Reflections on Innovative Interventional Pain-Relieving Procedures: Lessons Learned from Previous Mistakes

Radiofrequency ablation of terminal sensory articular nerves before arthroscopic rotator cuff repair surgery improved early postoperative functional outcomes: A pilot study with 3 ​months follow-up

INTRODUCTION

Chronic shoulder pain caused by a rotator cuff tear is commonly treated with arthroscopic rotator cuff repair surgery (ARCR). However, ARCR may be associated with moderate-to-severe postoperative pain, and poorly controlled pain can result in delayed functional recovery and the development of frozen shoulder. Terminal sensory articular nerve radiofrequency ablation (RFA) has been shown to be clinically effective in patients with severe refractory shoulder pain from multiple etiologies. We aimed to investigate whether preoperative RFA would improve the postoperative pain and functional outcomes after ARCR.

METHODS

In this prospective pilot study, participants were randomized to receive fluoroscopic-guided terminal sensory articular nerve-cooled RFA (CRFA) (supraspinatus nerve, axillary nerve, lateral pectoral nerve) 1-5 days prior to elective ARCR as an intervention group compared to ARCR without prior RFA as a control group. Constant score (CS), American Shoulder and Elbow Surgeon score (ASES), and pain numerical rating score (NRS) were assessed at 1, 2, 3, 4, 5, and 6 weeks and 3 months following ARCR.

RESULTS

Twenty-one participants were enrolled in this study, including 11 in the control group and 10 in the cooled RFA group. The cooled RFA group showed statistically significantly better CS and ASES both at 6 weeks and 3 months. The two groups showed no differences in pain outcomes at all time points. No intervention-related complications were noted.

CONCLUSION

Cooled RFA of the terminal sensory articular branches of the supraspinatus, axillary, and lateral pectoral nerves performed 1-5 days prior to elective ARCR as part of a multimodal postoperative pain management regimen can improve functional outcomes as early as 6 weeks.

LEVEL OF EVIDENCE

III.

Title: Novel Analgesic Potential of ß2-Agonists for Neuropathic Pain via ß2-Agonist Action

PURPOSE OF REVIEW

Multimodal therapies are often employed to treat chronic pain, and ß2-agonists are a potential drug class that shows promise. The primary aim of this paper is to discuss the role of ß2-agonists as an adjunctive therapy for chronic pain based on the current literature.

RECENT FINDINGS

Recent studies in mouse models have shown that the ß2-adrenergic system plays an essential role in the analgesic properties of antidepressant drugs used to treat neuropathic pain and that the adrenergic relies on an intact endogenous opioid system to be effective. Studies also show that ß2-agonism alone is adequate to exert anti-allodynic effects in a mouse model. This paper summarized the basic physiology and pharmacology of the sympathetic nervous system and specifically the ß2-adrenergic system and summarized current literature in its involvement in the treatment of chronic neuropathic pain.