Comparison between ultrasound-guided interfascial pulsed radiofrequency and ultrasound-guided interfascial block with local anesthetic in myofascial pain syndrome of trapezius muscle

Anatomical landmarks and procedure technique of Levator Scapulae Plane Block (LeSP block): Case report: Ultrasound-guided block of the superficial, deep and distal planes of the levator scapulae muscle for treatment of shoulder girdle myofascial pain

Neck pain is a prevalent issue associated with musculoskeletal disorders. This study describes the interfascial Levator Scapulae Plane Block (LeSP Block) technique, using ultrasound guidance for local anesthetic administration to treat chronic neck pain. Two patients, 1 77-year-old female and 1 50-year-old female, underwent the LeSP Block. Immediate postprocedure pain relief was achieved in both, with 1 patient experiencing complete pain remission (VAS = 0) and the other showing significant improvement (VAS = 2) after 30 days. The LeSP Block demonstrated effectiveness and ease of use, suggesting its inclusion in pain management strategies for shoulder girdle and scapular pain. Further anatomical studies aimed at improving the anatomical description of the accessory spinal nerve are recommended to refine the technique.

Ultrasound-guided pulsed radiofrequency versus dry needling for pain management in chronic neck and shoulder myofascial pain syndrome patients at a tertiary hospital in China: a randomised controlled trial protocol

INTRODUCTION

Myofascial pain syndrome (MPS), especially in the neck and shoulder region, is one of the most common chronic pain disorders worldwide. Dry needling (DN) and pulsed radiofrequency (PRF) are the two effective methods for treating MPS. We aimed to compare the effects of DN and PRF in chronic neck and shoulder MPS patients.

METHODS AND ANALYSIS

This is a prospective, single-centre, randomised, controlled trial in a tertiary hospital. We plan to recruit 108 patients aged 18-70 years who are diagnosed with chronic MPS in the neck, shoulder and upper back regions and randomly allocate them to either the DN or PRF group at a 1:1 ratio. The DN group will receive ultrasound-guided intramuscular and interfascial DN 8-10 times per pain point or until local twitch responses are no longer elicited and 30 min of indwelling. The PRF group will receive ultrasound-guided intramuscular (0.9% saline 2 mL, 42℃, 2 Hz, 2 min) and interfascial (0.9% saline 5 mL, 42℃, 2 Hz, 2 min) PRF. Follow-up will be performed by the research assistant at 0, 1, 3 and 6 months postoperatively. The primary outcome is the postoperative 6-month pain visual analogue score (0-100 mm). Secondary outcomes include pressure pain threshold measured by an algometer, Neck Disability Index, depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7), sleep status (Likert scale) and overall quality of life (36-Item Short Form Survey). Between-group comparisons will be analysed using either a non-parametric test or a mixed effects linear model.

ETHICS AND DISSEMINATION

This study was approved by the medical ethics committee of Peking Union Medical College Hospital (JS-3399). All participants will give written informed consent before participation. The results from this study will be shared at conferences and disseminated in international journals.

TRIAL REGISTRATION NUMBER

NCT05637047, Pre-results.

Ultrasound-guided caudal epidural pulsed radiofrequency for the treatment of failed back surgery syndrome: Results of a prospective clinical study

Background

The first aim of this study was to investigate the analgesic efficacy of US-guided caudal epidural pulsed radiofrequency (PRF) stimulation in patients with failed back surgery syndrome (FBSS); the second was to evaluate the effects on opioid use, disability, quality of life and patient satisfaction.

Methods

Thirty patients with > 6-month history of chronic leg pain of >4 on a numerical rating scale (NRS) due to FBSS were included. These patients had unsatisfactory responses to conventional treatments and at least two epidural steroid injections. PRF stimulation with ultrasound guidance was administered to the caudal epidural space. NRS was evaluated before treatment, at 2, 4, and 8 weeks after intervention. Short Form-36 (SF-36) for health-related quality of life, Oswestry Disability Index (ODI), changes in opioid use and patient satisfaction were evaluated at baseline and 8 weeks after treatment.

Results

Mean NRS scores were significantly lower at weeks 2, 4 and 8 compared to baseline (P ​< ​0.001). There were significant improvements in SF-36 and ODI scores compared with pretreatment (P ​< ​0.05). It was found that 31% and 13% of opioid users, respectively, discontinued and tapered off their opioid medication. 40% of patients were overall satisfied with the treatment.

Conclusion

In a cohort of patients with FBSS, caudal epidural PRF stimulation provided pain relief in 36% of treated subjects. Patients also experienced significant improvement in functionality, quality of life and opioid use. This technique can be considered as an alternative before considering neuromodulation, opiate therapy, or reoperation in patients with FBSS.

Effectiveness of pulsed radiofrequency on the medial cervical branches for cervical facet joint pain

BACKGROUND

Cervical facet joint pain (CFP) is one of the most common causes of neck pain and headache. Persistent CFP deteriorates the quality of life of patients and reduces their productivity at work.

AIM

To investigate the effectiveness of pulsed radiofrequency (PRF) stimulation of cervical medial branches in patients with chronic CFP.

METHODS

We retrospectively included 21 consecutive patients (age = 50.9 ± 15.3 years, range 26-79 years; male: female = 8:13; pain duration = 7.7 ± 5.0 mo) with chronic CFP, defined as ≥ 4 on the numeric rating scale (NRS). We performed PRF stimulation on the cervical medial branches. The outcomes of the PRF procedure were evaluated by comparing the NRS scores for CFP before treatment and 1 and 3 mo after treatment. Successful pain relief was defined as a ≥ 50% reduction in the NRS score at 3 mo when compared with the pretreatment NRS score.

RESULTS

No patient had immediate or late adverse effects following PRF. The average NRS score for CFP decreased from 5.3 ± 1.1 at pre-treatment to 2.4 ± 0.6 at the 1 mo follow-up, and 3.1 ± 1.1 at the 3 mo follow-up. Compared to the NRS scores before PRF stimulation, those at 1 and 3 mo after PRF stimulation had significantly decreased. Eleven of the 21 patients (52.4%) reported successful pain relief 3 mo after the PRF procedure. PRF stimulation on cervical medial branches may be a useful therapeutic option to control chronic CFP.

CONCLUSION

PRF stimulation of the cervical medial branches may be used as an alternative treatment method in patients with CFP. PRF can effectively alleviate CFP, and is safe to perform.

Trigger Point Injections

Myofascial pain and myofascial pain syndromes are among some of the most common acute and chronic pain conditions. Many interventional procedures can be performed in both an acute and chronic pain setting to address myofascial pain syndromes. Trigger point injections can be performed with or without imaging guidance such as fluoroscopy and ultrasound; however, the use of imaging in years past has been recommended to improve patient outcome and safety. Injections can be performed using no injectate (dry needling), or can involve the administration of local anesthetics, botulinum toxin, or corticosteroids.

Ultrasound-Guided Erector Spinae Plane Block and Trapezius Muscle Injection for Myofascial Pain Syndrome

OBJECTIVE

There were two goals to this study: the first goal was to research the analgesic effectiveness of erector spinae plane block (ESPB) added to the treatment after trapezius muscle injection (TMI) and the second was to investigate whether repeated TMI increases the analgesic effect in myofascial pain syndrome (MPS).

METHODS

Sixty patients with a diagnosis of MPS were randomized into two groups. The TMI group (n = 30) received ultrasound-guided (USG) TMI with 5 mL of 0.25% bupivacaine two times, with a 1-week interval in between. The ESPB group (n = 30) received USG TMI with 5 mL of 0.25% bupivacaine in the first week and USG ESPB with 20 mL of 0.125% bupivacaine in the second week. The pain severity of the patients was evaluated using the visual analog scale (VAS). The data obtained before (week 0) and after (weeks 1, 2, 3, and 4) the injections were statistically compared between the groups.

RESULTS

In both groups, the mean VAS score decreased in the first week compared to the mean pretreatment score (p < .001). When the VAS scores were compared between the first and second weeks, a decrease was observed in both groups (p < .001), but it was more evident in the ESPB group. Compared to previous weeks, there was no significant difference in VAS scores at the third and fourth weeks.

CONCLUSIONS

The analgesic effect of repeated TMI for MPS was superior to a single injection, but ESPB combined with TMI provided more effective analgesia than repeated TMI.

Long-term efficacy and patient satisfaction of pulsed radiofrequency therapy in temporomandibular disorders: A randomized controlled trial

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.

Comparison of the Effects of Physiologic Saline Interfascial and Lidocaine Trigger Point Injections in Treatment of Myofascial Pain Syndrome: A Double-Blind Randomized Controlled Trial

Objective

To compare the effects of physiological saline interfascial and lidocaine trigger point injections in the treatment of myofascial pain syndrome (MPS).

Design

Double-blind randomized controlled study.

Setting

Department of Rehabilitation Medicine.

Participants

Eighty patients (N=80; 15 men, 65 women; mean age, 40.4±10.9y) with MPS in the upper trapezius muscle.

Interventions

Patients were randomly assigned to 1 of 2 groups: group 1 (n=40) received ultrasound-guided interfascial injection with physiological saline, and group 2 (n=40) underwent ultrasound-guided trigger point injection with lidocaine.

Main Outcome Measures

The primary outcome was pain scores measured by the visual analog scale (VAS). Secondary outcomes included cervical range of motion (ROM) and adverse effects of the procedure. The outcomes were assessed before treatment and 10 minutes, 2 weeks, and 4 weeks after treatment.

Results

Lidocaine trigger point injection showed higher VAS score improvement at 10 minutes after the procedure (P=.037). However, there was no statistically significant difference at other follow-up points. Pain scores significantly decreased at 10 minutes, 2 weeks, and 4 weeks from baseline in both groups. Cervical ROM increased significantly over time in some directions without significant differences between the groups. There were no serious adverse effects in this study.

Conclusion

Physiologic saline interfascial and lidocaine trigger point injections effectively decreased MPS pain in the upper trapezius muscle at 2 and 4 weeks after treatment. However, lidocaine trigger point injection demonstrated better pain improvement at 10 minutes after treatment.

Editorial for the special issue of the Chinese Association for the Study of Pain

The Ministry of Health of China officially issued a document, adding the first level diagnosis and treatment discipline “Algology” in the list of diagnosis and treatment subjects of medical institutions on July 16, 2007. As the most important pain academic organization in China, the Chinese Association for the Study of Pain has made outstanding contributions in promoting the development of pain discipline and in establishing pain standards and disease diagnosis and treatment guidelines. In this special issue, under the leadership of Yan-Qing Liu, Chairman of the 7^th Committee of the Chinese Association for the Study of Pain, nine consensus and one guideline were included.

Expert consensus on the diagnosis and treatment of myofascial pain syndrome

Myofascial pain syndrome (MPS) is characterized by myofascial trigger points and fascial constrictions. At present, domestic and foreign scholars have not reached a consensus on the etiology and pathogenesis of MPS. Due to the lack of specific laboratory indicators and imaging evidence, there is no unified diagnostic criteria for MPS, making it easy to confuse with other diseases. The Chinese Association for the Study of Pain organized domestic experts to formulate this Chinese Pain Specialist Consensus on the diagnosis and treatment of MPS. This article reviews relevant domestic and foreign literature on the definition, epidemiology, pathogenesis, clinical manifestation, diagnostic criteria and treatments of MPS. The consensus is intended to normalize the diagnosis and treatment of MPS and be used by first-line doctors, including pain physicians to manage patients with MPS.

Effectiveness of Intravenous Immunoglobulin for Management of Pain in Patients with Postpolio Syndrome

Objective

Many patients with postpolio syndrome (PPS) experience pain. In this study, we aimed to review previous studies to investigate the effectiveness of intravenous immunoglobulin (IVIG) for managing pain in patients with PPS. We performed a narrative review.

Methods

In PubMed, we searched for the keywords ((Immunoglobulin OR IVIG) AND (poliomyelitis OR poliomyelitis syndrome)). We included articles in which IVIG was infused in patients with PPS and pain severity was measured before and after treatment.

Results

In the results, five articles (4 randomized controlled trials and 1 prospective observational study) were included in this review. Four of the studies reported that IVIG had a positive pain-reducing effect in patients with PPS. In addition, 4 studies evaluated the outcomes related to muscle strength and function. Of these studies, 3 showed some improvement in measurements for muscle strength and function.

Conclusion

In conclusion, IVIG might be one of the beneficial options for managing pain in PPS. Pain reduction might be responsible for the improvement of muscle strength or function. To confirm the benefits of IVIG in reducing pain, more high-quality studies are required.

Ultrasound-guided interventional procedures for myofascial trigger points: a systematic review

Myofascial pain syndrome (MPS) is characterized by the presence of clinically detected myofascial trigger points (MTrPs). Diagnostic ultrasound (US) has been proposed as a method to strengthen the reliability of MTrP localization, thus potentially improving the efficacy and safety profile of interventional procedures. The objective is to evaluate the benefit and safety profile of any US-guided interventional procedure for MPS. Medline, Embase, PubMed, the Allied and Complementary Medicine Database (AMED), and Web of Science were systematically searched from their inception to May 2020 for any randomized controlled trial that evaluated treatment benefit and safety of any US-guided interventional procedure for MPS. The primary outcome of interest was pain severity. Additional outcomes of interest were function and adverse effects. The risk of bias was assessed using the Risk of Bias V.2.0 tool. eleven studies met all inclusion and exclusion criteria. Two studies (n=174) with a high risk of bias revealed some evidence supporting US guidance over blinded interventions for improvement in pain and function. Eight studies (n=483) with varying risks of bias were of head-to-head comparisons of different US modalities. These studies revealed that US-guided local anesthetic injections were inferior to US-guided pulse radiofrequency and US-guided dry needling (DN). US-guided DN was also found to be superior to US-guided platelet-rich-plasma injections but inferior to US-guided miniscalpel. Meanwhile, one study (n=21) with some concerns of bias found that US-guided local anesthetic injections were superior to non-steroidal anti-inflammatory drugs for pain outcomes and fewer adverse events. All US-guided procedures resulted in zero or minimal self-limited adverse events. Issues with clinical relevance, limited sample sizes, and small point estimates warrant more high-quality research to better characterize the possible value of US-guided injections.

Epidural hematoma after caudal epidural pulsed radiofrequency stimulation: A case report

RATIONALE

Epidural hematoma is a possible complication after neuraxial procedures. Recently, caudal epidural pulsed radiofrequency (PRF) stimulation was reported as an effective method for controlling several types of chronic pain. Herein, we report on a patient who developed a lumbar epidural hematoma after receiving caudal epidural PRF stimulation.

PATIENT CONCERNS

A 75-year-old woman, who was taking oral warfarin (2 mg/d), received caudal epidural PRF stimulation for symmetrical neuropathic pain in both legs due to chronic idiopathic axonal polyneuropathy. She did not discontinue warfarin use before undergoing the procedure. Three days and 12 hours after the procedure, motor weakness suddenly manifested in the right leg (manual muscle testing [MMT] = 2-3).

DIAGNOSES

Lumbar magnetic resonance imaging (MRI) performed 7 days after the PRF procedure showed a spinal epidural hematoma at the L1 to L5 levels, compressing the thecal sac. The international normalized ratio was 6.1 at the time of the MRI.

INTERVENTIONS

Decompressive laminectomy from L1 to L5 with evacuation of the hematoma was performed.

OUTCOMES

Three months postoperatively, the motor weakness in the patient's right leg improved to MMT = 4 to 5.

LESSONS

This case suggests that clinicians should carefully check if patients are taking an anticoagulant medication and ensure that it is discontinued for an appropriate length of time before a caudal epidural PRF procedure is performed.

Effect of Pulsed Radiofrequency Therapy on Chronic Refractory Atlanto-Occipital Joint Pain

OBJECTIVE

Despite several methods of conservative management, many patients with atlanto-occipital (AO) joint pain complain of persistent pain. In the current study, the authors investigated the clinical efficacy of intra-articular pulsed radiofrequency (PRF) therapy for the management of refractory chronic AO joint pain.

METHODS

Twenty patients with refractory AO joint pain were recruited, and each received intra-articular AO joint PRF stimulation. Pain reduction after PRF therapy was measured using a numerical rating scale (NRS) before and at 1 and 3 months after treatment. Successful pain relief was defined as ≥50% reduction in the NRS score compared with the pretreatment score. At 3 months after treatment, patient satisfaction levels were also examined. Patients reporting very good (score = 7) or good (score = 6) results were considered to be satisfied with the procedure.

RESULTS

The NRS scores changed significantly over time. At 1 and 3 months after PRF therapy, the NRS scores were significantly reduced compared with pretreatment scores. Sixteen of the 20 (80%) patients reported pain relief and were satisfied with treatment results 3 months after PRF. No adverse effects were reported.

CONCLUSIONS

Intra-articular PRF therapy is a beneficial treatment tool for managing refractory chronic AO joint pain.

Comparison of ozone and lidocaine injection efficacy vs dry needling in myofascial pain syndrome patients

Purpose

Myofascial pain syndrome (MPS) is a common musculoskeletal disorder among young adults associated with presence of myofascial trigger points. We aimed to evaluate efficacy of ozone injection (OI) in MPS patients, compared with two currently used methods including lidocaine injection (LI) and dry needling (DN).

Patients and methods

In this single-blinded study, a total of 72 eligible patients were included and then randomly divided into three equal groups: DN, OI, and LI. All patients received treatment in three weekly sessions. Visual analog scale (VAS) for pain, cervical lateral flexion, pain pressure threshold (PPT), and neck disability index (NDI) were the main outcome measures, which were evaluated at baseline and at 4 weeks after injections. Analytic results were demonstrated as both within- and between-groups mean difference (MD).

Results

Sixty two patients finished the study, 20 participants in both the DN and LI groups, and 22 persons in OI group. Distribution of all demographics and baseline clinical variables were relatively similar among groups. All three interventions were remarkably effective in improving patients’ pain and PPT. Significant decrease in VAS (MD=–3.6±1.4) and increase in PPT (MD=7.2±5.1) within 4 weeks follow-up confirmed this finding. Also, NDI had similar significant improvement (MD=–9.9±8.7), but lateral flexion range did not show remarkable increase. There was also a statistically significant difference among three methods’ efficacy on VAS, NDI, and PPT, favoring OI and LI.

Conclusion

In summary, this data showed that in short-term follow-up, all three methods were significantly effective in MPS treatment; however, OI and LI groups had slightly better results than the DN group, with no remarkable preference between them.

Comparison of the Efficiency of Ultrasound-Guided Injections of the Rhomboid Major and Trapezius Muscles in Myofascial Pain Syndrome: A Prospective Randomized Controlled Double-blind Study

OBJECTIVES

We aimed to investigate the effect of ultrasound (US)-guided injections of the rhomboid major (deep) and trapezius (superficial) muscles on pain, disability, and quality of life in patients with myofascial pain syndrome.

METHODS

In this prospective randomized controlled double-blind study, 65 patients with a diagnosis of myofascial pain syndrome were randomized into 2 groups. In group 1 (n = 33), US-guided rhomboid major muscle injection was performed, and in group 2 (n = 32), US-guided trapezius muscle injection was performed. The patients were assessed by a visual analog scale for pain, the Pressure Pain Threshold, the Neck Pain and Disability Scale, and Short Form 12. Data were obtained before treatment (week 0), the second week after treatment, and the fourth week after treatment.

RESULTS

In both groups, significant improvements were observed for all parameters at both weeks 2 and 4 compared to pretreatment values (P < .05). A comparison of the groups showed significantly superior results in group 1 for all parameters at week 2 (P < .05) and for all parameters but the Physical Component Scale of Short Form 12 at week 4 (P < .05).

CONCLUSIONS

We think that US-guided deep injection of the rhomboid major muscle was more effective than superficial injection of the trapezius muscle for pain, disability, and quality of life in patients with myofascial pain syndrome.

Effect of intradiscal pulsed radiofrequency on refractory chronic discogenic neck pain: A case report

RATIONALE

Despite medication, exercise, and medical intervention, many patients complain of persistent discogenic neck pain. To manage discogenic neck pain, we performed intradiscal pulsed radiofrequency (PRF) stimulation in a patient with chronic discogenic neck pain refractory to oral medication and epidural steroid injection.

PATIENT CONCERNS

A 26-year-old man presented with a numeric rating scale (NRS) score of 7 for chronic neck pain. His pain was worse when the neck was held in one position for a prolonged period. There was no pain in the upper extremities.

DIAGNOSES

Discography was positive at C4-5. Based on the pain characteristics, and the result of discography, we diagnosed him as having discogenic neck pain originating from C4-5.

INTERVENTIONS

Intradiscal PRF on the C4-5 intervertebral disc was performed under C-arm fluoroscopy. The PRF treatment was administered at 2 Hz and a 20-ms pulsed width for 20 minutes at 60 V with the constraint that the electrode tip temperature should not exceed 42°C.

OUTCOMES

At the 2-week, and 1-month follow-up visits, the patient's pain was completely relieved. At 2, and 3 months after intradiscal PRF, the pain was scored as NRS 2. No adverse effects of intradiscal PRF stimulation were observed.

LESSONS

Application of intradiscal PRF appears to be an effective and safe technique for treating chronic discogenic neck pain.

Effect of Pulsed Radiofrequency Treatment on the Thoracic Medial Branch for Managing Chronic Thoracic Facet Joint Pain Refractory to Medial Branch Block with Local Anesthetics

OBJECTIVE

To evaluate the effect of pulsed radiofrequency (PRF) stimulation of the thoracic medial branch of the dorsal ramus in patients with chronic thoracic facet joint (TFJ) pain who were refractory to medial branch block (MBB).

METHODS

This was a prospective, observational study. The author retrospectively reviewed data from 72 patients who had received therapeutic MBB with 0.5 mL of 2% lidocaine mixed with 0.5 mL of 0.25% bupivacaine to treat TFJ-origin upper or midback pain. Of these patients, 20 were included to evaluate the effects of PRF on the thoracic medical branch to manage TFJ pain refractory to therapeutic MBB. PRF stimulation was administered at 5 Hz and a 5-millisecond pulsed width for 360 seconds at 45 V. The pain-reducing effect of the PRF procedure was evaluated via the numeric rating scale (NRS) at 1, 2, and 3 months after treatment. Successful pain relief was defined as ≥50% reduction in the NRS score compared with the score before treatment.

RESULTS

The NRS scores changed significantly over time (pretreatment, 6.0 ± 1.0; 1 month, 3.3 ± 2.2; 2 months, 3.9 ± 2.1; and 3 months, 4.0 ± 2.2). At 1, 2, and 3 months after the PRF procedure, the NRS scores were significantly reduced compared with the scores before the treatment. Eleven (55%) of 20 patients reported successful pain relief at 3 months after PRF.

CONCLUSIONS

The author suggests that PRF on the thoracic medial branch is an effective and safe interventional technique for the control of chronic TFJ pain.

Effect of transcutaneous electrical nerve stimulation therapy for the treatment of primary dysmenorrheal

BACKGROUND

This study aimed to investigate the effect and safety of transcutaneous electrical nerve stimulation (TENS) therapy for relieving pain in women with primary dysmenorrhea (PD).

METHODS

In this study, 134 participants with PD were randomly divided into the intervention group and the sham group, with 67 participants in each group. Participants in the intervention group received TENS, whereas those in the sham group received sham TENS. The primary outcome was measured by the Numeric Rating Scale (NRS). The secondary outcomes were measured by the duration of relief from dysmenorrheal pain, number of ibuprofen tablets taken, and the World Health Organization quality of life (WHOQOL)-BREF score, as well as the adverse events.

RESULTS

A total of 122 participants completed the study. Compared to sham TENS, TENS showed a greater effect in pain relief with regard to the NRS (P < .01), duration of relief from dysmenorrheal pain (P < .01), and number of ibuprofen tablets taken (P < .01). However, no significant differences in the quality of life, measured by the WHOQOL-BREF score, were found between 2 groups. The adverse event profiles were also similar between 2 groups.

CONCLUSION

TENS was efficacious and safe in relieving pain in participants with PD.

Effect of bipolar pulsed radiofrequency on refractory chronic cervical radicular pain: A report of two cases

RATIONALE

Despite undergoing transforaminal epidural steroid injection (TFESI), many patients complain of persisting cervical radicular pain. For the management of chronic cervical radicular pain, clinicians are widely applying pulsed radiofrequency (PRF) stimulation to dorsal root ganglions (DRGs). To enhance the effect of PRF stimulation, we conducted bipolar PRF stimulation in 2 patients with chronic cervical radicular pain that was refractory to monopolar PRF and repeated TFESIs.

PATIENT CONCERNS

Patients 1 and 2 presented with a numeric rating scale (NRS) score of 7 and 6 for chronic cervical radicular pain, respectively, despite undergoing monopolar PRF and 2 TFESIs.

DIAGNOSES

On cervical magnetic resonance imaging, foraminal stenosis at the right C6-7 and right central to right foraminal disc protrusion on C6-7 were observed in patients 1 and 2, respectively. Two patients showed a positive response on diagnostic right C7 selective nerve root block with 0.5 mL of 1% lidocaine.

INTERVENTIONS

Bipolar PRF stimulation was performed under C-arm fluoroscopy. Two parallel RF cannulas (less than 1 cm apart) were used for DRG stimulation. The PRF treatment was administered at 5 Hz and a 5-ms pulsed width for 360 seconds at 45 V with the constraint that the electrode tip temperature did not exceed 42°C.

OUTCOMES

At the 2-week and 1-month follow-up, after undergoing bipolar PRF, the pain of patient 1 was completely relieved, and at 2, 3, and 6 months, the pain was scored as NRS 2. In patient 2, at the 2-week follow-up after undergoing bipolar PRF, pain severity was reduced from NRS 6 to 2. The effect of bipolar PRF on patient 2 lasted for at least 6 months. No adverse effects were observed in either patient.

LESSONS

Application of bipolar PRF to DRGs seems to be an effective and safe technique for treating refractory chronic cervical radicular pain.