1
|
Liang CL, Yen CY, Wang HK, Tsai YD, Chye CL, Wang KW. Intramuscular Pulsed Radiofrequency Upregulates BNDF-TrKB Expression in the Spinal Cord in Rats as an Alternative Treatment for Complicated Pain. Int J Mol Sci 2024; 25:7199. [PMID: 39000303 PMCID: PMC11240886 DOI: 10.3390/ijms25137199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/15/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024] Open
Abstract
Two cases of complicated pain exist: posterior screw fixation and myofascial pain. Intramuscular pulsed radiofrequency (PRF) may be an alternative treatment for such patients. This is a two-stage animal study. In the first stage, two muscle groups and two nerve groups were subdivided into a high-temperature group with PRF at 58 °C and a regular temperature with PRF at 42 °C in rats. In the second stage, two nerve injury groups were subdivided into nerve injury with PRF 42 °C on the sciatic nerve and muscle. Blood and spinal cord samples were collected. In the first stage, the immunohistochemical analysis showed that PRF upregulated brain-derived neurotrophic factor (BDNF) in the spinal cord in both groups of rats. In the second stage, the immunohistochemical analysis showed significant BDNF and tropomyosin receptor kinase B (TrkB) expression within the spinal cord after PRF in muscles and nerves after nerve injury. The blood biomarkers showed a significant increase in BDNF levels. PRF in the muscle in rats could upregulate BDNF-TrkB in the spinal cord, similar to PRF on the sciatica nerve for pain relief in rats. PRF could be considered clinically for patients with complicated pain and this study also demonstrated the role of BDNF in pain modulation. The optimal temperature for PRF was 42 °C.
Collapse
Affiliation(s)
- Cheng-Loong Liang
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-L.L.); (H.-K.W.); (Y.-D.T.); (C.-L.C.)
| | - Cheng-Yo Yen
- Department of Orthopedic, E-Da Hospital, I-Shou University, Kaohsiung City 82445, Taiwan;
| | - Hao-Kuang Wang
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-L.L.); (H.-K.W.); (Y.-D.T.); (C.-L.C.)
| | - Yu-Duan Tsai
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-L.L.); (H.-K.W.); (Y.-D.T.); (C.-L.C.)
| | - Cien-Leong Chye
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-L.L.); (H.-K.W.); (Y.-D.T.); (C.-L.C.)
| | - Kuo-Wei Wang
- Department of Neurosurgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung City 824005, Taiwan
| |
Collapse
|
2
|
Park S, Park JH, Jang JN, Choi SI, Song Y, Kim YU, Park S. Pulsed radiofrequency of lumbar dorsal root ganglion for lumbar radicular pain: A systematic review and meta-analysis. Pain Pract 2024; 24:772-785. [PMID: 38294072 DOI: 10.1111/papr.13351] [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: 08/17/2023] [Revised: 12/04/2023] [Accepted: 01/09/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Pulsed radiofrequency (PRF) of the lumbar dorsal root ganglion (DRG) has been widely used as a method to relieve lumbar radicular pain (LRP). However, the value of PRF application in LRP patients remains uncertain. This systematic review aimed to compare the effects of PRF of lumbar DRG and LEI in patients with LRP. METHODS A literature search was performed using well-known databases for articles published up to May 2023. We included randomized controlled trials (RCTs) that evaluated the effects of PRF compared to LEI with or without steroids. We screened articles, extracted data, and assessed risk of bias in duplicate. The pain scores and Oswestry Disability Index (ODI) scores at 1, 3, and 6 months after procedures were obtained. A random-effects meta-analysis model was applied for outcomes. We evaluated evidence certainty for each outcome using the GRADE scoring system. This review was registered in the PROSPERO (ID: CRD42021253628). RESULTS A total of 10 RCTs were included and data of 613 patients were retrieved. We assessed the overall quality of the evidence as very low to moderate. PRF showed no difference in pain scores at 1 (mean difference [MD] -0.80, 95% confidence interval [CI] -1.59 to 0.00, low certainty) and 6 months (MD -2.37, 95% CI -4.79 to 0.05, very low certainty), and significantly improved pain scores at 3 months (MD -1.31, 95% CI -2.29 to -0.33, low certainty). There was no significant difference in ODI score at any interval (very low to low certainty). In the subgroup who underwent a diagnostic block, did not use steroids, and PRF duration greater than 360 s, PRF significantly reduced pain scores at 3 months after procedures. CONCLUSIONS We found low quality of the evidence supporting adjuvant PRF to the lumbar DRG has a greater analgesic effect at 3 months after procedures in patients with LRP than LEI. We identified no convincing evidence to show that this treatment improves function. High-quality evidence is lacking, and data were largely derived from short-term effects. Given these limitations, high-quality trials with data on long-term effects are needed.
Collapse
Affiliation(s)
- Soyoon Park
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, Catholic Kwandong University School of Medicine, Incheon, Korea
| | - Ji-Hoon Park
- Department of Anesthesiology and Pain Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Jae Ni Jang
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, Catholic Kwandong University School of Medicine, Incheon, Korea
| | - Su-Il Choi
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, Catholic Kwandong University School of Medicine, Incheon, Korea
| | - Yumin Song
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, Catholic Kwandong University School of Medicine, Incheon, Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, Catholic Kwandong University School of Medicine, Incheon, Korea
| | - Sukhee Park
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, Catholic Kwandong University School of Medicine, Incheon, Korea
| |
Collapse
|
3
|
Perdecioğlu GRG, Ateş MP, Yürük D, Can E, Yıldız G, Akkaya ÖT. A new neuromodulation method in chronic migraine; non-ınvasive pulsed radiofrequency, a single-blinded, randomised, controlled trial. Ir J Med Sci 2024; 193:1487-1493. [PMID: 38147268 DOI: 10.1007/s11845-023-03598-x] [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: 09/01/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE Non-invasive pulsed radiofrequency (NipRF) therapy, a neuromodulation method for peripheral nerves, is a new treatment modality for pain. We aimed to show the changes in pain severity and frequency per month in chronic migraine with NipRF treatment. METHODS We treated patients diagnosed with chronic migraine according to the International Classification of Headache Disorders III beta diagnostic criteria. In half of the patients, we applied pulsed radiofrequency (pRF) treatment with transcutaneous electrodes to the greater occipital nerve (GON) trace. In the other half, we applied the GON block under ultrasound guidance. The Migraine Disability Assessment Scale (MIDAS) was administered to the participants, and those with scores > 2 were included in the study. Pain intensity and frequency were evaluated using the visual analog scale (VAS) and a headache diary completed before and 4 weeks after treatment. RESULTS When both groups were compared, the pre- and post-treatment VAS scores and headache frequencies were similar. Comparing the pre-treatment and post-treatment values within the groups, VAS scores and headache frequency decreased significantly after treatment in both groups (p < 0.001). CONCLUSION In this study, we observed that NipRF treatment is safe and effective for treating chronic migraine. Pain intensity and frequency decreased with NipRF treatment, similar to that in the GON block group. CLINICAL TRIALS REGISTRATION NUMBER NCT05499689, Date: 08/11/2022.
Collapse
Affiliation(s)
- Gevher Rabia Genç Perdecioğlu
- Department of Algology, Etlik City Hospital Integrated Health Campus, Ankara.Varlık, Halil Sezai Erkut Avenue No:5 Yenimahalle, 06170, Ankara, Turkey.
| | - Mehlika Panpallı Ateş
- Departmant of Neurology, Etlik City Hospital Integrated Health Campus, Ankara, Turkey
| | - Damla Yürük
- Department of Algology, Etlik City Hospital Integrated Health Campus, Ankara.Varlık, Halil Sezai Erkut Avenue No:5 Yenimahalle, 06170, Ankara, Turkey
| | - Ezgi Can
- Department of Algology, Etlik City Hospital Integrated Health Campus, Ankara.Varlık, Halil Sezai Erkut Avenue No:5 Yenimahalle, 06170, Ankara, Turkey
| | - Gökhan Yıldız
- Department of Algology, Etlik City Hospital Integrated Health Campus, Ankara.Varlık, Halil Sezai Erkut Avenue No:5 Yenimahalle, 06170, Ankara, Turkey
| | - Ömer Taylan Akkaya
- Department of Algology, Etlik City Hospital Integrated Health Campus, Ankara.Varlık, Halil Sezai Erkut Avenue No:5 Yenimahalle, 06170, Ankara, Turkey
| |
Collapse
|
4
|
Perdecioğlu GRG, Ateş MP, Yürük D, Akkaya ÖT. Neuromodulation of the median nerve in carpal tunnel syndrome, a single-blind, randomized controlled study. Korean J Pain 2024; 37:34-40. [PMID: 38061772 PMCID: PMC10764211 DOI: 10.3344/kjp.23232] [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: 08/08/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 12/30/2023] Open
Abstract
Background This study aimed to evaluate the efficacy of pulsed radiofrequency applied using transcutaneous electrodes in carpal tunnel syndrome (CTS). Methods After randomization, the patients received two cycles of noninvasive pulsed radiofrequency (NiPRF), once weekly, or splinting (the control group) for three months. Clinical evaluations were recorded at baseline and weeks 4 and 8. The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was used to determine the functional status and symptom severity. Results Sixty-two patients were followed up for three months. There was no difference between the groups in the BCTQ scores before and after treatment. The NiPRF group found a significant difference between the BCTQ measurements at all time intervals (paired sample t -test; P < 0.001). In the splint group, there was a significant difference only between the basal-1st month and basal-3rd month (paired samples t -test; P < 0.001). The main effect of the time variable was statistically significant (ANOVA; P < 0.001), but the group variable was not. There was no correlation between the BCTQ results measured at any time and the electroneuromyelogragphy findings in either group. Conclusions NiPRF effectively improves symptoms and functionality in patients with CTS for up to 3 months. Thus, NiPRF can be considered an easy, safe, and useful alternative treatment modality for CTS.
Collapse
Affiliation(s)
| | | | - Damla Yürük
- Department of Algology, Etlik City Hospital, Ankara, Turkey
| | | |
Collapse
|
5
|
Song Z, Gao Y, Zhao Y, Feng X, Zhao Z, Wang W. miR-129-5p Induces Cell Apoptosis and Inhibits Inflammation by Inflammatory Signaling to Alleviate Spinal Cord Injury (SCI). J BIOMATER TISS ENG 2023. [DOI: 10.1166/jbt.2023.3197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Spinal cord injury (SCI) is a spinal cord nerve dysfunction secondary to trauma. Until now, still no appropriate drug with unclear etiology. Therefore, it is to develop effective SCI treatment methods. Herein, we intended to detect the impact of miR-129-5p in SCI After establishment
of a mouse SCI model, the animals received intrathecal injection of agomir-miR-129-5p or normal saline. Then, the miR-129-5p’s effect was evaluated by assessing motor function, spinal cord tissue edema, apoptosis and inflammation of mice upon treatments and potential targeted pathways
of the miRNA were detected. Overexpressed miR-129-5p facilitated the wound healing with less spare tissue and water content. Additionally, overexpressed miR-129-5p suppressed the in vivo inflammation with decreased apoptotic rate of neurons. As SCI induced increased expression of HMGB1,
TLR4, and NF-κB in tissues, but the presence of miR-129-5p reversed the expressions. Collectively, this study elucidate miR-129-5p significantly improves inflammatory response and apoptosis, thereby improving the condition of SCI. These findings might provide a new theory for
the disorder, and promote the research progress on the disease.
Collapse
Affiliation(s)
- Zhengdong Song
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, 730030, China
| | - Yuwei Gao
- Department of Emergency Critical Care Medicine, The First Hospital of Lanzhou University, Lanzhou, Gansu, 730030, China
| | - Yuhao Zhao
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, 730030, China
| | - Xiaofei Feng
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, 730030, China
| | - Zhenrui Zhao
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, 730030, China
| | - Wenji Wang
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, 730030, China
| |
Collapse
|
6
|
Ilfeld BM, Said ET, Gabriel RA, Curran BP, Swisher MW, Jacobsen GR, Wallace AM, Doucet J, Adams LM, Ventro GJ, Abdullah B, Finneran JJ. Wearable, noninvasive, pulsed shortwave (radiofrequency) therapy for analgesia and opioid sparing following outpatient surgery: A proof-of-concept case series. Pain Pract 2022. [PMID: 36463434 DOI: 10.1111/papr.13188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/15/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND It is often difficult to concurrently provide adequate analgesia while minimizing opioid requirements following ambulatory surgery. Nonthermal, pulsed shortwave (radiofrequency) fields are a noninvasive treatment used as an adjunct analgesic and wound healing therapy. The devices may be placed by nursing staff in less than a minute, are relatively inexpensive and readily available, theoretically provide analgesia for nearly any anatomic location, and have no systemic side effects-patients cannot detect any sensations from the devices-or significant risks. Here we present a case series to demonstrate the use of pulsed, electromagnetic field devices for outpatient herniorrhaphy and breast surgery. CASE REPORT Following moderately painful ambulatory umbilical (n = 3) and inguinal (n = 2) hernia repair as well as bilateral breast surgery (n = 2), patients had taped over their surgical incision(s) 1 or 2 noninvasive, wearable, disposable, pulsed shortwave therapy devices (RecoveryRx, BioElectronics Corporation, Frederick, Maryland) which functioned continuously for 30 days. Average resting pain scores measured on the 0-10 numeric rating scale were a median of 0 during the entire treatment period. Six patients avoided opioid use entirely, while the remaining individual required only 5 mg of oxycodone during the first postoperative day. CONCLUSIONS These cases demonstrate that the ambulatory use of pulsed shortwave devices is feasible and may be an effective analgesic, possibly obviating opioid requirements following outpatient herniorrhaphy and breast surgery. Considering the lack of any side effects, adverse events, and misuse/dependence/diversion potential, further study with a randomized, controlled trial appears warranted.
Collapse
Affiliation(s)
- Brian M Ilfeld
- Department of Anaesthesiology, University of California San Diego, California, USA.,Outcomes Research Consortium, Cleveland, Ohio, USA
| | - Engy T Said
- Department of Anaesthesiology, University of California San Diego, California, USA
| | - Rodney A Gabriel
- Department of Anaesthesiology, University of California San Diego, California, USA.,Outcomes Research Consortium, Cleveland, Ohio, USA
| | - Brian P Curran
- Department of Anaesthesiology, University of California San Diego, California, USA
| | - Matthew W Swisher
- Department of Anaesthesiology, University of California San Diego, California, USA.,Outcomes Research Consortium, Cleveland, Ohio, USA
| | - Garth R Jacobsen
- Department of Surgery, University of California San Diego, California, USA
| | - Anne M Wallace
- Department of Surgery, University of California San Diego, California, USA
| | - Jay Doucet
- Department of Surgery, University of California San Diego, California, USA
| | - Laura M Adams
- Department of Surgery, University of California San Diego, California, USA
| | - George J Ventro
- Department of Surgery, University of California San Diego, California, USA
| | - Baharin Abdullah
- Department of Anaesthesiology, University of California San Diego, California, USA
| | - John J Finneran
- Department of Anaesthesiology, University of California San Diego, California, USA.,Outcomes Research Consortium, Cleveland, Ohio, USA
| |
Collapse
|
7
|
Unveil the pain of endometriosis: from the perspective of the nervous system. Expert Rev Mol Med 2022; 24:e36. [PMID: 36059111 DOI: 10.1017/erm.2022.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Endometriosis is a chronic inflammatory disease with pelvic pain and uncharacteristic accompanying symptoms. Endometriosis-associated pain often persists despite treatment of the disease, thus it brings a deleterious impact on their personal lives as well as imposing a substantial economic burden on them. At present, mechanisms underlie endometriosis-associated pain including inflammatory reaction, injury, aberrant blood vessels and the morphological and functional anomaly of the peripheral and central nervous systems. The nerve endings are influenced by the physical and chemical factors surrounding the lesion, via afferent nerve to the posterior root of the spinal nerve, then to the specific cerebral cortex involved in nociception. However, our understanding of the aetiology and mechanism of this complex pain process caused by endometriosis remains incomplete. Identifying the pathogenesis of endometriosis is crucial to disease management, offering proper treatment, and helping patients to seek novel targets for the maintenance and contributors of chronic pain. The main aim of this review is to focus on every possible mechanism of pain related to endometriosis in both peripheral and central nervous systems, and to present related mechanisms of action from the interaction between peripheral lesions and nerves to the changes in transmission of pain, resulting in hyperalgesia and the corresponding alterations in cerebral cortex and brain metabolism.
Collapse
|