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Membrilla JA, Roa J, Díaz-de-Terán J. Preventive treatment of refractory chronic cluster headache: systematic review and meta-analysis. J Neurol 2023; 270:689-710. [PMID: 36310189 DOI: 10.1007/s00415-022-11436-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Preventive treatment for refractory chronic cluster headache (rCCH) is challenging and many therapies have been tried. OBJECTIVE To study what could be considered the therapy of choice in rCCH through a systematic review and meta-analysis. METHODS This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was registered in PROSPERO (ID CRD42021290983). A systematic search was performed in MEDLINE, Embase, Cochrane, clinicaltrials.gov, and the WHO's-International-Clinical-Trials-Registry-Platform. Studies on the preventive treatment for rCCH as defined by the European Headache Federation consensus statement were included. A meta-analysis of the pooled response rate was conducted for the different therapies. RESULTS Of 336 results, 45 were eligible for inclusion. Most articles studied the effect of neuromodulation as a preventive treatment for rCCH. The most studied neuromodulation technique was occipital nerve stimulation (ONS), with a pooled response rate in the meta-analysis of 57.3% (95% CI 0.481-0.665). Deep brain stimulation (DBS) was the second most studied treatment with a pooled response rate of 77.0% (95% CI 0.594-0.957). DBS results were more heterogeneous than ONS, which could be related to the different stimulation targets in DBS studies, and reported more serious adverse events than in ONS studies. The remaining therapies (anti-CGRP pathway drugs, warfarin, ketamine-magnesium infusions, serial occipital nerve blocks, clomiphene, onabotulinum toxin A, ketogenic diet, sphenopalatine ganglion radiofrequency or stimulation, vagus nerve stimulation, percutaneous bioelectric current stimulation, upper cervical cord stimulation, and vidian neurectomy) present weaker results or have less quality of evidence. CONCLUSIONS The results of this systematic review and meta-analysis suggest that ONS could be the first therapeutic strategy for patients with rCCH based on the current evidence.
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Affiliation(s)
- Javier A Membrilla
- Neurology Department, "La Paz" University Hospital, P.º de la Castellana 261, 28046, Madrid, Spain.
| | - Javier Roa
- Neurology Department, "La Paz" University Hospital, P.º de la Castellana 261, 28046, Madrid, Spain
| | - Javier Díaz-de-Terán
- Neurology Department, "La Paz" University Hospital, P.º de la Castellana 261, 28046, Madrid, Spain
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Cai Z, Quan L, Chang X, Qiu Z, Zhou H. High-voltage long-duration pulsed radiofrequency attenuates neuropathic pain in CCI rats by inhibiting Cav2.2 in spinal dorsal horn and dorsal root ganglion. Brain Res 2022; 1785:147892. [PMID: 35341732 DOI: 10.1016/j.brainres.2022.147892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/02/2022]
Abstract
Inclinicalpractice, high-voltage, long-duration pulsed radiofrequency (HL-PRF) is effective for several types of intractable neuropathic pain (NP), but the mechanisms have not been well explored. Cav2.2 channels could increase neuronal excitability and neurotransmission accompanying NP. This study investigated the relationship of the efficacy of HL-PRF on NP with the levels of Cav2.2 in the spinal dorsal horn (SDH) and dorsal root ganglions (DRGs) of chronic constriction injury (CCI) in rats. Sham HL-PRF, GVIA (a specific Cav2.2 channel blocker), HL-PRF, or GVIA + HL-PRF was applied to CCI rats. The results showed: compared with the sham group, the PWT and PWL of CCI rats decreased significantly (P < 0.05), and Cav2.2 expression was elevated significantly in the SDH and DRGs (P < 0.05). Compared with the CCI group, both HL-PRF and ω-conotoxin GVIA treatment reversed the increased PWT and PWL (P < 0.05) and downregulated the overexpression of Cav2.2 in the SDH and DRGs (P < 0.05). Furthermore, PWT, PWL, and the expression of Cav2.2 in the SDH and DRGs were not significantly different among the 3 treatment groups. HL-PRF on L5 DRG reversed the hyperalgesia behavior of NP and reduced the levels of Cav2.2 in the ipsilateral SDH and DRGs in CCI rats. Moreover, the underlying mechanism may be related to the downregulation of CaV2.2 protein levels in both SDH and DRG.
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Affiliation(s)
- Zhenhua Cai
- Department of Pain Management, the Fourth Affiliated Hospital of Harbin Medical University, No.37, Yiyuan Street, Nangang District, Harbin,150001, Heilongjiang Province, China; Department of Pain Management, the Second Affiliated Hospital of Harbin Medical University, No.246, Xuefu Road, Nangang District, Harbin 150086, Heilongjiang Province, China.
| | - Lini Quan
- Department of Pain Management, the Fourth Affiliated Hospital of Harbin Medical University, No.37, Yiyuan Street, Nangang District, Harbin,150001, Heilongjiang Province, China; Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, No.246, Xuefu Road, Nangang District, Harbin 150086, Heilongjiang Province, China.
| | - Xiaotao Chang
- Department of Pain Management, the Fourth Affiliated Hospital of Harbin Medical University, No.37, Yiyuan Street, Nangang District, Harbin,150001, Heilongjiang Province, China.
| | - Zhijie Qiu
- Department of Pain Management, the Fourth Affiliated Hospital of Harbin Medical University, No.37, Yiyuan Street, Nangang District, Harbin,150001, Heilongjiang Province, China.
| | - Huacheng Zhou
- Department of Pain Management, the Fourth Affiliated Hospital of Harbin Medical University, No.37, Yiyuan Street, Nangang District, Harbin,150001, Heilongjiang Province, China.
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Ma L, Yao M. Safety and Efficacy of CT-Guided Pulsed Radiofrequency Combined with Steroid and Ozone Injection-Treated Cervical 3-8 Herpes Zoster Neuralgia Using a Posterior and Upper Quarter of the Cervical Foramina Puncture Approach. J Pain Res 2022; 15:23-32. [PMID: 35023968 PMCID: PMC8747784 DOI: 10.2147/jpr.s333481] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/21/2021] [Indexed: 12/02/2022] Open
Abstract
Background Herpes zoster neuralgia has a considerable impact on people’s quality of life, especially after the development of postherpetic neuralgia. There are many clinical reports on the treatment of herpes zoster neuralgia, but there have been no special reports on the treatment of herpes zoster involving the neck. Our research focuses on a posterior and upper quarter of the cervical foramina puncture approach for herpes zoster involving the cervical 3–8 (C3-8) nerve region and to consider the safety and efficacy of pulsed radiofrequency combined with steroid injection and ozone injection in this puncture path under CT guidance. Materials and Methods A total of 104 patients with herpes zoster neuralgia involved in the cervical 3–8 nerve region use a posterior and upper quarter of the cervical foramina puncture approach received pulsed radiofrequency combined with steroid and ozone injection to the dorsal root ganglion. The total number of injection procedures, complications, NRS collection (preprocedure, postprocedure at once, two, four and 12 weeks) and drug dose decreases were documented. Results During a total of 257 procedures, 254 procedures successfully completed PRF (3 cases failed to reach the C8 aim points), and the rate of puncture failure was 1.17%. Drug injection was successfully performed in 252 procedures (the injection success rate was 99.21%); the NRSs (preprocedure, postprocedure at once, two, four and twelve weeks) were 5.75 ± 0.682, 2.6 ± 1.023, 2.21 ± 0.925, 1.89 ± 1.162, and 1.43 ± 1.369, and the difference among them was statistically significant. Drug dosages decreased before and after operation and showed statistically significant differences. Conclusion Pulsed radiofrequency combined with steroid and ozone injection for herpes zoster neuralgia involving the C3-8 nerves under CT guidance through a posterior superior quarter approach showed safety and efficacy and had a high success rate, and the NRS decreased significantly.
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Affiliation(s)
- Ling Ma
- Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China
| | - Ming Yao
- Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China
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Jo JH, Jang Y, Chung G, Chung JW, Park JW. Long-term efficacy and patient satisfaction of pulsed radiofrequency therapy in temporomandibular disorders: A randomized controlled trial. Medicine (Baltimore) 2021; 100:e28441. [PMID: 34967382 PMCID: PMC8718209 DOI: 10.1097/md.0000000000028441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/06/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Pulse radiofrequency (PRF) therapy is one of effective physical therapy modalities for treat temporomandibular disorders (TMD). This prospective randomized controlled trial aimed to evaluate the long-term treatment efficacy and patient satisfaction with PRF therapy in TMD. METHODS Eighty-six female patients with TMD were randomly assigned to either pulsed radiofrequency or placebo therapy in combination with other conventional treatments once a week for 12 weeks. A final analysis was performed 12 weeks after the completion of treatment. Clinical parameters and patient satisfaction were analyzed at baseline, 4, 8, and 12 weeks of intervention and at 24 weeks from baseline. RESULTS Pain intensity, comfortable and maximum mouth opening, and pain on capsule and masticatory muscle palpation were significantly improved after treatment in both groups. Notably, the pulsed radiofrequency group showed a significantly lower pain intensity at the final evaluation performed 3 months after the completion of treatment. Significantly more patients reported subjective pain improvement and satisfaction with treatment following intervention at baseline in the PRF group. Most patients did not report any discomfort following treatment in either group. However, significantly more patients in the PRF group reported a burning sensation with intervention. CONCLUSION Long-term regular pulsed radiofrequency therapy was effective in significantly reducing TMD pain, and the effect was long-lasting following treatment completion. Pulsed radiofrequency therapy should be considered as a supportive physical therapy modality for TMD.
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Affiliation(s)
- Jung Hwan Jo
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Korea
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry, Seoul National University, Seoul, Korea
| | - Yewon Jang
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Korea
| | - Gehoon Chung
- Department of Oral Physiology and Program in Neurobiology, School of Dentistry, Seoul National University, Seoul, Korea
- Dental Research Institute, Seoul National University, Seoul, Korea
| | - Jin Woo Chung
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Korea
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry, Seoul National University, Seoul, Korea
- Dental Research Institute, Seoul National University, Seoul, Korea
| | - Ji Woon Park
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Korea
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry, Seoul National University, Seoul, Korea
- Dental Research Institute, Seoul National University, Seoul, Korea
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Zhu J, Fei Y, Deng J, Huang B, Yao M. Application and Therapeutic Effect of Puncturing of the Costal Transverse Process for Pulsed Radiofrequency Treated T1-T3 Herpes Zoster Neuralgia. J Pain Res 2020; 13:2519-2527. [PMID: 33116793 PMCID: PMC7548316 DOI: 10.2147/jpr.s266481] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/19/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose In CT-guided dorsal root ganglion puncture, especially T1–T3, it is often difficult to reach the target due to obstruction of the lamina, transverse process, and ribs. Therefore, a safe and effective puncture method with high success rate is urgently needed to guide us in our clinical work. Patients and Methods A total of 44 patients with dorsal root ganglion underwent pulsed radiofrequency therapy for pain T1–T3 herpes zoster neuralgia at the pain department of Affiliated Hospital of Jiaxing University from January 2019 to February 2020 were retrospectively reviewed. Each patient underwent the same surgical method. The patient’s operation time, CT filming times, nerve electrophysiological tests, the NRS scores before and after operation at one, four, eight, and 12 weeks, Pittsburgh Sleep Disorder Index (PSQI), dosage of gabapentin capsules and tramadol hydrochloride sustained-release tablets, surgical complications and incidence of postherpetic neuralgia (PHN) were recorded. Results The success rate of 44 patients who underwent puncturing of the costal transverse process to T1 target was 88.46%, to T2 target was 90.68%, and to T3 target was 90.68%, respectively. The NRS score of patients before surgery was 5.48±0.59, and those at one, four, eight, and 12 weeks after surgery were 3 (3,3), 1 (1,2), 0 (0, 1), and 0 (0, 0). The difference of NRS score between preoperation and postoperation is statistically significant. No intraoperative and postoperative complications occurred. Two patients developed PHN after standard treatment, and the incidence of it was 4.55%. Conclusion CT-guided puncturing of the costal transverse process in the dorsal root ganglion of patients who underwent pulsed radiofrequency treatment of T1–T3 herpes zoster neuralgia showed a high success rate and is considered to be safe and effective.
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Affiliation(s)
- Jianjun Zhu
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China.,Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China
| | - Yong Fei
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China
| | - Jiajia Deng
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China
| | - Bin Huang
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China
| | - Ming Yao
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China
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