, Amaya S. Nonpharmacological Interventions for Postmastectomy Pain Syndrome-A Systematic Review of the Literature. Clin Breast Cancer 2025; 25:e133-e151.e6. [PMID: 39562190 DOI: 10.1016/j.clbc.2024.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 10/11/2024] [Indexed: 11/21/2024]
Abstract
OBJECTIVE Literature regarding nonpharmacological interventions (NPI) for PMPS or CP after mastectomy is scarce and not fully appraised, therefore we conducted this systematic review to explore the current panorama of treatment options. METHODS A systematic review to assess the existing evidence regarding nonpharmacological approaches for PMPS. We reviewed the following databases: PubMed-MEDLINE, Embase, and Ovid (including the Cochrane Database for Clinical studies) using the following search terms: CP, mastectomy, and PMPS, and adjusted the terms depending on the database used. We included observational studies including case reports, cross sectional studies, cohort studies, and clinical trials (randomized or not) that included a NPI to treat PMPS. RESULTS Total 1061 records were identified. After duplicate elimination, 863 records were screened for eligibility. A total of 717 records were excluded using our criteria, 138 records were sought for retrieval, and 117 full text records were assessed. Finally, 30 studies were included: seven case series, one cross-sectional study, two cohort studies, one case-control study, five nonrandomized clinical trials, ten randomized clinical trials (RCT), one qualitative study, and three systematic reviews of the literature, including two meta analyses, were included. DISCUSSION Findings suggest that there is a great response of patients to some NPI. Regarding surgical interventions, autologous fat grafting and lymph node transplantation showed to have the greatest benefit for patients in terms of quality of life and reduced pain scores. Pulsed radiofrequency demonstrated the highest quality of evidence for energy related procedures. Within the physical therapy interventions, transcutaneous electric nerve stimulation and dry needling showed the greatest benefit. Finally, virtual reality demonstrated the greatest benefit in educational interventions.
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Affiliation(s)
- Edmundo Gónima Valero
- Department of Pain and Palliative Care Medicine, Hospital Militar Central, Bogotá, Colombia
| | - Cristian D Rodríguez Miranda
- Department of Anesthesiology, Universidad Militar Nueva Granada - Hospital Universitario Clínica San Rafael, Bogotá, Colombia
| | - Sandra Contreras Arrieta
- Department of Anesthesiology, Universidad Militar Nueva Granada - Hospital Universitario Clínica San Rafael, Bogotá, Colombia
| | - Maria I Daza Morelli
- Anesthesiology and Critical Care Interest Group, Universidad El Bosque Colombian School of Medicine, Bogotá, Colombia
| | - Daniela Seija Butnaru
- Department of Pain and Palliative Care Medicine, Unidad de Hematologia y Oncologia de Santander, Santander, Colombia
| | - Mariana Reyes Carrillo
- Anesthesiology and Critical Care Interest Group, Universidad El Bosque Colombian School of Medicine, Bogotá, Colombia
| | - Laura D Aponte Camacho
- Anesthesiology and Critical Care Interest Group, Universidad El Bosque Colombian School of Medicine, Bogotá, Colombia
| | - Sebastian Amaya
- Anesthesiology and Critical Care Interest Group, Universidad El Bosque Colombian School of Medicine, Bogotá, Colombia.
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Kim CS, Kim Y, Kim DH, Kwon HJ, Shin JW, Choi SS. Effects of Pulsed Radiofrequency Duration in Patients With Chronic Lumbosacral Radicular Pain: A Randomized Double-Blind Study. Neuromodulation 2025; 28:256-262. [PMID: 38752945 DOI: 10.1016/j.neurom.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/11/2024] [Accepted: 03/26/2024] [Indexed: 01/22/2025]
Abstract
OBJECTIVES We hypothesized that the duration of pulsed radiofrequency (PRF) application may affect the effectiveness of PRF in patients with chronic lumbosacral radicular pain (LRP). MATERIALS AND METHODS In this prospective, double-blind, randomized study, 68 patients were randomly allocated to two groups: a 6-minute group, in which PRF was applied at 42 °C for 2 minutes followed by a 2-minute pause, repeated three times; and a 12-minute group, with a continuous application at 42 °C for 12 minutes. The total application time in each group was equal. After PRF, 2 to 3 mL of 1% lidocaine with 5 mg of dexamethasone was injected. The primary outcome was the intensity of leg pain measured using a numerical rating scale (NRS) three months after the procedure. The secondary outcomes were intensities of leg and back pain, the Oswestry Disability Index (ODI), the Medication Quantification Scale III (MQS), the Global Perceived Effect of Satisfaction (GPES), and the incidence of adverse events during follow-up. Primary and secondary outcomes were analyzed using a linear mixed-effect model in the modified intention-to-treat population. RESULTS Each group comprised 34 patients. Three patients in each group did not receive the allocated intervention owing to alleviation of pain. The estimated NRS mean of leg pain at three months was 4.0 (95% CI, 3.2-4.9) and 4.5 (95% CI, 3.6-5.4) in the 6- and 12-minute groups, respectively, with no significant difference between groups (estimated mean difference, -0.5; 95% CI, -1.8 to 0.8; p = 0.436). Regarding the intensities of leg and back pain, ODI, MQS, and GPES, there was no significant difference between the two groups except for GPES at six months. No adverse events were observed in the groups. CONCLUSIONS Among patients with chronic LRP, a prolonged PRF application of 12 minutes, compared with 6 minutes, caused no significant difference in leg pain intensity. CLINICAL TRIAL REGISTRATION The Clinicaltrials.gov registration number under the Clinical Trial Registry of Korea for the study is KCT0003850; https://cris.nih.go.kr.
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Affiliation(s)
- Chan-Sik Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yujin Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Doo-Hwan Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyun-Jung Kwon
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jin-Woo Shin
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seong-Soo Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Li F, Lu H, Gong G, Ou C, Zhang Y. The efficacy of ultrasound-guided pulsed radiofrequency in the treatment of primary glossopharyngeal neuralgia. Front Neurol 2024; 15:1453598. [PMID: 39669105 PMCID: PMC11634690 DOI: 10.3389/fneur.2024.1453598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 11/14/2024] [Indexed: 12/14/2024] Open
Abstract
Objective This study evaluates the clinical efficacy and safety of ultrasound-guided long duration, high voltage pulse radiofrequency (PRF) in managing primary glossopharyngeal neuralgia (GPN). Methods Clinical data were retrospectively analyzed for 13 patients with primary GPN who underwent this treatment between August 2019 and October 2022. Visual Analog Scale (VAS) scores were assessed pre-treatment and at 1 week, 1 month, 3 months, and 6 months post-treatment. Additionally, the rates of discontinuation of oral oxcarbazepine and pregabalin, efficacy, and complication rates at 6 months post-procedure were monitored. Results Significant post-treatment pain relief, was observed across all patients, with statistically significant improvements in VAS scores (p < 0.05). Discontinuation rates for oxcarbazepine and pregabalin were also high (p < 0.05). At the 6-month follow-up, 69.23% of patients achieved excellent and good efficacy, 84.61% demonstrated overall effectiveness, while 15.38% showed poor efficacy. No critical complications were reported in any case. Conclusion Ultrasound-guided, long-term, high-voltage PRF effectively relieves primary glossopharyngeal neuralgia and improves quality of life. Featuring ease of operation, high safety and minimal complications making it a promising approach for clinical application.
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Affiliation(s)
- Fubo Li
- Department of Pain Management, The Affliated Hospital of Southwest Medical University, Luzhou, China
| | - Hongcheng Lu
- Department of Pain Management, The Affliated Hospital of Southwest Medical University, Luzhou, China
| | - Gege Gong
- Department of Physical Diagnosis, The Affliated Hospital of Southwest Medical University, Luzhou, China
| | - Cehua Ou
- Department of Pain Management, The Affliated Hospital of Southwest Medical University, Luzhou, China
| | - Yue Zhang
- Department of Pain Management, The Affliated Hospital of Southwest Medical University, Luzhou, China
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Chen R, Xu X, Yu Y, Chen Y, Lin C, Liu R. High-voltage pulsed radiofrequency improves ultrastructure of DRG and enhances spinal microglial autophagy to ameliorate neuropathic pain induced by SNI. Sci Rep 2024; 14:4497. [PMID: 38402335 PMCID: PMC10894304 DOI: 10.1038/s41598-024-55095-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/20/2024] [Indexed: 02/26/2024] Open
Abstract
Neuropathic pain (NeP) is intractable for which many therapies are ineffective. High-voltage pulsed radiofrequency (HVPRF) on dorsal root ganglion (DRG) is considered an effective treatment for NeP. The aim of this study is to explore the therapeutic voltage for the optimal efficacy of PRF and the underlying mechanisms. The radiofrequency electrode was placed close to the L5 DRG of rats with spared nerve injury (SNI) and emitted current by the corresponding voltage in different groups. Four different voltages (45 V, 65 V, 85 V, and 100 V) of PRF on DRG significantly alleviated the SNI-induced NeP, reduced the levels of activating transcription factor 3 (ATF3) in DRG, improved the ultrastructure of DRG, and promoted autophagy in spinal microglia to varying degrees and partially reversed the increased expression of TNF-α and the reduced expression of IL-10 in spinal cord dorsal horn (SCDH). The beneficial effect of 85V-PRF was superior to those of other three PRF treatments. The underlying mechanisms may be related to repairing the DRG damage and improving the DRG ultrastructure while regulating spinal microglial autophagy and thereby alleviating neuroinflammation.
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Affiliation(s)
- Ri Chen
- Department of Pain Management, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Xueru Xu
- Department of Pain Management, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Youfen Yu
- Department of Pain Management, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Yanqin Chen
- Department of Anesthesiology, Women's and Children's Hospital of Xiamen University, Xiamen, China
| | - Chun Lin
- School of Basic Medical Sciences, Institute of Pain Research, Fujian Medical University, Fuzhou, Fujian, China
| | - Rongguo Liu
- Department of Pain Management, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China.
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Silva J, Sehmbi H, Fiala KJ, Shehata P, Abd-Elsayed A. Radiofrequency ablation and pulsed radiofrequency of the upper extremities. RADIOFREQUENCY ABLATION TECHNIQUES 2024:97-139. [DOI: 10.1016/b978-0-323-87063-4.00022-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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7
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Pulsed radiofrequency of occipital nerve to manage intractable occipital neuralgia due to occipital mass. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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The Clinical Application of Pulsed Radiofrequency Induces Inflammatory Pain via MAPKs Activation: A Novel Hint for Pulsed Radiofrequency Treatment. Int J Mol Sci 2021; 22:ijms222111865. [PMID: 34769297 PMCID: PMC8584518 DOI: 10.3390/ijms222111865] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Pulsed radiofrequency (PRF) works by delivering short bursts of radiofrequency to a target nerve, thereby affecting nerve signal transduction to reduce pain. Although preliminary clinical investigations have shown that PRF treatment can be used safely as an alternative interventional treatment in patients with refractory pain conditions, unexpected damage to a normal nerve/ganglion is still one of the possible complications of using the PRF strategy. Noxious pain may also be triggered if PRF treatment accidentally damages an intact nerve. However, few studies in the literature have described the intracellular modifications that occur in neuronal cells after PRF stimulation. Therefore, in this study, we evaluated the effects of PRF on unimpaired nerve function and investigated the potential mechanisms of PRF-induced pain. Wistar rats were stimulated with 30-60 V of PRF for 6 min, and mechanical allodynia, cold hypersensitivity, cytokine and matrix metalloproteinase (MMP) production, and mitogen-activated protein kinase activity (p38 MAPK, ERK1/2, JNK/SAPK) were analyzed. The results indicated that PRF stimulation induced a significant algesic effect and nociceptive response. In addition, the protein array and Western blotting analyses showed that the clinical application of 60 V of PRF can induce the activation of MAPKs and the production of inflammatory cytokines and MMPs in the lumbar dorsal horn, which is necessary for nerve inflammation, and it can be suppressed by MAPK antagonist treatment. These results indicate that PRF stimulation may induce inflammation of the intact nerve, which in turn causes inflammatory pain. This conclusion can also serve as a reminder for PRF treatment of refractory pain.
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Chen X, Dai J, Li D, Huang X, Qu C. Effects of Pulsed Radiofrequency with Different Temperature on Model Rats of Chronic Constriction Injury. PAIN MEDICINE 2021; 22:1612-1618. [PMID: 33620466 DOI: 10.1093/pm/pnab045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The treatment for neuropathic pain is still a big challenge. Pulsed radiofrequency technique has been widely used to relieve neuropathic pain in recent years. The purpose of this study is to optimize the temperature for pulsed radiofrequency therapy. DESIGN Animal, experimental study. METHODS Seventy-five male SD rats were randomly divided into five groups: Sham operation group (Sham group), chronic constriction injury group (CCI group), PRF 42°C group (P42 group), PRF 50°C group (P50 group), and PRF 60°C group (P60 group). The hindpaw withdrawal threshold (HWT), paw thermal withdrawal latency (PTWL), sciatic nerve structure, and the concentration of spinal methionine enkephalin(M-ENK) were detected to identify which temperature is the best for PRF treatment. RESULTS PRF at 42°C, 50°C and 60°C significantly alleviated the pain in CCI rats. The therapeutic effects of 50°C and 60°C were similar, and both were better than 42°C. In addition, PRF using 42°C, 50°C, and 60°C mediated nerve injury to sciatic nerve were grade 1, 1, and 2, respectively. The concentration of M-ENK in spinal cord increased accompanying with the increasing of the temperature of PRF. CONCLUSIONS PRF using 50°C could induce less damage while achieving better improvement of mechanical and thermal pain threshold than 42°C and 60°C in CCI rats, which may be achieved by promoting the expression of M-ENK in spinal cord.
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Affiliation(s)
- Xun Chen
- Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan Province, China.,Department of Anesthesiology Management, Chongqing Nan'an District People's Hospital, Chongqing, China.,Laboratory of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan Province, China
| | - Jianbo Dai
- Department of surgery Management, Chongqing Nan'an District People's Hospital, Chongqing, China
| | - Dan Li
- Department of Stomatology Management, Chongqing Tongnan District People's Hospital, Chongqing, China
| | - Xingliang Huang
- Department of Respiratory and Critical Care Medicine Management, Chongqing Tongnan District People's Hospital, Chongqing, China
| | - Cehua Qu
- Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan Province, China
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Huang X, Ma Y, Wang W, Guo Y, Xu B, Ma K. Efficacy and safety of pulsed radiofrequency modulation of thoracic dorsal root ganglion or intercostal nerve on postherpetic neuralgia in aged patients: a retrospective study. BMC Neurol 2021; 21:233. [PMID: 34162352 PMCID: PMC8223296 DOI: 10.1186/s12883-021-02286-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/10/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Postherpetic neuralgia (PHN) is common in elderly patients and can be alleviated by pulsed radiofrequency (PRF). However, PRF treatments display different efficacy on different nerves. The purpose of this study was to evaluate the efficacy and safety of ultrasound-guided PRF modulation on thoracic dorsal root ganglion (DRG) or intercostal nerve (ICN) for PHN in aged patients and to provide a theoretical basis for clinical treatment. METHODS We classified aged patients into two groups, DRG group and ICN group, based on the needle tip position. Visual analogue scale (VAS) and concise health status questionnaire (Short-form 36 health/survey questionnaire, SF-36) were used to evaluate the pain intensity and the life quality of the patients before and 2, 4 and 12 weeks after the PRF treatments. We also recorded the adverse reactions during the treatments. RESULTS After the PRF treatment, the scores of VAS and SF-36 (assessing general health perception, social function, emotional role, mental health, and pain) improved significantly in both groups (P < 0.05). The mean VAS score in the DRG group was significantly lower than that in the ICN group 2 weeks after treatment, and remained for 12 weeks. The SF-36 scores in the DRG group were significantly higher than those in the ICN group (P < 0.05). We found a similar incidence of adverse reactions between the two groups (P > 0.05). CONCLUSIONS PRF therapy is safe and effective for elderly patients with postherpetic neuralgia. However, PRF treatment in dorsal root ganglion is superior to that in intercostal nerve with improving VAS and SF-36 scores to a greater extent in older patients. TRIAL REGISTRATION ChiCTR2100044176 .
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Affiliation(s)
- Xuehua Huang
- Department of Pain, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Yanfeng Ma
- Department of Pain, The Seventh People's Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
| | - Weimin Wang
- Department of Pain, The Fourth People's Hospital, Yancheng, Jiangsu, PR China
| | - Yunxiu Guo
- Department of Anesthesiology, Xinhua Hospital Chongming Branch, Shanghai, PR China
| | - Bo Xu
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China.
| | - Ke Ma
- Department of Pain, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China.
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Vuka I, Marciuš T, Došenović S, Ferhatović Hamzić L, Vučić K, Sapunar D, Puljak L. Efficacy and Safety of Pulsed Radiofrequency as a Method of Dorsal Root Ganglia Stimulation in Patients with Neuropathic Pain: A Systematic Review. PAIN MEDICINE 2021; 21:3320-3343. [PMID: 32488240 DOI: 10.1093/pm/pnaa141] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Pulsed radiofrequency (PRF) is a nonablative pain treatment that uses radiofrequency current in short high-voltage bursts, resulting in interruption of nociceptive afferent pathways. We conducted a systematic review with the aim to create a synthesis of evidence about the efficacy and safety of PRF applied to the dorsal root ganglion (DRG) for the treatment of neuropathic pain. METHODS We searched MEDLINE, CINAHL, Embase, and PsycINFO through January 8, 2019, as well as ClinicalTrials.gov and the clinical trial register of the World Health Organization. All study designs were eligible. We assessed risk of bias using the Cochrane tool for randomized controlled trials and the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I). We assessed level of evidence using the Oxford tool and quality of evidence with GRADE. RESULTS We included 28 studies with participants suffering from lumbosacral, cervical, or thoracic radicular pain, post-herpetic neuralgia, neuropathicbone pain in cancer patients, or carpal tunnel syndrome. Only five studies were randomized controlled trials (RCTs), while others were of nonrandomized designs, predominantly before and after comparisons. A total of 991 participants were included, with a median number (range) of 31 (1-101) participants. Only 204 participants were included in the RCTs, with a median number (range) of 38 (23-62) participants. The overall quality of evidence was low, as the majority of the included studies were rated as evidence level 4 or 5. The quality of evidence was very low. CONCLUSIONS Evidence about the efficacy and safety of PRF of the DRG for the treatment of neuropathic pain is based mainly on results from very small studies with low evidence quality. Current research results about the benefits of PRF of the DRG for the treatment of neuropathic pain should be considered preliminary and confirmed in high-quality RCTs with sufficient numbers of participants.
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Affiliation(s)
- Ivana Vuka
- Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia
| | - Tihana Marciuš
- Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia
| | - Svjetlana Došenović
- Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Split, Split, Croatia
| | - Lejla Ferhatović Hamzić
- Department of Proteomics, Centre for Translational and Clinical Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Katarina Vučić
- Department for Safety and Efficacy Assessment of Medicinal Products, Agency for Medicinal Products and Medical Devices, Zagreb, Croatia
| | - Damir Sapunar
- Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia.,Centre for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Zagreb, Croatia
| | - Livia Puljak
- Centre for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Zagreb, Croatia
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Fujihara F, Kim K, Kokubo R, Isu T, Miki K, Morimoto D, Iwamoto N, Inoue T, Morita A. High-frequency thermal coagulation to treat middle cluneal nerve entrapment neuropathy. Acta Neurochir (Wien) 2021; 163:823-828. [PMID: 32415488 DOI: 10.1007/s00701-020-04404-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/10/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Middle cluneal nerve entrapment (MCN-E) around the sacroiliac joint can elicit low back pain (LBP). Pain control can be obtained with anesthetic nerve blocks; however, when their effectiveness is transient, surgical release may be necessary. We investigated the efficacy of radiofrequency thermocoagulation (RFTC) in patients with MCN-E. METHODS Between December 2018 and August 2019, 11 consecutive patients (4 men, 7 women; mean age 76.4 years) with intractable medial buttock pain due to MCN-E underwent MCN RFTC. The mean symptom duration was 49.5 months; pre-RFTC local MCN blocks provided pain relief for a mean of 7.7 days. The severity of pain in the medial buttock due to MCN-E was recorded before and 2, 6, 12, and 24 weeks after RFTC on the numerical rating scale (NRS) and the Roland-Morris Disability Questionnaire (RDQ). RESULTS All patients reported pain alleviation; there were no complications. While there was a significant difference in the pre- and post-RFTC treatment NRS (p < 0.05), the RDQ scores were significantly lower only after 12 weeks. The duration of pain relief was significantly prolonged by RFTC (p < 0.05). Two patients suffered pain relapse 10 weeks post-RFTC; pain alleviation was obtained by re-RFTC performed 2 weeks after pain recurrence. Two other patients relapsed 20 and 21 weeks post-RFTC; their symptoms also disappeared by MCN block administered 24 weeks after they had undergone RFTC. CONCLUSION RFTC may safely control intractable LBP due to MCN-E.
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Tanabe K, Takashima S, Iida H. Changes in the gene expression in mouse astrocytes induced by pulsed radiofrequency: A preliminary study. Neurosci Lett 2020; 742:135536. [PMID: 33259929 DOI: 10.1016/j.neulet.2020.135536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 11/27/2022]
Abstract
Glial cells, both astrocytes and microglia, play important roles in the induction and maintenance of neuroinflammation resulting in neuropathic pain. Pulsed radiofrequency (PRF) is applied to various nerves for the treatment of pain, although the molecular mechanism underlying its effects is still unclear. We herein investigated the genomic effects of PRF on a mouse cultured astrocyte cell line. PRF was applied to the cultured astrocytes in 20-msec pulses of 480 kHz every 500 msec, delivered at the rate of 2 Hz, for 30 min. PRF increased the expression of 2,431 genes and decreased that of 209 genes. Among these genes, 435 genes were upregulated >10-fold and 89 genes >30-fold, while no genes showed a 10-fold decrease in expression. A gene ontology analysis using the list of >10-fold upregulated genes showed that PRF treatment activated immune responses. A pathway analysis using the Kyoto Encyclopedia of Gene and Genomes with the same list detected seven pathways related to neuropathic pain. These findings suggest that PRF improves neuropathic pain via neuroimmunomodulation.
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Affiliation(s)
- Kumiko Tanabe
- Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, 501-1194, Japan.
| | - Shigeo Takashima
- Division of Genomics Research, Life Science Research Center Gifu University, Gifu, 501-1193, Japan
| | - Hiroki Iida
- Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, 501-1194, Japan
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14
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Nishioka A, Kimura M, Sakamoto E, Nagasaka H, Azma T. Continuous But Not Pulsed Radiofrequency Current Generated by NeuroTherm NT500 Impairs Mitochondrial Membrane Potential in Human Monocytic Cells THP-1. J Pain Res 2020; 13:1763-1768. [PMID: 32765051 PMCID: PMC7367739 DOI: 10.2147/jpr.s242204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 06/24/2020] [Indexed: 11/28/2022] Open
Abstract
Background The application of pulsed radiofrequency (PRF) current to peripheral nerves with conditions related to neuropathic pain is considered to be clinically safe, while it has been reported that the destruction of mitochondria after PRF application was observed by electron microscopy. If it occurs reproducibly, PRF applied to peripheral nerves should provoke neurolysis because the impairment of mitochondria is known as the primary cause of apoptosis. Methods Human monocytic cells THP-1 loaded with 100 nM tetramethylrhodamine methyl ester (TMRM), a fluorescent dye that proves the mitochondrial membrane potential (MMP), were exposed to the electric field of continuous radiofrequency (CRF) or PRF current. The TMRM-related fluorescence from THP-1 cells was measured by flow cytometry. Results The exposure of THP-1 cells to a PRF electric field generated by NeuroTherm NT500 for 15 min with maximum power did not decrease MMP in these cells, nor did it cause the induction of apoptosis. By contrast, the application of CRF current at 70 °C for 3 min significantly decreased MMP and induced apoptosis within 10 min after CRF application. Conclusion We conclude from these findings that PRF application does not provoke mitochondrial injury in various types of mammalian cells because the size and the subcellular structure of the plasma membrane or mitochondria are similar among those. However, the present results cannot address the effect of PRF current on organic structure around the nervous system. Further study is required to solve the question of whether PRF current causes neurolysis or not.
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Affiliation(s)
- Akira Nishioka
- Department of Anesthesiology & Pain Medicine, Kohondai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba 272-8516, Japan
| | - Maiko Kimura
- Department of Anesthesiology & Pain Medicine, Kohondai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba 272-8516, Japan
| | - Eriko Sakamoto
- Department of Anesthesiology & Pain Medicine, Kohondai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba 272-8516, Japan
| | - Hiroshi Nagasaka
- Department of Anesthesiology, Saitama Medical University Hospital, Iruma, Saitama 350-0495, Japan
| | - Toshiharu Azma
- Department of Anesthesiology & Pain Medicine, Kohondai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba 272-8516, Japan.,Department of Anesthesiology, Saitama Medical University Hospital, Iruma, Saitama 350-0495, Japan
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15
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Ren H, Zhao C, Jia Z, Bian J, Luo F. Predictors of the Analgesic Efficacy of CT-Guided Percutaneous Pulsed Radiofrequency Treatment of Gasserian Ganglion in Patients With Idiopathic Trigeminal Neuralgia. Pain Pract 2020; 20:850-858. [PMID: 32379916 DOI: 10.1111/papr.12910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/11/2020] [Accepted: 04/26/2020] [Indexed: 11/26/2022]
Abstract
AIMS Although pulsed radiofrequency (PRF) has few postoperative adverse reactions, its analgesic efficacy for trigeminal neuralgia (TN) is not always guaranteed. The response rate of PRF targeting the Gasserian ganglion for patients with TN varies. This study aims to identify the predictors of the analgesic efficacy of CT-guided percutaneous PRF in patients with idiopathic TN. METHODS The patients with idiopathic TN who failed to respond to conservative treatment and underwent CT-guided percutaneous PRF treatment of the Gasserian ganglion from July 2008 to August 2018 at our pain clinic were screened. A positive response was defined as a ≥50% reduction in the pain numeric rating scale (NRS) score from baseline. The demographics and other pretreatment clinical data were analyzed by logistic regression analysis to identify the predictors of a positive response. RESULTS Of the total 102 patients with idiopathic TN who were evaluated in this study, 57 patients (55.9%) were positively responsive to our treatment after 1 year. The binary logistic regression analysis revealed that the positive response to a prior peripheral branch nerve block of the trigeminal nerve with steroid and local anesthetic agents was an independent predictor of the analgesic efficacy of PRF treatment (odds ratio [OR] = 3.685, 95% confidence interval [CI] = 1.583 to 8.577, P = 0.002). The disease duration of TN was also included in the multivariate regression model, although the P value was 0.058 (OR 0.807, 95% CI 0.646 to 1.007). CONCLUSION For patients who previously had positive responses to peripheral branch nerve block of the trigeminal nerve, PRF is likely to have better efficacy.
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Affiliation(s)
- Hao Ren
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunmei Zhao
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zipu Jia
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiajia Bian
- Department of Anesthesiology, Hebei Petro China Central Hospital, Hebei, China
| | - Fang Luo
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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16
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Lee HJ, Cho HH, Nahm FS, Lee PB, Choi E. Pulsed Radiofrequency Ablation of the C2 Dorsal Root Ganglion Using a Posterior Approach for Treating Cervicogenic Headache: A Retrospective Chart Review. Headache 2020; 60:2463-2472. [PMID: 32052873 DOI: 10.1111/head.13759] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate the efficacy and complications of C2 dorsal root ganglion (DRG) pulsed radiofrequency ablation (RFA) for cervicogenic headache (CEH) and to identify factors related to the outcome of the procedure in this retrospective analysis. BACKGROUND Although conventional high-temperature C2 DRG RFA was effective in patients with CEH in previous studies, the effect of pulsed RFA on C2 DRG in cases of CEH has not yet been evaluated. METHODS We examined the electronic medical records of consecutive patients who underwent C2 DRG block for CEH from January 2012 to May 2018 at a pain center. Consequent C2 DRG pulsed RFA was performed for patients in whom the headache recurred after an initial period of relief 24 hours after the C2 DRG block. A successful outcome was defined as at least 50% pain relief at 6 months after C2 DRG pulsed RFA. We also examined variables associated with the outcome and prognostic factors of CEH. RESULTS Fluoroscopy-guided C2 DRG block was performed in 114 patients with CEH. Forty-five patients received C2 DRG pulsed RFA and 40.0% among them (18/45, success group) had ≥50% pain relief after 6 months. There were no post-procedure complications throughout the study period. Significantly more patients in the success group than in the failure group had a definite positive response (≥50% pain relief) to a previous C2 DRG block (P < .001). CONCLUSION C2 DRG pulsed RFA may be an effective treatment for patients with CEH, particularly for patients who have previously experienced definite pain reduction after C2 DRG block. However, the limitations of our study design and small number of patients preclude firm conclusions.
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Affiliation(s)
- Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun Hoo Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seongnam, Republic of Korea
| | - Francis Sahngun Nahm
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seongnam, Republic of Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University, Seoul, Republic of Korea
| | - Pyung-Bok Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seongnam, Republic of Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University, Seoul, Republic of Korea
| | - Eunjoo Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seongnam, Republic of Korea
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17
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Michno A, Kirkor Z, Gojtowska E, Suchorzewski M, Śmietańska I, Baścik B. Pulsed Radiofrequency Neuromodulation Contributes to Activation of Platelet-Rich Plasma in In Vitro Conditions. Neuromodulation 2020; 24:1451-1457. [PMID: 32027438 DOI: 10.1111/ner.13105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/13/2019] [Accepted: 01/02/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Recent years have brought new developments in interventional chronic pain management, namely regenerative orthopedics utilizing platelet-rich plasma (PRP) as well as further evolution of pulsed radiofrequency neuromodulation (PRF). Both methods have been used separately. Here, we investigated whether PRF may potentiate the activation of platelets in PRP samples when both these techniques are combined together in in vitro conditions. MATERIALS AND METHODS Studies were performed on concentrated PRP samples (PRPs) obtained from acid citrate dextrose-treated blood taken from 11 healthy volunteers. PRPs were divided into four groups: 1) nonactivated PRP; 2) thrombin-activated PRP as a positive control for maximal platelets activation; 3) PRF-treated PRP exposed for 20 min to PRF energy generated by neurotherm radio frequency generator at 500 kHz, with a voltage of 40 V and maximal temperature of 42°C; and 4) a combination of groups 2 and 3. RESULTS PRF-induced platelet activation measured by platelet factor 4 (PF4) and ATP release from PRPs was significantly higher compared to nonactivated PRPs, and similar to PF4 and ATP release from thrombin-activated PRPs. Thrombin activation did not potentiate PF4 release in PRF samples and even reduced ATP level. Additionally, PRF neither induced any platelet membrane damage measured by lactic dehydrogenase release from PRP nor modified any platelets viability or metabolism measured by MTT. CONCLUSIONS We confirmed that PRF may activate PRP without additional platelet activators. So, a combination of both methods PRF and PRP application may provide a more effective opportunity for tissue regeneration in dentistry, surgery, dermatology, or in orthopedics.
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Affiliation(s)
- Anna Michno
- Department of Laboratory Medicine, Medical University of Gdańsk, Poland
| | | | - Ewelina Gojtowska
- Department of Laboratory Medicine, Medical University of Gdańsk, Poland
| | - Marek Suchorzewski
- Anaesthesiology and Intensive Care Department, Medical University of Gdańsk, Poland
| | - Irmina Śmietańska
- Anaesthesiology and Intensive Care Department, Medical University of Gdańsk, Poland
| | - Bartosz Baścik
- Radiology Department, Medical University of Gdańsk, Poland
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18
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Kelderman T, Vanschoenbeek G, Crombez E, Paemeleire K. Safety and efficacy of percutaneous pulsed radiofrequency treatment at the C1-C2 level in chronic cluster headache: a retrospective analysis of 21 cases. Acta Neurol Belg 2019; 119:601-605. [PMID: 31482444 DOI: 10.1007/s13760-019-01203-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/20/2019] [Indexed: 12/22/2022]
Abstract
We performed a study of the safety and efficacy of percutaneous pulsed radiofrequency (PRF) treatment directed at C1 and C2 levels as performed at our local pain clinic in refractory chronic cluster headache (CCH) patients. We identified 21 CCH patients treated with PRF (240 s, max. 45 V, max. 42 °C) directed at the ganglion and/or nerve root of C1 and C2. Data were collected through retrospective analysis of patients' files and include demographic variables, onset and duration of the headache, mean attack frequency, and prior pharmacological treatment. Safety and reduction of attack frequency in the first 3 months after a first PRF treatment was the primary outcome parameter of this study. All patients had been treated with at least two prophylactic drugs and 19 (90%) had previously been treated with verapamil, lithium, and topiramate. Ten patients (47.6%) reported no meaningful effect, four patients (19%) reported a meaningful reduction of < 50%, and seven patients (33.3%) reported a reduction in headache burden of at least 50% in the 3 months following treatment. Two patients reported occurrence or increase in frequency of contralateral cluster attacks. No other adverse events were reported or detected at follow-up. Upper cervical PRF treatment appears to be a safe procedure that could prove effective in the treatment of patients with refractory CCH and warrants a prospective study.
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19
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Sir E, Eksert S. Comparison of block and pulsed radiofrequency of the ganglion impar in coccygodynia. Turk J Med Sci 2019; 49:1555-1559. [PMID: 31652036 PMCID: PMC7018354 DOI: 10.3906/sag-1906-51] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/22/2019] [Indexed: 12/14/2022] Open
Abstract
Background/aim Ganglion impar block is used for the treatment of chronic coccygodynia. Pulsed radiofrequency (PRF) of the ganglion impar is a promising novel technique. The aim of this study was to determine and compare the efficacy of the blockade and PRF of the ganglion impar. Materials and methods Thirty-nine consecutive patients diagnosed with coccygodynia and treated with a blockade or PRF of the ganglion impar were included in this retrospective study. We compared the ganglion impar block (GIB) group (n = 25) with the ganglion impar pulsed radiofrequency (GIPRF) group (n = 14) in terms of pain intensity and patient satisfaction. We applied a numeric pain rating scale (NPRS) and a Likert scale (LS). Results The NPRS scores in both groups had improved significantly from baseline at 3 weeks and at 3 and 6 months. However, in the sixth month, pain levels in the GIPRF group remained good, but they had returned to almost initial levels in the GIB group. Correspondingly, there were significant differences between groups in NPRS and patient satisfaction scores at 6 months (P ˂ 0.05). Conclusion PRF neuromodulation provides significantly longer pain relief and reduces the risk of recurrence of pain in chronic coccygodynia as compared with blockade of the impar ganglion.
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Affiliation(s)
- Ender Sir
- Department of Pain Medicine, Health Sciences University, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Sami Eksert
- Department of Anesthesia and Reanimation, Health Sciences University, Gülhane Training and Research Hospital, Ankara, Turkey
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20
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De M, Mohan VK, Bhoi D, Talawar P, Kumar A, Garg B, Trikha A, Dehran M, Kashyap L, Shende DR. Transforaminal Epidural Injection of Local Anesthetic and Dorsal Root Ganglion Pulsed Radiofrequency Treatment in Lumbar Radicular Pain: A Randomized, Triple-Blind, Active-Control Trial. Pain Pract 2019; 20:154-167. [PMID: 31538405 DOI: 10.1111/papr.12840] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/10/2019] [Accepted: 09/07/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Lumbar radicular pain (LRP) results from inflammation and irritation of lumbar spinal nerves and the dorsal root ganglion (DRG). METHODS Our study is a prospective, triple-blind, randomized, activecontrol trial (CTRI/2016/02/006666) comparing transforaminal epidural local anesthetic (LA) injection and pulsed radiofrequency treatment of DRG in patients with chronic LRP. Patients with LRP after failed conservative management for >3 months received selective diagnostic nerve root block with 1 mL 2% lidocaine. Fifty patients showing positive responses were divided into groups of 25 each. The LA group received transforaminal epidural injection of 1 mL 0.5% bupivacaine. The lumbar pulsed radiofrequency (LPRF) group received transforaminal epidural injection of 1 mL 0.5% bupivacaine with 3 cycles of pulsed radiofrequency of the DRG for 180 seconds RESULTS: Both groups were compared by observing pain intensity on a 0- to 100-point VAS and improvement in functional status by the Oswestry Disability Index (ODI version 2.0) at 2 weeks and 1, 2, 3, and 6 months. All baseline variables were comparable between the 2 groups. Statistically significant reduction in both outcomes was seen in the LPRF group compared to the LA group from 2 weeks to 6 months. One hundred percent of patients in the LPRF group had a ≥20- point decrease in VAS and significant percentage reduction in ODI at all time intervals up to 6 months, whereas it was seen in 80% and 28% of patients in the LA group at 3 and 6 months, respectively. No complications were seen in any patients CONCLUSION: Pulsed radiofrequency of the DRG applied for longer duration results in long-term pain relief and improvement in the functional quality of life in patients with chronic LRP.
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Affiliation(s)
- Manish De
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Virender K Mohan
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Debesh Bhoi
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Talawar
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, India
| | - Ajeet Kumar
- Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, India
| | - Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Maya Dehran
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Lokesh Kashyap
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Dilip R Shende
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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21
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Hatipoğlu Z, Özbek HT. Bel ağrısında pulsed ve konvansiyonel radyofrekans termokoagulasyon uygulamaları. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.465286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Arakawa K, Kaku R, Kurita M, Matsuoka Y, Morimatsu H. Prolonged-duration pulsed radiofrequency is associated with increased neuronal damage without further antiallodynic effects in neuropathic pain model rats. J Pain Res 2018; 11:2645-2651. [PMID: 30464582 PMCID: PMC6214336 DOI: 10.2147/jpr.s168064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim of investigation Pulsed radiofrequency (PRF) is a safe and effective approach for treating neuropathic pain. However, the optimal treatment conditions and analgesic mechanisms of PRF remain unclear. The aim of our study was to assess the beneficial and adverse effects of prolonged-duration PRF and the analgesic mechanisms of PRF treatment with neuropathic pain rats. Methods Male Sprague Dawley rats received L5 spinal nerve ligation (SNL) for developing neuropathic pain. Fourteen days after L5 SNL surgery, they were divided into three groups according to duration of PRF current for 6 minutes, 12 minutes, and none. PRF current was delivered via direct visualization adjacent to the L5 dorsal root ganglion (DRG). Pain behavior was evaluated every week after L5 SNL surgery, until day 28. Seven days after PRF treatment, L5 DRG tissue was harvested to detect levels of activating translation factor 3 (ATF3; a marker of neuronal damage) and hyperpolarization-activated cyclic nucleotide (HCN)-gated cation channels (key factors in neuropathic pain) using quantitative PCR. Results Before PRF application, withdrawal thresholds were significantly lower than at baseline and did not differ significantly between the three groups. After PRF application, withdrawal thresholds in the PRF6 and PRF12 groups were significantly increased compared to those in the sham group. However, those in the PRF6 and PRF12 groups did not differ significantly. The expression level of ATF3 mRNA in the PRF12 group was significantly higher than that in the sham group (P<0.01), but the expression of HCN1 and HCN2 channels did not differ significantly between the three groups. Conclusion Prolonged PRF exposure, from 6 to 12 minutes, was not only ineffective but also associated with increased neuronal damage. These findings do not support prolonged PRF exposure as a helpful treatment for neuropathic pain. In this study, the involvement of HCN channels in the antiallodynic effects of PRF was uncertain.
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Affiliation(s)
- Kyosuke Arakawa
- Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan,
| | - Ryuji Kaku
- Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan,
| | - Masako Kurita
- Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan,
| | - Yoshikazu Matsuoka
- Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan,
| | - Hiroshi Morimatsu
- Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan,
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23
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Azma T, Nishioka A, Ogawa S, Nagasaka H, Matsumoto N. Enhanced expression of gene coding for β-endorphin in human monocytic cells exposed to pulsed radio frequency electric fields through thermal and non-thermal effects. J Pain Res 2018; 11:2887-2896. [PMID: 30532582 PMCID: PMC6247966 DOI: 10.2147/jpr.s171974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background The enhanced expression of endogenous opioid peptides, including β-endorphin, has been implicated in the mechanism of action of pulsed radio frequency (PRF) application in pain modulation. Because thermal effects cannot be separated from the physical property of PRF application to biological tissues, we evaluated whether temperatures higher than that of the normal body temperature (37°C) modulate mRNA expression for the precursor of β-endorphin, proopiomelanocortin (POMC) in human monocytic cells THP-1. We also attempted to examine whether mechanisms other than thermal effects also modulate such gene expression. Methods and results The mRNA for POMC in THP-1 cells increased by a 15-minutes incubation at 42°C, 45°C, or 70°C without PRF application as compared with that in cells incubated at 37°C. On the other hand, gene expression for POMC in cells incubated at 20°C as well as at 37°C with PRF application for 15 minutes increased as compared to that in cells incubated at 37°C without PRF application. Continuous radio frequency at 70°C but not PRF provoked apoptotic cell death at 1–2 hour, and necrotic cell death at 24 hours after the RF application. Conclusion A simple experimental system using human monocytic cells in culture demonstrated that a 15 minute elevation of temperature above 37°C enhanced gene expression for POMC in THP-1 cells, while a 15 minute application of PRF to these cells incubated at 37°C or lower, also enhanced gene expression, indicating that temperature-independent mechanisms as well as thermal effects may be involved in such gene expression.
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Affiliation(s)
- Toshiharu Azma
- Department of Anesthesiology and Pain Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba 272-8516, Japan, .,Department of Anesthesiology, Saitama Medical University Hospital, Moroyama-cho, Iruma-gun, Saitama 350-0495, Japan,
| | - Akira Nishioka
- Department of Anesthesiology and Pain Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba 272-8516, Japan,
| | - Saori Ogawa
- Department of Dental Anesthesiology, Matsumoto Dental University, Shiojiri, Nagano 399-0781, Japan
| | - Hiroshi Nagasaka
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama-cho, Iruma-gun, Saitama 350-0495, Japan,
| | - Nobuyuki Matsumoto
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama-cho, Iruma-gun, Saitama 350-0495, Japan,
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24
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Ding Y, Li H, Hong T, Zhao R, Yao P, Zhao G. Efficacy and Safety of Computed Tomography-Guided Pulsed Radiofrequency Modulation of Thoracic Dorsal Root Ganglion on Herpes Zoster Neuralgia. Neuromodulation 2018; 22:108-114. [PMID: 30288853 DOI: 10.1111/ner.12858] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/18/2018] [Accepted: 08/13/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Pulsed radiofrequency (PRF) can relieve postherpetic neuralgia (PHN) caused by herpes zoster (HZ) infection. Nevertheless, its curative effect can vary and may be related to the duration of treatment period. The following study investigates the efficacy and safety of CT-guided PRF modulation on HZ neuralgia over different periods and different time points. MATERIALS AND METHODS A total of 150 patients with HZ/PHN were enrolled at the Pain Department, Shengjing Hospital of China Medical University between January 2013 and December 2016. According to the course of disease, the patients were randomly divided into group A, which included patients with acute stage (n = 50; course <1 m); group B, which included patients with subacute stage (n = 50; 1 m <course <3 m); and group C, which included patients with chronic stage (n = 50; course >3 m). The PRF therapy was performed in all patients by targeting thoracic dorsal root ganglion (DRG). The visual analogue scale (VAS), SF-36, total effective rate of treatment, and dosage of antiepileptic analgesic drugs were observed at different time points, before and after the surgery. RESULTS Compared to preoperative time, decreased VAS, improved SF-36, and the decreased dosage of antiepileptic analgesic drugs were observed at all time points, and in all groups after surgery (p < 0.05). In group A, pain relief lasted longer, and it further decreased over time. In addition, significantly lower VAS, higher SF-36, and lower dosage of antiepileptic analgesic drugs were found in group A compared to group B, and in group B compared to group C (all p < 0.05). Furthermore, the total effective rates in groups A, B, and C were 88, 72, and 52%, respectively. CONCLUSIONS CT-guided PRF targeting thoracic DRG for modulation of HZ neuralgia in different periods is safe and effective. It is recommended to perform early intervention therapy at the acute phase of HZ.
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Affiliation(s)
- Yuanyuan Ding
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hongxi Li
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tao Hong
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Rongjie Zhao
- Class 5 of 2020 Session, Shenyang No. 20 High School, Shenyang, China
| | - Peng Yao
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guangyi Zhao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
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Abstract
Background Occipital neuralgia is an uncommon disorder characterized by severe pain involving the posterior scalp in the distribution of the greater and lesser occipital nerves. In cases refractory to pharmacotherapy, invasive treatment options may be warranted. The aim of the present study was to examine the effects of thermal radiofrequency ablation (TRF) on occipital neuralgia. We hypothesized that this procedure would result in long-term pain relief. Methods All patients who underwent TRF of the greater and lesser occipital nerves between January 1, 2013 and March 23, 2016 were identified. Medical records were reviewed for preprocedure pain score, 1-month postprocedure pain score, patient-defined percent pain relief according to the visual analog scale (on which zero equals no pain and 10 represents the worst pain imaginable), and length of pain relief. The primary outcomes were the differences between preprocedure and 1-month postprocedure pain scores (mean change from baseline), percent pain relief, and patient-reported length of relief. Results A total of 50 patients were identified; 4 patients were excluded because of insufficient data as a result of loss to follow-up. A significant difference was found between preprocedure and postprocedure patient-reported pain scores (6.7 vs 2.7, respectively; P < 0.001), equating to a mean reduction in pain scores 1-month postprocedure of 4.0 ± 3.3. The mean patient-defined percent pain relief was 76.3% ± 25.0%. The mean patient-reported length of relief was 6.5 ± 5.1 months. Conclusion This study suggests that TRF may reduce pain scores for approximately 6 months.
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Ding Y, Li H, Zhu Y, Yao P, Zhao G. Transforaminal epidural steroid injection combined with pulsed radio frequency on spinal nerve root for the treatment of lumbar disc herniation. J Pain Res 2018; 11:1531-1539. [PMID: 30147357 PMCID: PMC6097521 DOI: 10.2147/jpr.s174318] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Lumbar disc herniation (LDH) is a common disease in clinical practice. The symptoms recur and are aggravated by time; severe pain and long-term movement disorder cause physiological and psychological problems that affect the quality of life of patients. Therefore, relieving the pain symptoms and promoting functional recovery are the primary goals that have gained increased attention. Objective To assess the efficacy of CT-guided transforaminal epidural steroid injection (TFESI) combined with pulsed radio frequency (PRF) on spinal nerve root for the treatment of LDH. Study design Retrospective comparative study. Setting Shengjing Hospital of China Medical University. Methods A total of 135 patients with LDH were selected from the Department of Pain Management in the Shengjing Hospital of China Medical University between January 2014 and December 2016. All patients were divided into three groups according to the order of entry (n=45): TFESI (group A); PRF on spinal nerve root (group B); and TFESI combined with PRF on spinal nerve root (group C). The visual analog scale (VAS), Oswestry disability index (ODI), and global perceived effect (GPE) before treatment and at different time points after treatment were observed, and patients' satisfaction was assessed. Results At every point of observation, the VAS and ODI decreased significantly as compared to that before treatment in all groups (P<0.05). The VAS and ODI in group A at 3 and 6 months after treatment were significantly higher than that in the other two groups (P<0.05). At day 1, day 14, and 1 month after treatment, the VAS and ODI in group C were significantly lower than that in group B (P<0.05). The GPE in group C was high in the early days, while that at day 14 and 1 month after treatment was significantly higher than that in the other two groups (P<0.05); no significant difference was observed in GPE at 3 and 6 months after treatment between groups B and C (P>0.05). Conclusion TFESI combined with PRF for the treatment of LDH could effectively and rapidly relieve lumbago and radicular pain and achieve long-term remission. Although the method is widely applicable, the precise selection of patients is imperative.
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Affiliation(s)
- Yuanyuan Ding
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hongxi Li
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yongqiang Zhu
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Peng Yao
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guangyi Zhao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China,
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Zhao W, Chen JZ, Hu JH, Huang JQ, Jiang YN, Luo G, Yi GF, Peng ZH, Wang H, Shen J, Gao BL. In vivo effects of radiofrequency ablation on long bones and the repair process in swine models. Jpn J Radiol 2016; 35:31-39. [PMID: 27822778 DOI: 10.1007/s11604-016-0596-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/21/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE To investigate in vivo effect of radiofrequency ablation (RFA) on swine long bones and the repair process. MATERIALS AND METHODS RFA was performed in six swine at the end and middle part of the tibia or femur. After RFA, radiological examinations were performed, and the swine were killed immediately and at different time points post-RFA for histopathological examination. RESULTS All swine had successful RFA. The RFA-induced elliptical necrotic area ranged from 3.81-5.24 cm2 (mean 4.08 ± 0.73 cm2) at the bone end but 5.60-8.98 cm2 (mean 7.58 ± 1.41) at the middle part immediately after RFA until 10 days, with the necrosis area significantly smaller (P = 0.000) at the end than at the middle. RFA only damaged the cortical bone slightly (0.01 cm thick) with no damage to the soft tissues outside the compact bone at both the end and middle. Surrounding the elliptic pale zone of coagulative necrosis was a narrow brown band of hemorrhage and inflammatory exudate. From day 10 until week 12, tissue proliferation and repair became increasingly apparent, with proliferated granulation, fibrous tissue, and fresh and mature bone trabecula. CONCLUSION RFA can quickly and effectively destroy the cancellous bone tissue without affecting the cortical bone and activate bone remodeling.
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Affiliation(s)
- Wei Zhao
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming, Yunnan, 650032, People's Republic of China
| | - Jin-Zhou Chen
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming, Yunnan, 650032, People's Republic of China
| | - Ji-Hong Hu
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming, Yunnan, 650032, People's Republic of China
| | - Jian-Qiang Huang
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming, Yunnan, 650032, People's Republic of China
| | - Yong-Neng Jiang
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming, Yunnan, 650032, People's Republic of China
| | - Gang Luo
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming, Yunnan, 650032, People's Republic of China
| | - Gen-Fa Yi
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming, Yunnan, 650032, People's Republic of China
| | - Zhao-Hong Peng
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming, Yunnan, 650032, People's Republic of China
| | - Hui Wang
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming, Yunnan, 650032, People's Republic of China
| | - Jin Shen
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming, Yunnan, 650032, People's Republic of China
| | - Bu-Lang Gao
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming, Yunnan, 650032, People's Republic of China.
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Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness. Pain 2016; 156:2585-2594. [PMID: 26447705 DOI: 10.1097/j.pain.0000000000000373] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Occipital neuralgia (ON) is characterized by lancinating pain and tenderness overlying the occipital nerves. Both steroid injections and pulsed radiofrequency (PRF) are used to treat ON, but few clinical trials have evaluated efficacy, and no study has compared treatments. We performed a multicenter, randomized, double-blind, comparative-effectiveness study in 81 participants with ON or migraine with occipital nerve tenderness whose aim was to determine which treatment is superior. Forty-two participants were randomized to receive local anesthetic and saline, and three 120 second cycles of PRF per targeted nerve, and 39 were randomized to receive local anesthetic mixed with deposteroid and 3 rounds of sham PRF. Patients, treating physicians, and evaluators were blinded to interventions. The PRF group experienced a greater reduction in the primary outcome measure, average occipital pain at 6 weeks (mean change from baseline -2.743 ± 2.487 vs -1.377 ± 1.970; P < 0.001), than the steroid group, which persisted through the 6-month follow-up. Comparable benefits favoring PRF were obtained for worst occipital pain through 3 months (mean change from baseline -1.925 ± 3.204 vs -0.541 ± 2.644; P = 0.043), and average overall headache pain through 6 weeks (mean change from baseline -2.738 ± 2.753 vs -1.120 ± 2.1; P = 0.037). Adverse events were similar between groups, and few significant differences were noted for nonpain outcomes. We conclude that although PRF can provide greater pain relief for ON and migraine with occipital nerve tenderness than steroid injections, the superior analgesia may not be accompanied by comparable improvement on other outcome measures.
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Huang YH, Hou SY, Cheng JK, Wu CH, Lin CR. Pulsed radiofrequency attenuates diabetic neuropathic pain and suppresses formalin-evoked spinal glutamate release in rats. Int J Med Sci 2016; 13:984-991. [PMID: 27994505 PMCID: PMC5165693 DOI: 10.7150/ijms.16072] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 11/01/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pulsed radiofrequency (PRF) has been used to treat chronic pain for years, but its effectiveness and mechanism in treating diabetic neuropathic pain are still unexplored. The aim of this study was to elucidate the modulation of diabetic neuropathic pain induced by streptozotocin and the release of spinal excitatory amino acids by PRF. METHODS Diabetes was induced by intraperitoneal administration of streptozotocin. Pulsed radiofrequency was applied to L5 and L6 dorsal roots at 42 °C for 2 min. The responses of all of the groups to thermal, mechanical and cold stimuli were measured for a period of 6 d after this process. Seven days after PRF treatment, intrathecal microdialysis was used to examine the effect of pulsed radiofrequency on the formalin-evoked spinal release of excitatory amino acids and concurrent behaviour responses from diabetic rats. RESULTS Three weeks after intraperitoneal streptozotocin treatment and before PRF application, mechanical, thermal and cold hypersensitivity occurred. Application of PRF significantly alleviated hyperglycaemia-induced mechanical, thermal and cold hypersensitivity and also attenuated the increase in formalin-evoked CSF glutamate concentration, compared with sham treated diabetic rats. CONCLUSION It may be concluded that PRF has an analgesic effect on neuropathic pain by suppressing the nociception-induced release of excitatory neurotransmitters. PRF may provide a novel promising therapeutic approach for managing diabetic neuropathic pain.
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Affiliation(s)
- Yu-Hsin Huang
- Department of Anesthesiology, Chang Gung Memorial Hospital-Kaohsiung Medical Centre, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shao-Yun Hou
- Department of Anesthesiology, Chang Gung Memorial Hospital-Kaohsiung Medical Centre, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jen-Kun Cheng
- Department of Anesthesiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chih-Hsien Wu
- Department of Anesthesiology, Chang Gung Memorial Hospital-Kaohsiung Medical Centre, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chung-Ren Lin
- Department of Anesthesiology, Chang Gung Memorial Hospital-Kaohsiung Medical Centre, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Robbins MS, Robertson CE, Kaplan E, Ailani J, Charleston L, Kuruvilla D, Blumenfeld A, Berliner R, Rosen NL, Duarte R, Vidwan J, Halker RB, Gill N, Ashkenazi A. The Sphenopalatine Ganglion: Anatomy, Pathophysiology, and Therapeutic Targeting in Headache. Headache 2015; 56:240-58. [DOI: 10.1111/head.12729] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 10/15/2015] [Accepted: 10/15/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Matthew S. Robbins
- Montefiore Headache Center; Bronx NY USA
- Department of Neurology; Montefiore Medical Center, Albert Einstein College of Medicine; Bronx NY USA
| | | | - Eugene Kaplan
- The Kaplan Headache Center, Optimum Health Medical Group, PLLC; Clifton Park NY USA
| | - Jessica Ailani
- Department of Neurology; Medstar Georgetown University Medical Center; Washington DC USA
| | - Larry Charleston
- Department of Neurology; University of Michigan Health System; Ann Arbor MI USA
| | - Deena Kuruvilla
- Department of Neurology; Yale School of Medicine; New Haven CT USA
| | | | - Randall Berliner
- Department of Neurology; Montefiore Medical Center, Albert Einstein College of Medicine; Bronx NY USA
| | - Noah L. Rosen
- Pain and Headache Center, Cushing Neuroscience Institute, Department of Neurology, Hofstra North Shore LIJ Medical Center; Manhasset NY USA
| | - Robert Duarte
- Pain and Headache Center, Cushing Neuroscience Institute, Department of Neurology, Hofstra North Shore LIJ Medical Center; Manhasset NY USA
| | | | | | | | - Avi Ashkenazi
- Department of Medicine (Neurology); Doylestown Hospital; Doylestown PA USA
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Lee JB, Byun JH, Choi IS, Kim Y, Lee JS. The Effect of Pulsed Radiofrequency Applied to the Peripheral Nerve in Chronic Constriction Injury Rat Model. Ann Rehabil Med 2015; 39:667-75. [PMID: 26605164 PMCID: PMC4654073 DOI: 10.5535/arm.2015.39.5.667] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 05/29/2015] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To investigate the effect of pulsed radiofrequency (PRF) applied proximal to the injured peripheral nerve on the expression of tumor necrosis factor-α (TNF-α) in a neuropathic pain rat model. METHODS Nineteen male Sprague-Dawley rats were used in the study. All rats underwent chronic constriction injury (CCI) procedure. After 7 days of CCI, withdrawal frequency of affected hind paw to mechanical stimuli and withdrawal latency of affected hind paw to heat stimulus were measured. They were randomly divided into two groups: group A, CCI group (n=9) and group B, CCI treated with PRF group (n=10). Rats of group B underwent PRF procedure on the sciatic nerve. Withdrawal frequency and withdrawal latency were measured at 12 hours, and 7 days after PRF. Immunohistochemistry and Western blot analysis were performed using a TNF-α antibody. RESULTS Before PRF, withdrawal frequency and withdrawal latency were not different in both groups. After PRF, withdrawal frequency decreased and withdrawal latency prolonged over time in group B. There was significant interaction between time and group for each withdrawal frequency and withdrawal latency. Group B showed decreased TNF-α immunoreactivity of the spinal cord and sciatic nerve at 7 days. CONCLUSION PRF applied proximal to the peripheral nerve injury is potentially helpful for the reduction of neuropathic pain by neuromodulation of inflammatory markers.
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Affiliation(s)
- Jun-Beom Lee
- Department of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Jeong-Hyun Byun
- Department of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - In-Sung Choi
- Department of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Young Kim
- Department of Pathology, Research Institute of Medical Sciences, Chonnam National University Medical School, Gwangju, Korea
| | - Ji Shin Lee
- Department of Pathology, Research Institute of Medical Sciences, Chonnam National University Medical School, Gwangju, Korea
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Lin WT, Chang CH, Cheng CY, Chen MC, Wen YR, Lin CT, Lin CW. Effects of low amplitude pulsed radiofrequency stimulation with different waveform in rats for neuropathic pain. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2013:3590-3. [PMID: 24110506 DOI: 10.1109/embc.2013.6610319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Pulsed-radiofrequency (PRF) electrical stimulation has been widely used for chronic pain treatment. It has been demonstrated with advantages of low temperature over traditional continuous radiofrequency (CRF) lesions with higher amplitude and mono polar electrode to treat pain in clinics (frequency 500 KHz, Pulse duration 20 msec, Amplitude 45 V, Treatment 2 min). We compare the effects of different pulse waveforms and PRF parameters (Pulse duration 25 ms, Treatment duration 5 min, low amplitude of 2.5/1.25 V) with a miniature bi-polar electrode on Dorsal root ganglion (DRG). The pain relief effect due to PRF is evaluated by using Von Frey method for the pain threshold index based on behavior response to mechanical stimulus of various strengths. Experimental results of Von Frey Score show that the sinusoidal group has higher responses than the square wave one. Both fast and secondary expressed proteins of c-fos and pp38 are measured from spinal cord tissue sectioning slides to characterize the pain associated inflammatory responses and their responses due to PRF stimulation.
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Intra-articular Pulsed Mode Radiofrequency for Hip Pain: Inoperable Coxarthrosis Case. W INDIAN MED J 2015; 63:526-7. [PMID: 25781295 DOI: 10.7727/wimj.2013.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 10/16/2013] [Indexed: 11/18/2022]
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Apiliogullari S, Aydin BK, Onal O, Kirac Y, Celik JB. Pulsed Radiofrequency of Dorsal Root Ganglia for the Treatment of Complex Regional Pain Syndrome in an Adolescent with Poliomyelitis Sequel: A Case Report. PAIN MEDICINE 2015; 16:1369-72. [PMID: 25688583 DOI: 10.1111/pme.12710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Complex regional pain syndrome (CRPS) is a painful and disabling syndrome in which the patient presents with neuropathic pain, edema, or vasomotor or pseudomotor abnormalities that are often refractory to treatment. Polio paralysis is caused by the damage or destruction of motor neurons in the spine, which lead to corresponding muscle paralysis. This report is a case report on the application of a pulsed radiofrequency (PRF) current to dorsal root ganglia (DRG) for the treatment of CRPS type 1 in an adolescent patient. DESIGN Single case report. SETTING Selcuk University Hospital. PATIENT A 16-year-old girl who suffered from CRPS type 1 secondary to surgeries for the sequelae of poliomyelitis. INTERVENTIONS PRF current application to the lumbar 4 and lumbar 5 DRG. OUTCOME MEASURES Pain reduction. RESULTS The patient had complete resolution of her symptoms, which was maintained at a 6-month follow-up. CONCLUSIONS This case illustrates that PRF applied to lumbar 4 and lumbar 5 DRG may play a significant role in CRPS type 1 management after the surgical treatment of poliomyelitis sequelae in adolescent patients. Further randomized, controlled studies are needed to support this argument.
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Affiliation(s)
- Seza Apiliogullari
- Department of Anesthesia and Intensive Care, Selcuk University Medical Faculty, Konya, Turkey
| | - Bahattin Kerem Aydin
- Department of Orthopedics and Traumatology, Selcuk University Medical Faculty, Konya, Turkey
| | - Ozkan Onal
- Department of Anesthesia and Intensive Care, Selcuk University Medical Faculty, Konya, Turkey
| | - Yunus Kirac
- Department of Orthopedics and Traumatology, Selcuk University Medical Faculty, Konya, Turkey
| | - Jale Bengi Celik
- Department of Anesthesia and Intensive Care, Selcuk University Medical Faculty, Konya, Turkey
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Schianchi PM. A new technique to treat facet joint pain with pulsed radiofrequency. Anesth Pain Med 2015; 5:e21061. [PMID: 25789234 PMCID: PMC4350159 DOI: 10.5812/aapm.21061] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 10/05/2014] [Accepted: 10/13/2014] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Facet joint pain affects 5% to 15% of the population with low back pain and the prevalence increases with age due to progression of arthritis. While conservative treatments are often unsuccessful, the scientific evidence on minimally invasive therapies such as intra-articular steroid infiltration and continuous and pulsed radiofrequency (PRF) of the medial branches is contradictory. Since PRF has recently been reported to successfully treat joint pain, a new application of this method is proposed for facetogenic lumbar pain via an intra-articular subcapsular approach. Here we reported two cases with successful treatment. CASE PRESENTATION A 71-year-old patient presented because of persisting pain in the left gluteal region radiating to the lateral thigh and calf when standing. Anti-inflammatory drugs produced only short-lasting insufficient relief. A 52-year-old employee was admitted in June 2012 because of axial lower lumbar pain with intermittent diffuse radiation to the right lower extremity that worsened during walking and lying down despite receiving analgesics and physiotherapy. CONCLUSIONS A new approach to treat lumbar facet joint pain with PRF is simple to perform and without serious complications. In view of the good long-lasting results obtained with the two reported cases, randomized control trials are necessary to validate this new approach.
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Affiliation(s)
- Pietro Martino Schianchi
- Department of Pain Management, S. Anna Clinic, Lugano, Switzerland
- Corresponding author: Pietro Martino Schianchi, Department of Pain Management, S. Anna Clinic, Lugano, Switzerland. Tel: +41-919233978, Fax: +41-919238917, E-mail:
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Koh W, Choi SS, Karm MH, Suh JH, Leem JG, Lee JD, Kim YK, Shin J. Treatment of chronic lumbosacral radicular pain using adjuvant pulsed radiofrequency: a randomized controlled study. PAIN MEDICINE 2014; 16:432-41. [PMID: 25530347 DOI: 10.1111/pme.12624] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective of this study was to determine the effects of combining pulsed radiofrequency (PRF) treatment and transforaminal epidural injection (TFEI) to treat patients with chronic refractory lumbar radicular pain caused by lumbar spinal stenosis. STUDY DESIGN Randomized control trial. SETTINGS Interventional pain management practice. METHOD Sixty-two patients were assigned to the study groups (PRF group = 31; control group = 31). Under fluoroscopic guidance, the RF needle was positioned close to the lumbar dorsal root ganglion. The PRF group received 3 cycles of PRF treatment, and sensory stimulation without RF lesioning was applied to the control group. After PRF or sham lesioning, a local anesthetic with steroid was injected. The primary outcome of a successful response was defined as: 1) ≥50% or 4-point pain reduction in the numerical rating scale (NRS) without an increase in the Oswestry disability index (ODI) or medication quantification scale (MQS), or mean score <4 in the global perceived effect (GPE) scale; or 2) ≥30% or 2-point pain reduction in NRS with a simultaneous decrease in ODI, MQS, or ≥6 points in the GPE scale. RESULT The number of patients with successful treatment results was higher in the PRF group at 2 months (P = 0.032) and 3 months (P = 0.018). No significant differences were observed in terms of the secondary outcome variables between the 2 groups. CONCLUSION The TFEI provided significant short-term pain relief and PRF can be applied in conjunction with TFEI to achieve higher treatment efficacy compared with TFEI alone.
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Affiliation(s)
- Wonuk Koh
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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Chen KH, Yang CH, Juang SE, Huang HW, Cheng JK, Sheen-Chen SM, Cheng JT, Lin CR. Pulsed radiofrequency reduced complete Freund's adjuvant-induced mechanical hyperalgesia via the spinal c-Jun N-terminal kinase pathway. Cell Mol Neurobiol 2014; 34:195-203. [PMID: 24242210 PMCID: PMC11488954 DOI: 10.1007/s10571-013-0003-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 10/28/2013] [Indexed: 12/29/2022]
Abstract
Pulsed radiofrequency (PRF) treatment involves the pulsed application of a radiofrequency electric field to a nerve. The technology offers pain relief for patients suffering from chronic pain who do not respond well to conventional treatments. We tested whether PRF treatment attenuated complete Freund's adjuvant (CFA) induced inflammatory pain. The profile of spinal c-Jun N-terminal kinases (JNKs) phosphorylation was evaluated to elucidate the potential mechanism. Injection of CFA into the unilateral hind paw of rats induced mechanical hyperalgesia in both the ipsilateral and contralateral hind paws. We administered 500-kHz PRF treatment in 20-ms pulses, at a rate of 2 Hz (2 pulses per second) either to the sciatic nerve in the mid-thigh, or to the L4 anterior primary ramus just distal to the intervertebral foramen in both the CFA group and no-PRF group rats. Tissue samples were examined at 1, 3, 7, and 14 days following PRF treatments. Behavioral studies showed that PRF applied close to the dorsal root ganglion (DRG) significantly attenuated CFA-induced mechanical hyperalgesia compared to no-PRF group (P < .05). And western blotting revealed significant attenuation of the activation of JNK in the spinal dorsal horn compared to no-PRF group animals (P < .05). Application of PRF close to DRG provides an effective treatment for CFA-induced persistent mechanical hyperalgesia by attenuating JNK activation in the spinal dorsal horn.
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Affiliation(s)
- Kuan-Hung Chen
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung, 833 Taiwan
- Department of Biological Sciences, National Sun Yat-Sen University, No.70 Lienhai Rd., Gushan Dist., Kaohsiung, 80424 Taiwan
| | - Chien-Hui Yang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung, 833 Taiwan
| | - Sin-Ei Juang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung, 833 Taiwan
| | - Hui-Wen Huang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung, 833 Taiwan
- Department of Biological Sciences, National Sun Yat-Sen University, No.70 Lienhai Rd., Gushan Dist., Kaohsiung, 80424 Taiwan
| | - Jen-Kun Cheng
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shyr-Ming Sheen-Chen
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jiin-Tsuey Cheng
- Department of Biological Sciences, National Sun Yat-Sen University, No.70 Lienhai Rd., Gushan Dist., Kaohsiung, 80424 Taiwan
| | - Chung-Ren Lin
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung, 833 Taiwan
- Department of Anesthesiology, National Taiwan University College of Medicine, Taipei, Taiwan
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Hamer JF, Purath TA. Response of cervicogenic headaches and occipital neuralgia to radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerve. Headache 2014; 54:500-10. [PMID: 24433241 DOI: 10.1111/head.12295] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This article investigates the degree and duration of pain relief from cervicogenic headaches or occipital neuralgia following treatment with radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerves. It also addresses the procedure's complication rate and patient's willingness to repeat the procedure if severe symptoms recur. METHODS This is a single-center retrospective observational study of 40 patients with refractory cervicogenic headaches and or occipital neuralgia. Patients were all referred by a headache specialty clinic for evaluation for radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerves. After treatment, patients were followed for a minimum of 6 months to a year. Patient demographics and the results of radiofrequency ablation were recorded on the same day, after 3-4 days, and at 6 months to 1 year following treatment. RESULTS Thirty-five percent of patients reported 100% pain relief and 70% reported 80% or greater pain relief. The mean duration of improvement is 22.35 weeks. Complication rate was 12-13%. 92.5% of patients reported they would undergo the procedure again if severe symptoms returned. CONCLUSIONS Radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerve can provide many months of greater than 50% pain relief in the vast majority of recipients with an expected length of symptom improvement of 5-6 months.
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Affiliation(s)
- John F Hamer
- Department of Radiology, Wheaton Franciscan Franklin Hospital, Milwaukee, WI, USA
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Lin ML, Lin WT, Huang RY, Chen TC, Huang SH, Chang CH, Tsai SY, Chiu HW, Yeh GC, Lin CW, Wen YR. Pulsed radiofrequency inhibited activation of spinal mitogen-activated protein kinases and ameliorated early neuropathic pain in rats. Eur J Pain 2013; 18:659-70. [DOI: 10.1002/j.1532-2149.2013.00419.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- M.-L. Lin
- Institute of Biomedical Engineering; National Taiwan University; Taipei Taiwan
- Pain Center; Zhongxing Branch of Taipei City Hospital; Taipei Taiwan
| | - W.-T. Lin
- Institute of Biomedical Electronics and Bioinformatics; National Taiwan University; Taipei Taiwan
| | - R.-Y. Huang
- Graduate Institute of Clinical Medical Science; China Medical University; Taichung Taiwan
| | - T.-C. Chen
- Institute of Biomedical Engineering; National Taiwan University; Taipei Taiwan
| | - S.-H. Huang
- Department of Anesthesiology; Shin-Kong Wu-Ho-Su Memorial Hospital; Taipei Taiwan
| | - C.-H. Chang
- Institute of Biomedical Engineering; National Taiwan University; Taipei Taiwan
| | - S.-Y. Tsai
- Department of Anesthesiology; School of Medicine; China Medical University; Taichung Taiwan
| | - H.-W. Chiu
- Graduate Institute of Computer and Communication Engineering; National Taipei University of Technology; Taiwan
| | - G.-C. Yeh
- Department of Pediatrics; School of Medicine; Taipei Medical University; Taiwan
| | - C.-W. Lin
- Institute of Biomedical Engineering; National Taiwan University; Taipei Taiwan
- Institute of Biomedical Electronics and Bioinformatics; National Taiwan University; Taipei Taiwan
| | - Y.-R. Wen
- Department of Anesthesiology; School of Medicine; China Medical University; Taichung Taiwan
- Department of Anesthesiology; China Medical University Hospital; Taichung Taiwan
- Center for Pain Management and Research; China Medical University Hospital; Taichung Taiwan
- Graduate Institute of Acupuncture Science; College of Chinese Medicine; China Medical University; Taichung Taiwan
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Internal-specific morphological analysis of sciatic nerve fibers in a radiofrequency-induced animal neuropathic pain model. PLoS One 2013; 8:e73913. [PMID: 24066083 PMCID: PMC3774755 DOI: 10.1371/journal.pone.0073913] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 07/23/2013] [Indexed: 12/27/2022] Open
Abstract
This study investigated the reversible effects of pulsed radiofrequency (PRF) treatment at 42 °C on the ultrastructural and biological changes in nerve and collagen fibers in the progression of neuropathic pain after rat sciatic nerve injury. Assessments of morphological changes in the extracellular matrices by atomic force microscopy and hematoxylin-eosin, Masson's trichrome and picrosirius-red staining as well as the expressions of two fibril-forming collagens, types-I and -III, and two inflammatory cytokines, TNF-α and IL-6, were evaluated on day 30 after RF exposure. There were four groups for different RF thermal treatments: no treatment, no current, PRF, and continuous RF (CRF). An RF procedure similar to that used in human clinical trials was used in this study. The CRF treatment at 82 °C led to neural and collagen damage by the permanent blockage of sensory nociceptors. The PRF treatment led to excellent performance and high expandability compared to CRF, with effects including slight damage and swelling of myelinated axons, a slightly decreased amount of collagen fibers, swelling of collagen fibril diameters, decreased immunoreactivity of collagen types-I and -III, presence of newly synthesized collagen, and recovery of inflammatory protein immunoreactivity. These evidence-based findings suggest that PRF-based pain relief is responsible for the temporary blockage of nerve signals as well as the preferential destruction of pain-related principal sensory fibers like the Aδ and C fibers. This suggestion can be supported by the interaction between the PRF-induced electromagnetic field and cell membranes; therefore, PRF treatment provides pain relief while allowing retention of some tactile sensation.
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Schianchi PM, Sluijter ME, Balogh SE. The Treatment of Joint Pain with Intra-articular Pulsed Radiofrequency. Anesth Pain Med 2013; 3:250-5. [PMID: 24282777 PMCID: PMC3833041 DOI: 10.5812/aapm.10259] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 02/20/2013] [Indexed: 01/11/2023] Open
Abstract
Background The intra-articular (IA) application of pulsed radiofrequency (PRF) for pain in small and large joints represents a recent development that has proven to be effective in many cases. We performed a retrospective study of 89 such procedures in 57 consecutive patients with chronic articular pain. Objectives The aim of this retrospective study is to evaluate the effectiveness of intraarticular PRF in a group of 57 consecutive patients with chronic joint pain. Patients and Methods Patients with intractable joint pain for more than 6 months were treated with IA PRF 40-45V for 10-15 min in small joints and 60V for 15 min in large joints using fluoroscopic confirmation of correct needle position. A total of 28 shoulders, 40 knees, 10 trapezio-metacarpal, and 11 first metatarso-phalangeal joints were treated. Results were evaluated at 1, 2, and 5 months. The procedure was repeated after 1 month in 10 patients with initial suboptimal results. Success was defined as a reduction of pain score by at least 50%. Results All groups showed significant reductions in pain scores at all three follow-up visits. Success rates were higher in small joints (90% and 82%, respectively) than large ones (64% and 60%, respectively). Interestingly, IA PRF was successful in 6 out of 10 patients who had undergone previous surgery, including 3 with prosthetic joint replacement and in 6 of the 10 repeated procedures. There were no significant adverse effects or complications. Conclusions IA PRF induced significant pain relief of long duration in a majority of our patients with joint pain. The exact mechanism is unclear, but may be related to the exposure of immune cells to low-strength RF fields, inducing an anti-inflammatory effect. The success rate appears to be highest in small joints. We recommend additional research including control groups to further investigate and clarify this method; our data suggest that it may represent a useful modality in the treatment of arthrogenic pain.
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Affiliation(s)
- Pietro M Schianchi
- S. Anna Clinic, Lugano, Switzerland
- Corresponding author: Pietro M. Schianchi, S. Anna Clinic, Lugano, Switzerland. Tel: +41-919233978, Fax: +41-919238917, E-mail:
| | - Menno E Sluijter
- Centre for Pain Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Susan E Balogh
- Centre for Pain Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
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Choi S, Choi H, Cheong Y, Chung S, Park H, Lim Y. Inflammatory responses and morphological changes of radiofrequency-induced rat sciatic nerve fibres. Eur J Pain 2013; 18:192-203. [DOI: 10.1002/j.1532-2149.2013.00391.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2013] [Indexed: 01/27/2023]
Affiliation(s)
- S. Choi
- Department of Biomedical Engineering & Healthcare Industry Research Institute; Kyung Hee University; Seoul Korea
| | - H.J. Choi
- Department of Neurosurgery; Kyung Hee University; Seoul Korea
| | - Y. Cheong
- Department of Biomedical Engineering & Healthcare Industry Research Institute; Kyung Hee University; Seoul Korea
| | - S.H. Chung
- Department of Pharmacology and Clinical Pharmacy & Life and Nanopharmaceutical Science; Kyung Hee University; Seoul Korea
| | - H.K. Park
- Department of Biomedical Engineering & Healthcare Industry Research Institute; Kyung Hee University; Seoul Korea
- Department of Medical Engineering; Kyung Hee University; Seoul Korea
| | - Y.J. Lim
- Department of Neurosurgery; Kyung Hee University; Seoul Korea
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Sluijter ME, Imani F. Evolution and mode of action of pulsed radiofrequency. Anesth Pain Med 2013; 2:139-141. [PMID: 24223349 PMCID: PMC3821144 DOI: 10.5812/aapm.10213] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 01/14/2013] [Indexed: 11/16/2022] Open
Affiliation(s)
- Menno E. Sluijter
- Department of Pain Medicine, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Farnad Imani
- Department of Anesthesiology and Pain Medicine, Rasoul Akram Medical Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Mehnert MJ, Freedman MK. Update on the Role of Z-Joint Injection and Radiofrequency Neurotomy for Cervicogenic Headache. PM R 2013; 5:221-7. [DOI: 10.1016/j.pmrj.2013.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 10/28/2012] [Accepted: 01/03/2013] [Indexed: 02/02/2023]
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Park HW, Ahn SH, Son JY, Kim SJ, Hwang SJ, Cho YW, Lee DG. Pulsed Radiofrequency Application Reduced Mechanical Hypersensitivity and Microglial Expression in Neuropathic Pain Model. PAIN MEDICINE 2012; 13:1227-34. [DOI: 10.1111/j.1526-4637.2012.01453.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Affiliation(s)
- Gunnvald Kvarstein
- Department of Pain Management and Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Rohof OJ. In Response: Intradiscal Pulsed Radiofrequency and Provocative Discography. Pain Pract 2012. [DOI: 10.1111/j.1533-2500.2012.00538_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shanthanna H, Chan P, McChesney J, Paul J, Thabane L. Assessing the effectiveness of 'pulse radiofrequency treatment of dorsal root ganglion' in patients with chronic lumbar radicular pain: study protocol for a randomized control trial. Trials 2012; 13:52. [PMID: 22540851 PMCID: PMC3404908 DOI: 10.1186/1745-6215-13-52] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 04/28/2012] [Indexed: 11/17/2022] Open
Abstract
Background Chronic lumbar radicular pain can be described as neuropathic pain along the distribution of a particular nerve root. The dorsal root ganglion has been implicated in its pathogenesis by giving rise to abnormal impulse generation as a result of irritation, direct compression and sensitization. Chronic lumbar radicular pain is commonly treated with medications, physiotherapy and epidural steroid injections. Epidural steroid injections are associated with several common and rarer side effects such as spinal cord infarction and death. It is essential and advantageous to look for alternate interventions which could be effective with fewer side effects. Pulse radio frequency is a relatively new technique and is less destructive then conventional radiofrequency. Safety and effectiveness of pulse radio frequency in neuropathic pain has been demonstrated in animal and humans studies. Although its effects on dorsal root ganglion have been studied in animals there is only one randomized control trial in literature demonstrating its effectiveness in cervical radicular pain and none in lumbar radicular pain. Our primary objective is to study the feasibility of a larger trial in terms of recruitment and methodology. Secondary objectives are to compare the treatment effects and side effects. Methods/designs This is a single-center, parallel, placebo-controlled, triple-blinded (patients, care-givers, and outcome assessors), randomized control trial. Participants will have a history of chronic lumbar radicular pain for at least 4 months in duration. Once randomized, all patients will have an intervention involving fluoroscopy guided needle placement to appropriate dorsal root ganglion. After test stimulation in both groups; the study group will have a pulse radio frequency treatment at 42°C for 120 s to the dorsal root ganglion, with the control group having only low intensity test stimulation for the same duration. Primary outcome is to recruit at least four patients every month with 80% of eligible patients being recruited. Secondary outcomes would be to assess success of intervention through change in the visual analogue scale measured at 4 weeks post intervention and side effects. Allocation to each group will be a 1:1 ratio with allocation block sizes of 2, 4, and 6. Trial registration ClinicalTrials.gov NCT01117870
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Affiliation(s)
- Harsha Shanthanna
- Department of Anesthesia and Pain Medicine (D-149), St Joseph's Hospital, 50 Charlton Avenue East Hamilton, Ontario, L8N 4A6, Canada.
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Simopoulos TT, Nagda J, Aner MM. Percutaneous radiofrequency lesioning of the suprascapular nerve for the management of chronic shoulder pain: a case series. J Pain Res 2012; 5:91-7. [PMID: 22570561 PMCID: PMC3346065 DOI: 10.2147/jpr.s29864] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The objective of this study was to retrospectively evaluate the analgesic effects of continuous radiofrequency lesioning of the suprascapular nerve (SSN) for chronic shoulder pain. The authors sought to obtain insight into the time-sensitive analgesic success and complications of this therapy. PATIENTS AND METHODS This study was a retrospective case series involving patients with unremitting shoulder pain that had lasted for at least 12 months. Patients were selected if they showed a reduction of at least 50% in pain intensity during the anesthetic phase after SSN block, no additional motor weakness of the shoulder, and pain relief lasting for less than 2 months after separate treatments of the SSN with depot corticosteroids and pulsed radiofrequency. Nine patients were referred to the Arnold Pain Management Center. Of these nine patients, six patients who had significant chronic shoulder pain unresponsive to oral medications and intra-articular injections and who were not considered surgical candidates were selected. These patients were treated with a single radiofrequency lesion of the SSN at 80°C for 60 seconds. The primary outcome was a reduction in pain intensity by 50%, as determined by the numeric rating scale, and duration of this effect. The secondary outcome was improvement in either the passive or the active range of motion (ROM). Patients were also monitored for adverse effects such as weakness or increased pain. RESULTS The pooled mean numeric rating scale score before the procedure was 7.2 ± 1.2; this fell to 3.0 ± 0.9 at 5-7 weeks post procedure. The duration of pain relief ranged from 3 to 18 months, and all patients underwent at least one additional treatment. The change in baseline ROM improved from an average of 60° ± 28° (flexion) and 58° ± 28° (abduction) to 99° ± 46° (flexion) and 107° ± 39° (abduction). No adverse side effects were observed. CONCLUSION Continuous radiofrequency lesioning of the SSN seems to be an effective treatment for chronic shoulder pain. There can be improved ROM of the shoulder following this treatment. More formal, controlled studies are required to confirm these observations.
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Affiliation(s)
- Thomas T Simopoulos
- Arnold Pain Management Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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