mag 22 2012

Short-Term Effects of Pulsed Radiofrequency on Chronic Refractory Cervical Radicular Pain

Ann Rehabil Med. 2011 December; 35(6): 826–832.
Published online 2011 December 30. doi:  10.5535/arm.2011.35.6.826
PMCID: PMC3309390

Gyu-Sik Choi, M.D., Sang-Ho Ahn, M.D., Ph.D.,corresponding author Yun-Woo Cho, M.D., Ph.D., and Dong-Kyu Lee, M.D.

Abstract

Objective

To evaluate the short-term effectiveness of pulsed radiofrequency on the dorsal root ganglion (DRG) in patients with chronic refractory cervical radicular pain.

Method

Fifteen patients (13 males, 2 females; mean age, 55.9 years) with chronic radicular pain due to cervical disc herniation or foraminal stenosis refractory to active rehabilitative management, including transforaminal cervical epidural steroid injection and exercise, were selected. All patients received pulsed radiofrequency on the symptomatic cervical dorsal root ganglion and were carefully evaluated for neurologic deficits and side effects. The clinical outcomes were measured using a visual analogue scale (VAS) and a neck disability Leggi l’articolo completo →

mag 12 2012

Percutaneous radiofrequency lesioning of the suprascapular nerve for the management of chronic shoulder pain: a case series.

J Pain Res. 2012;5:91-7. Epub 2012 Apr 24.

Simopoulos TT, Nagda J, Aner MM.

Source

Arnold Pain Management Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

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.

Leggi l’articolo completo →

mag 9 2012

Pulsed Radiofrequency of Suprascapular Nerve for Chronic Shoulder Pain: A Randomized Double-Blind Active Placebo-Controlled Study.

Pain Pract. 2012 May 4. doi: 10.1111/j.1533-2500.2012.00560.x. [Epub ahead of print]

Gofeld M, Restrepo-Garces CE, Theodore BR, Faclier G.

Source

Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, U.S.A Department of Anesthesiology, University of Toronto, Toronto, Ontario, Canada Pain Clinic & Palliative Care Unit, Neurological Institute of Antioquia (INDEA), Medellin, Colombia.

Abstract

Background:  The suprascapular nerve block is frequently implemented to treat chronic shoulder pain. Although effective the nerve blockade provides only a short-term relief, and more compelling approaches have been investigated. Pulsed radiofrequency (pRF) has Leggi l’articolo completo →

mag 4 2012

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 Apr 28;13(1):52. [Epub ahead of print]

Shanthanna H, Chan P, McChesney J, Paul J, Thabane L.

Abstract

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 Leggi l’articolo completo →

apr 27 2012

Pulsed radiofrequency in the treatment of persistent pain after inguinal herniotomy: a systematic review.

Reg Anesth Pain Med. 2012 May;37(3):340-3.

Werner MU, Bischoff JM, Rathmell JP, Kehlet H.

Source

From the *Multidisciplinary Pain Center and †Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Denmark; and ‡Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Abstract

ABSTRACT: In the United States, it is estimated that between 6000 and 18,000 individuals each year present with disabling pain after inguinal hernia repair. Although surgical treatment with mesh removal is one of few options available, effective alternatives to nonsurgical management are needed. The use of pulsed radiofrequency (PFR), leading to nondestructive lesions of nerve structures, has been proposed as a treatment option. To examine the evidence of treatment efficacy, a systematic literature search was made. From the databases PubMed, Embase, and CINAHL, 4 case reports were retrieved and 8 patients were included for analysis. The PFR treatment was peripheral (n = 4) and central (n = 4). Pain relief varied between 63% and 100%, the follow-up period was 3 to 9 months, and no adverse effects or complications were reported. In conclusion, the evidence base of PRF in persistent pain after inguinal herniotomy is fairly limited. Suggestions for improved research strategies are presented.

PMID:22476237

 [PubMed - in process]Pubblicato su PubMed a http://www.ncbi.nlm.nih.gov/pubmed/22476237

apr 21 2012

Short-Term Effects of Pulsed Radiofrequency on Chronic Refractory Cervical Radicular Pain

Ann Rehabil Med. 2011 December; 35(6): 826–832.
Published online 2011 December 30. doi:  10.5535/arm.2011.35.6.826
PMCID: PMC3309390
Copyright © 2011 by Korean Academy of Rehabilitation Medicine
Gyu-Sik Choi, M.D., Sang-Ho Ahn, M.D., Ph.D.,corresponding author Yun-Woo Cho, M.D., Ph.D., and Dong-Kyu Lee, M.D.
Department of Rehabilitation Medicine, Yeungnam University College of Medicine, Daegu 705-717, Korea.
corresponding authorCorresponding author.
Corresponding author: Sang-Ho Ahn. Department of Rehabilitation Medicine & Spine Center, Yeungnam University College of Medicine, 317-1, Daemyung-dong, Nam-gu, Daegu 705-717, Korea. Tel: +82-53-620-3268, Fax: +82-53-625-3508, Email: spineahn@yumail.ac.kr
Received September 6, 2010; Accepted September 20, 2011.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Objective
To evaluate the short-term effectiveness of pulsed radiofrequency on the dorsal root ganglion (DRG) in patients with chronic refractory cervical radicular pain.
Method
Fifteen patients (13 males, 2 females; mean age, 55.9 years) with chronic radicular pain due to cervical disc herniation or foraminal stenosis refractory to active rehabilitative management, including transforaminal cervical epidural steroid injection and exercise, were selected. All patients received pulsed radiofrequency on the symptomatic cervical dorsal root ganglion and were carefully evaluated for neurologic deficits and side effects. The clinical outcomes were measured using a visual analogue scale (VAS) and a neck disability index (NDI) before treatment, one and three months after treatment. Successful pain relief was defined as a 50% or greater reduction in the VAS score as compared with the pre-treatment score. After three months, we categorized the patients’ satisfaction.
Results
The average VAS for radicular pain was reduced significantly from 5.3 at pretreatment to 2.5 at 3 months post-treatment (p<0.05). Eleven of 15 patients (77.3%) after cervical pulsed RF stimulation reported pain relief of 50% or more at the 3 month follow-up. The average NDI was significantly reduced from 44.0% at pretreatment to 35.8% 3 months post-treatment (p<0.05). At 3 months post-treatment, eleven of fifteen patients (73.3%) were satisfied with their status. No adverse effects were observed.
Conclusion
The results demonstrate that the application of pulsed radiofrequency on DRG might be an effective short-term intervention for chronic refractory cervical radicular pain. Further studies, including a randomized controlled trial with long-term follow-up, are now needed.
Keywords: Pulsed radiofrequency, Cervical radicular pain
INTRODUCTION
In a population of 100,000 persons, 83 will, on average, suffer from cervical radiculopathy every year.1 Radicular pain in the upper extremity is a form of neuralgia that is triggered by damage or irritation of sensory nerve roots located in the dorsal root ganglion of spinal nerves. This results in ectopic irritation in the dermatome controlled by the relevant nerves, which in turn is sensed as pain.2 By definition, radicular pain includes pain in areas beyond the spine and such pains are often described as ones that are sharp and stabbing, coming down along the arms.3Cervical radiculopathy occurs by the compression of nerve roots, or by an inflammatory response in them, around the neural foramen. The most common causes are a herniated cervical disc or cervical foraminal stenosis.4
Biochemical factors that promote inflammatory responses in a nerve root include Phospholipase A2, interleukin-1β, interleukin-6, tumor necrosis factor-α (TNF-α), and interleukin-8.5-7Steroids are reported to be substances that are engaged in suppressing these various inflammatory cytokines and chemokines.8,9 Recently, this knowledge has prompted the use of transforaminal epidural steroid injections performed with fluoroscopic control in patients with cervical radicular pain. Cyteval et al.10 reported a success rate of 60 percent with this technique.
In the 1980s, percutaneous radiofrequency treatment of dorsal root ganglia was introduced as one of the techniques to replace surgical rhizotomy in patients with chronic refractory radicular pain.11 Surgical rhizotomy had shown great short-term effects on patients with diverse pain syndromes, including those with chronic refractory radicular pain.12 However, this surgical technique was likely to trigger severe side effects due to the progression of the denervation over time.13 In contrast, percutaneous radiofrequency treatment of dorsal root ganglion coagulates only part of the dorsal root ganglia. It raises the threshold at which a harmful irritation is perceived as painful and reduces pain to a point that does not adversely affect normal sensation.14
Radiofrequency treatments are divided into continuous radiofrequency stimulation and pulsed radiofrequency stimulation using an electromagnetic field. Continuous radiofrequency treatment uses frictional heat arising from a catheter needle that is designed to deliver radiofrequency currents to surrounding tissues with only its needle tip. This induces heat coagulation of tissues in an excessively excited or morbid state, thereby blocking pain. However, complications from thermal injury induced by the radiofrequency waves sometimes lead to wide-ranging nerve destruction; therefore, continuous radiofrequency treatment has become a controversial choice of therapy.15,16 Recently, efforts have been made to circumvent these problems by using a pulsed radiofrequency treatment. These methods have evolved into short pulse radiofrequency treatments that use an electromagnetic field and pulsed radiofrequency treatments in which temperature is maintained at 42[degree celsius] or below so that tissues are not damaged.17 A recent study that induced a cervical dorsal root ganglion block in patients with chronic cervical radicular pain using pulsed radiofrequency reported that 7 of the 11 subjects experienced pain reduction of 50 percent or higher after 6 months.18
Radiofrequency treatment of dorsal root ganglia is becoming increasingly common in Europe and America. The application of this type of treatment to patients with cervical radicular pain in Korea has not yet been reported. Accordingly, the present study performed pulsed radiofrequency stimulation of domestic Korean patients who complained of chronic refractory cervical radicular pain and who had not obtained satisfactory treatment outcomes from many rounds of transforaminal epidural steroid injections and active rehabilitation treatment methods including exercise. The effectiveness of the radiofrequency treatment was examined during a three-month follow-up period.
MATERIALS AND METHODS
Subjects
A prospective follow-up study was conducted on fifteen patients (males: 12; females: 3) who presented with cervical radicular pain. This study included patients who had findings of neurological abnormalities such as radicular pain in a unilateral upper extremity, posterior neck pain, dysesthesia, and muscle weakness. The nerve root lesions predicted by their trigger symptoms had been discovered by magnetic resonance imaging (MRI) or computed tomography (CT), and results of electrophysiological findings were consistent with the results of imaging tests. The patients felt pain ordinarily and had experienced reduced pain after transforaminal epidural steroid injections with fluoroscopic control, but the effects of this treatment were not long-lasting or were unsatisfactory, and the level of pain did not change much for a minimum of 4 weeks after the final transforaminal epidural steroid injection. Among these 15 subjects, imaging tests revealed cervical soft disc herniation in 5 patients and spondylotic radiculopathy with cervical foraminal stenosis caused by hypertrophy of Luschka’s joints or spinal facets in 10 patients (Fig. 1).
Fig. 1
Fig. 1

These axial T2-weighted magnetic resonance images show an extruded disc (thin line arrow) in the left C5-6 paramedian area (A) and foraminal stenosis due to Luschka joint hypertrophy (thick line arrow) on the Right C6-7 level (B).
The subjects were 55.9±10.7 years old, their period of complaint of pain before pulsed radiofrequency treatment was applied spanned 13.3±9.6 months, and their average number of nerve root steroid injections prior to pulsed radiofrequency treatment was three.
Methods
Pulsed radiofrequency stimulation

Pulsed radiofrequency treatment was performed aseptically. The subject was laid in the supine position under fluoroscopic control using a C-arm (Arcadis Orbic, Siemens, Germany). A 22-gauge cannula SMK Pole needle 54 mm long with a 4 mm active tip (Cotop International BV, Amsterdam, Netherland) was placed around the dorsal root ganglion that lie within the intervertebral foramen. The cannula was inserted over the caudal and posterior parts of the intervertebral foramen and its tip was placed at the border between the center and one third of the caudal part from the posterior neural foramen. The catheter needle was then inserted and positioned as near as possible to the dorsal root ganglion with the aid of a radiofrequency generator RFG-1A (Cosman Medical Inc., MA, USA), and a sensory stimulation test was performed. When abnormal sensation or pain was observed with a stimulation of less than 0.3 V, the catheter needle was considered to be placed near the dorsal root ganglion. When sensory stimulation was not achieved, the catheter needle was inserted more deeply into the intervertebral foramen until the subject complained of a dull pain; however, the needle was not inserted beyond the lateral half of the articular mass seen on an anteroposterior view. The radiofrequency generator was set so that the temperature of the catheter needle tip would not exceed 42[degree celsius] and a radiofrequency magnetic field was applied at 45 V for 120 seconds (Fig. 2).
Fig. 2
Fig. 2

(A) RF generator, (B) Cannula and Catheter needle, (C, D) Fluoroscopy-guided pulsed radiofrequency of the Right C8 dorsal root ganglion.
Outcome measurements

A visual analog scale (VAS) was used to measure the intensity of the subjects’ pain and the neck disability index (NDI) was used to evaluate the functions affected by this pain. These measurements were obtained prior to treatment and one and three months after treatment. The NDI consisted of 10 items – the intensity of pain, personal management (bathing and putting on clothes), raising objects, reading books, headache, concentration, working, driving, sleeping, and leisure activities. The score for each item was zero to five points and the total score ranged from zero to 50 points. An NDI score was calculated from the total of the scores for each item. A high NDI score indicated a more severe functional disability related to the cervical abnormality. In this study, the severity of functional disabilities due to pain was represented by a percentage (%) (disability in percent=(total score)/50×100). A successful treatment was defined as a reduction in pain of 50 percent or more compared with the VAS score prior to the treatment. Three months after pulsed radiofrequency treatment was performed, the subjects’ degree of satisfaction with the treatment was recorded as “excellent,” “good,” “fair,” or “poor.” “Excellent” meant that the subject’s level of satisfaction with treatment results was equal to his or her expectation. “Good” meant that although the subject’s level of satisfaction was not up to his or her expectation, the subject was willing to receive treatment in case of another attack of pain. “Fair” meant that although the treatment was not ineffective, the subject was unwilling to opt for this treatment in case of another attack of pain. “Poor” meant that this treatment effect was similar to or worse than prior treatment effects. A third party who was blinded to the patients’ conditions and treatment history evaluated questionnaires on pain and degree of satisfaction with treatment.19SPSS 18.0 software was used for statistical analysis. Repeated measures of one factor analysis was employed to compare differences between time points through a contrast test to determine clinical progression. Significance was reached if the p-value was less than 0.05.
RESULTS
Changes in the VAS of pain in the upper extremity
The VAS of pain in the upper extremity was an average of 5.3±1.4 prior to pulsed radiofrequency treatment and this score significantly decreased to 2.7±1.9 at one month after the treatment, and to 2.5±1.9 at 3 months after the treatment (p<0.05) (Fig. 3). The VAS score of 11 (73.3%) of the 15 patients was reduced by more than 50% compared with scores prior to treatment, indicating a successful reduction in pain. However, the other three patients showed no response at all to pulsed radiofrequency treatment (Fig. 4).
Fig. 3
Fig. 3

Scores of the visual analogue scale (VAS) for cervical radicular pain were reduced significantly from 5.3 at pre-treatment to 2.7 at 1 month post-treatment, and to 2.5 at 3 months post-treatment, respectively.*p<0.05: Compared with pre-treatment. (more …)
Fig. 4
Fig. 4

Individual changes in visual analogue scale (VAS) scores versus time: pre-treatment, and 1 and 3 months post-treatment.
NDI
The NDI score averaged 44.0±15.3% before treatment and decreased to 37.0±15.8% and 35.8±15.7%, respectively, one and three months after treatment (p<0.05) (Fig. 5).
Fig. 5
Fig. 5

Average Neck disability index (NDI) was reduced significantly from 44.0% at pre-treatment to 35.8% at 3 months post-treatment.*p<0.05: Compared with pre-treatment.
Subjects’ satisfaction with the treatment
After three months of pulsed radiofrequency treatment, the number of patients who answered “excellent,” “good,” “fair,” and “poor” was 46.7%, 26.7%, 13.3%, and 13.3%, respectively, and 73.3% of the subjects indicated positive responses such as “excellent” or “good”.
DISCUSSION
In this study we administered pulsed radiofrequency treatment to chronic cervical radicular pain patients who had not obtained satisfactory treatment effects from several transforaminal epidural steroid injections with fluoroscopic control. The patients were then prospectively followed for three months. The patients’ VAS of radicular pain and NDI significantly decreased from one month after the treatment and decreased further at 3 months. In total, 73.3% of the patients responded that the result was “excellent” or “good”.
In general, radicular pain is explained by a mechanism in which the nerve roots are damaged by compression of their surrounding structures. The resulting ischemia20or the inflammatory responses that occur near nerve roots due to the release of inflammatory mediators from a herniated nucleus pulposus then triggers the damage in nerve roots.21 Recent studies verified that epidural steroid injections have noticeable effects in treating radicular pain originating from cervical disc disease and this treatment shows continuous efficacy for more than 6 months.22 However, 20 to 40 percent of steroid-treated patients do not experience a satisfactory reduction in pain23,24 and therefore other therapeutic approaches are needed.
Most reports have dealt with surgical approaches.25,26 A representative non-surgical approach is radiofrequency treatment. In the 1980s, attempts were made to apply continuous radiofrequency treatment to patients with chronic refractory radicular pain. Thereafter, pulsed radiofrequency treatment was performed on these patients in order to decrease secondary nerve damage.17,27 This technique does not cause a temperature rise that would be destructive to nerves17 and it is considered to be a more appropriate method for treating refractory pain resulting from radiculopathy compared to neurodestructive procedures. A recent study that examined the treatment effects of pulsed radiofrequency techniques on patients with radicular pain (due to herniated intervertebral disc or previous failed surgery) reported that 53% of patients with cervical radicular pain and 51% of those with lumbar radicular pain experienced a reduction in pain of more than 50% one week after treatment. In addition, 55% of those with cervical radicular pain and 45% of those with lumbar radicular pain experienced pain reduction of more than 50% three months after treatment.28 Another study reported that 7 of 11 patients with chronic cervical radicular pain who underwent a dorsal root ganglion block using pulsed radiofrequency experienced reductions in pain of more than 50%.18 In the present study, 11 of the 15 patients with chronic refractory cervical radicular pain who underwent pulsed radiofrequency stimulation of the cervical dorsal root ganglion had their pain reduced by more than 50% three months after the procedures, suggesting short-term efficacy for this treatment.
The mechanism of pain regulation by pulsed radiofrequency stimulation has yet to be discovered.14 Higuchi et al.29 performed an experiment in which pulsed radiofrequency and continuous radiofrequency stimulation were administered to the dorsal root ganglion of mice. Only pulsed stimulation increased c-Fos expression. Similarly, van Zundert et al.30 observed an increase in c-Fos expression in the dorsal root ganglion of mice seven days after continuous radiofrequency stimulation at 67[degree celsius] or pulsed radiofrequency stimulation at less than 42[degree celsius]. The clinical relationship between c-Fos expression and pain alleviation has not yet been determined and additional research is necessary to examine expression of pain-related factors through methods like immunochemical staining. In the present study, treatment effects observed in the first month after pulsed radiofrequency treatment continued until the third month, showing a short-term effect. No specific complications were observed during the follow-up period, suggesting that pulsed radiofrequency treatment is relatively safe for cervical radicular pain patients.
This study’s limitation is that pulsed radiofrequency treatment was performed on all chronic cervical radicular pain patients who met the study criteria, without establishing any control group. Therefore, future research with a control group and long-term follow-up (more than 1 year) are necessary to validate the present findings. The number of subjects enrolled in the present study was small and future prospective follow-up studies will also need to study a greater number of patients.
CONCLUSION
Pulsed radiofrequency stimulation was performed on patients who complained of chronic refractory cervical radicular pain and who had not obtained satisfactory treatment outcomes from many rounds of transforaminal epidural steroid injections. Pulsed radiofrequency treatment of dorsal root ganglion had a good short-term antinociceptive effect that continued for three months. In 73.3% of the patients, their VAS scores were reduced by more than 50% by the treatment and they responded that the treatment effect was “excellent” or “good.” Pulsed radiofrequency treatment could be applied as a secondary treatment method for patients with chronic radicular pain due to cervical herniated disc or cervical foraminal stenosis who do not experience satisfactory treatment effects from transforaminal epidural steroid injections.
ACKNOWLEDGEMENTS
This study was supported by a grant of the Korea Healthcare technology R&D Project, Ministry for Health, Welfare&Family Affairs, Republic of Korea (A084177).
References
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Articles from Annals of Rehabilitation Medicine are provided here courtesy of
Korean Academy of Rehabilitation Medicine
apr 12 2012

Meta-analysis of clinical efficacy of pulsed radio frequency energy treatment.

Ann Surg. 2012 Mar;255(3):457-67.

Guo L, Kubat NJ, Nelson TR, Isenberg RA.

Source

Department of Plastic Surgery, Lahey Clinic Medical Center, Burlington, MA, USA. lifei.guo@lahey.org

Abstract

OBJECTIVE:

To statistically evaluate published clinical efficacy data related to the use of pulsed radio frequency energy (PRFE) therapy in 3 clinical applications.

BACKGROUND:

Numerous clinical studies have reported efficacy outcomes for PRFE therapy use in the palliative treatment of both postoperative and nonpostoperative pain and edema, and for its use as an adjunctive wound-healing (WH) therapeutic. Although diverse in design and endpoint, these studies are amenable to systematic review using both a vote-counting and P-value combination meta-analytic technique.

METHODS:

A meta-analysis of efficacy outcomes reported in clinical trials was performed using a vote-counting procedure. In addition, when possible, the sum of logs method of P-value combination was used to determine a significance level for the combined evidence within each endpoint and clinical area.

RESULTS:

Of the 186 clinical articles identified after application of selection criteria, there were 25 controlled trials that met criteria for inclusion in vote-counting and P-value combination methods and were used for formal statistical analysis. In total, 1332 patients receiving PRFE treatment were studied. Vote-counting procedure applied to clinical outcomes from controlled studies resulted in a greater number of positive outcomes than neutral outcomes, and zero negative outcomes, for each of the clinical application groups evaluated. The sum of logs P-value method found statistically significant improvement in pain, reduction in edema, and improvement in WH outcomes.

CONCLUSIONS:

On the basis of statistical evaluation of published clinical efficacy data, there is strong statistical evidence that PRFE therapy is effective in the treatment of postoperative and nonpostoperative pain and edema and in WH applications.

PMID:22301609

 

[PubMed - indexed for MEDLINE]
Pubblicato su Pubmed a http://www.ncbi.nlm.nih.gov/pubmed/22301609
apr 5 2012

Would pulsed radiofrequency applied to different anatomical regions have effective results for chronic pain treatment?

J Pak Med Assoc. 2011 Sep;61(9):879-85.

Karaman H, Tüfek A, Kavak GO, Yildirim ZB, Celik F.

Source

Pain Management Center, Dicle University, Diyarbakir, Turkey.

Abstract

OBJECTIVE:

To observe the effect of Pulsed radiofrequency on patients presenting with complaints of chronic pain.

METHODS:

It was a retrospective cross sectional study which included patients with chronic pain who did not respond to conventional treatment.The study was conducted at the Pain Management Centre, Dicle University, Diyarbakir, Turkey from October 2008 to September 2010. The applications of Pulsed radiofrequency (PRF) were made under the guidance of C-arm fluoroscopy, local anaesthesia, and sedoanalgesia. The intervention types applied consisted of sacroiliac intraarticular, heel, sciatic nerve and impar ganglion Pulsed radiofrequency. Visual Analogue Scale (VAS) was used for pain assessment.Sacroiliac intraarticular PRF was applied to nine patients, impar ganglion PRF to eight patients, heel PRF to four patients and sciatic nerve PRF was applied to three patients.

RESULTS:

The mean age of the patients was 41.3 +/- 16.9 (range 15-77) years, 15 (62.5%) were females. The mean follow-up period was 8.5 +/- 5.4 months. A minimum 50% decrease was determined in the VAS scores of 16 (66.7%) patients compared to the initial values. The patients who had > or = 50% decrease in their VAS scores in the sacroiliac group was 55.6. This value was 75.0, 75.0 and 66.7 in the impar, heel and sciatic nerve groups respectively. No early- or late-term complications were observed in any of the patients.

CONCLUSIONS:

P Pulsed Radiofrequency implementation was found to be an effective and safe method for chronic pain treatment in our centre.

PMID:22360028

 

[PubMed - in process]
Pubblicato su PubMed a http://www.ncbi.nlm.nih.gov/pubmed/22360028
mar 31 2012

PM R. 2012 Mar;4(3):176-81. Epub 2012 Feb 18.

Weber T, Kabelka B.

Source

Facharzt für Orthopädie und Sportmedzin, Kümmellstr 1, 20249 Hamburg, Germany (⁎).

Abstract

OBJECTIVE:

To evaluate noninvasive monopolar capacitive-coupled radiofrequency (mcRF) for the treatment of pain associated with lateral elbow tendinopathies.

DESIGN:

Prospective, single-center, single-arm, 1-year follow-up.

SETTING:

Private sports medicine practice.

PARTICIPANTS:

Thirty-nine consecutive patients with diagnosis of lateral elbow tendinopathy (including 3 bilateral cases, for a total of 42 elbows) participated in the study. All patients had been unsuccessfully treated with a variety of nonoperative therapies (eg, nonsteroidal anti-inflammatory drugs, corticosteroid injections, and braces) for at least 3 months before they were enrolled in the study.

INTERVENTION:

Patients were treated with mcRF technology in the office without local anesthetic or any particular preparation. Anatomic landmarks and careful determination of the most tender point defined the area treated; rapid and precise mcRF pulses were delivered covering the area in a staggered fashion; and 10 additional pulses were delivered directly to the point of maximum tenderness (total of 100 pulses). Patients returned to activities of daily living without restriction and were instructed to avoid nonsteroidal anti-inflammatory drugs and/or ice over the treated area. Physical therapy or other treatment modalities were disallowed.

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