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Lefel N, van Suijlekom H, Cohen SPC, Kallewaard JW, Van Zundert J. 11. Cervicogenic headache and occipital neuralgia. Pain Pract 2024. [PMID: 39219023 DOI: 10.1111/papr.13405] [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: 09/04/2024]
Abstract
INTRODUCTION Cervicogenic headache (CEH) and occipital neuralgia (ON) are headaches originating in the occiput and that radiate to the vertex. Because of the intimate relationship between structures based in the occiput and those in the upper cervical region, there is significant overlap between the presentation of CEH and ON. Diagnosis starts with a headache history to assess for diagnostic criteria formulated by the International Headache Society. Physical examination evaluates range of motion of the neck and the presence of tender areas or pressure points. METHODS The literature for the diagnosis and treatment of CEH and ON was searched from 2015 through August 2022, retrieved, and summarized. RESULTS Conservative treatment includes pain education and self-care, analgesic medication, physical therapy (such as reducing secondary muscle tension and improving posture), the use of TENS (transcutaneous electrical nerve stimulation), or a combination of the aforementioned treatments. Injection at various anatomical locations with local anesthetic with or without corticosteroids can provide pain relief for a short period. Deep cervical plexus block can result in improved pain for less than 6 months. In both CEH and ON, an occipital nerve block can provide important diagnostic information and improve pain in some patients, with PRF providing greater long-term pain control. Radiofrequency ablation of the cervical facet joints can result in improvement for over 1 year. Occipital nerve stimulation (ONS) should be considered for the treatment of refractory ON. CONCLUSION The treatment of CEH preferentially consists of radiofrequency treatment of the facet joints, while for ON, pulsed radiofrequency of the occipital nerves is indicated. For refractory cases, ONS may be considered.
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Affiliation(s)
- Nicole Lefel
- Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hans van Suijlekom
- Anesthesiology and Pain Management, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Steven P C Cohen
- Anesthesiology, Neurology, Physical Medicine and Rehabilitation and Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Anesthesiology and Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Jan Willem Kallewaard
- Anesthesiology and Pain Medicine, Rijnstate Ziekenhuis, Velp, The Netherlands
- Anesthesiology and Pain Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jan Van Zundert
- Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Genk, Limburg, Belgium
- Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands
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Oliveira KD, Dhondt N, Englesakis M, Goel A, Hoydonckx Y. Pulsed Radiofrequency Neuromodulation of the Greater Occipital Nerve for the Treatment of Headache Disorders in Adults: A Systematic Review. Can J Pain 2024; 8:2355571. [PMID: 38915302 PMCID: PMC11195485 DOI: 10.1080/24740527.2024.2355571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/11/2024] [Indexed: 06/26/2024]
Abstract
Background Pulsed radiofrequency neuromodulation (PRFN) of greater occipital nerve (GON) is considered in patients with headaches failing to achieve sustained analgesic benefit from nerve blocks with local anesthetic and steroids. However, the evidence supporting this practice is unclear. Aims This narrative systematic review aims to explore the effectiveness and safety of GON PRFN on headaches. Methods Databases were searched for studies, published up to February 1, 2024, investigating PRFN of GON for adults with headaches. Abstracts and posters were excluded. Primary outcome was change in headache intensity. Secondary outcomes included effect on monthly headache frequency (MHF), mental and physical health, mood, sleep, analgesic consumption, and side-effects. Two reviewers screened and extracted data. Results Twenty-two papers (2 randomized controlled trials (RCT), 11 cohort, and 9 case reports/series) including 608 patients were identified. Considerable heterogeneity in terms of study design, headache diagnosis, PRF target and settings, and image-guidance was noted. PRFN settings varied (38-42°C, 40-60 V, and 150-400 Ohms). Studies demonstrated PRFN to provide significant analgesia and reduction of MHF in chronic migraine (CM) from 3 to 6 months; and significant pain relief for ON from six to ten months. Mild adverse effects were reported in 3.1% of cohort. A minority of studies reported on secondary outcomes. The quality of the evidence was low. Conclusions Low-quality evidence indicates an analgesic benefit from PRFN of GON for ON and CM, but its role for other headache types needs more investigation. Optimal PRFN target and settings remain unclear. High-quality RCTs are required to further explore the role of this intervention. PROSPERO ID CRD42022363234.
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Affiliation(s)
- Kyle De Oliveira
- Department of Anesthesia and Pain Management, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nina Dhondt
- Department of Pain Medicine, Multidisciplinary Pain Center, VITAZ, Sint-Niklaas, Belgium
| | - Marina Englesakis
- The Institute of Education Research, Library & Information Services, University Health Network, Toronto, Ontario, Canada
| | - Akash Goel
- Department of Anesthesia and Pain Management, St Michael's Hospital, Unity Health, Toronto, Ontario, Canada
| | - Yasmine Hoydonckx
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, Toronto, Ontario, Canada
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3
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Elmati PR, Wilkinson TJ, Bautista A. Pulsed Radiofrequency Ablation for Refractory Cancer-Related Leg Pain: A Case Report. Cureus 2024; 16:e58779. [PMID: 38784371 PMCID: PMC11111418 DOI: 10.7759/cureus.58779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Metastatic cancers often lead to distant metastasis, accompanied by debilitating symptoms such as chronic pain, which can be refractory to conventional analgesic modalities. Pulsed radiofrequency ablation (Pulsed RFA) has emerged as a promising intervention for neuropathic pain syndromes, offering long-lasting relief with minimal tissue damage. We present a case of a 36-year-old male with metastatic gastric adenocarcinoma and refractory leg pain due to femoral nerve involvement. Despite aggressive multimodal analgesia, the patient experienced persistent pain, necessitating alternative interventions. Pulsed RFA targeting the right L2-L4 dorsal root ganglia (DRG) provided significant and sustained pain relief, allowing improved functional status and reduced opioid requirements. This case underscores the potential of pulsed RFA as an effective intervention for refractory cancer-related pain, enhancing patients' comfort and quality of life. Further research is warranted to establish its long-term efficacy and safety.
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Ma D, Maimaitimin A, Wang Y. A Novel Ultrasound-Guided "Three in One" Approach Plus Interfascial Plane Blocks for the Treatment of Cervicogenic Headache. Local Reg Anesth 2024; 17:1-8. [PMID: 38323022 PMCID: PMC10843979 DOI: 10.2147/lra.s446667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/16/2024] [Indexed: 02/08/2024] Open
Abstract
Objective Cervicogenic headache (CEH) is a condition resulting from upper cervical spine dysfunction and associated structural and soft tissue abnormalities, significantly impacting patients' quality of life. To acquire better therapeutic results, we presented a novel ultrasound-guided "three in one" approach plus interfascial plane (IFP) blocks for the treatment of CEH. This approach allows for the modulation of C2 dorsal root ganglion (DRG), third occipital nerve (TON), and C3 medial branch with one-point puncture. Additionally, it allows for IFP blocks between the upper neck and occipital muscles within the same scanning plane. Patients and Methods We evaluated patients diagnosed with CEH from July 2021 to December 2022 in our pain clinic. We included those who did not respond to conservative treatment and single occipital nerve block, therefore received nerve block or pulsed radiofrequency (PRF) using the "Three in One" approach plus IFP blocks. The accuracy of the ultrasound-guided C2 DRG puncture procedures was confirmed through fluoroscopy with C-arm and the sensory testing of PRF. The therapeutic effect of these interventions was assessed using the numerical rating scale (NRS) scores during telephone follow-ups at 1, 3, and 6 months. Results Utilizing the "Three in One" approach, a total of 5 patients diagnosed with CEH underwent nerve block plus IFP blocks, while 2 patients underwent PRF plus IFP blocks. Employing ultrasound-guided C2 DRG puncture procedures, the needle tip's correct placement was confirmed through both fluoroscopy and sensory testing of PRF. Notably, none of the cases experienced any complications associated with the approach. Subsequent follow-up assessments revealed an improvement in the NRS scores for CEH in all patients. Conclusion The ultrasound-guided "Three in One" approach plus IFP blocks may be a potential effective method for the treatment of CEH.
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Affiliation(s)
- Danxu Ma
- Department of Anesthesiology and Pain Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Abulaihaiti Maimaitimin
- Department of Rheumatology and Immunology, Moyu Uighur Medicine Hospital, Xinjiang, People’s Republic of China
| | - Yun Wang
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
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Tybout C, Zhou S, Hussain N, Abd-Elsayed A. Radiofrequency ablation for headache. RADIOFREQUENCY ABLATION TECHNIQUES 2024:169-185. [DOI: 10.1016/b978-0-323-87063-4.00024-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Hua L, Sha K, Lu H, Han Y, Ou C, Wang JL, Zhang Y. Clinical Efficacy Evaluation of Ultrasound-Guided C2 Dorsal Root Nerve Pulsed Radiofrequency Combined with Stellate Ganglion Block in the Treatment of Cervicogenic Headache: A Retrospective Cohort Study. J Pain Res 2023; 16:2655-2663. [PMID: 37533562 PMCID: PMC10392809 DOI: 10.2147/jpr.s409226] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023] Open
Abstract
Purpose To explore the therapeutic effect of C2 dorsal root ganglion pulsed radiofrequency (PRF) combined with stellate ganglion block (SGB) in patients with cervicogenic headache (CEH). Patients and Methods We retrospectively reviewed 90 patients diagnosed with CEH who were admitted to our hospital between May 2019 and May 2022. All patients were divided into three groups (n = 30 each) according to the actual treatment method used: ultrasound-guided SGB, ultrasound-guided C2 dorsal root ganglion PRF treatment, and ultrasound-guided C2 dorsal root ganglion PRF combined with SGB treatment. Patients' pain intensity, sleep, and mood changes were assessed by statistically analyzing their pain visual analog scale (VAS), Pittsburgh Sleep Quality Inventory (PSQI), and short-form McGill Pain Questionnaire affective item scores before and after treatment. Results The post-treatment VAS, PSQI, and McGill scores were significantly decreased in all patients (P < 0.05), and all three scores in ultrasound-guided C2 dorsal root ganglion PRF combined with SGB were lower than those in ultrasound-guided SGB alone and ultrasound-guided C2 dorsal root ganglion PRF alone (P < 0.05). Conclusion The use of ultrasound-guided C2 dorsal root ganglion PRF combined with SGB in patients with CHE is effective in alleviating pain and improving sleep, and deserves to be replicated in the clinic.
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Affiliation(s)
- Lu Hua
- Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou Southwest Medical University, Luzhou, Sichuan Province646000People’s Republic of China
| | - Kaiyuan Sha
- Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou Southwest Medical University, Luzhou, Sichuan Province646000People’s Republic of China
| | - HongCheng Lu
- Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou Southwest Medical University, Luzhou, Sichuan Province646000People’s Republic of China
| | - Ying Han
- Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou Southwest Medical University, Luzhou, Sichuan Province646000People’s Republic of China
| | - Cehua Ou
- Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou Southwest Medical University, Luzhou, Sichuan Province646000People’s Republic of China
| | - Jiang-Lin Wang
- Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
| | - Yue Zhang
- Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou Southwest Medical University, Luzhou, Sichuan Province646000People’s Republic of China
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Ekhator C, Urbi A, Nduma BN, Ambe S, Fonkem E. Safety and Efficacy of Radiofrequency Ablation and Epidural Steroid Injection for Management of Cervicogenic Headaches and Neck Pain: Meta-Analysis and Literature Review. Cureus 2023; 15:e34932. [PMID: 36938280 PMCID: PMC10016315 DOI: 10.7759/cureus.34932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Dysfunction of the cervical spine and its anatomical features, mostly innervated by the C1, C2, and C3 spinal nerves, can result in a secondary headache known as cervicogenic headache (CHA), mainly characterized by unilateral pain. The usefulness of pharmaceutical medications and physical therapy is currently the subject of scant literature. Interventional pain management techniques can be applied when conservative treatment is unsuccessful. This study looks at radiofrequency ablation (RFA) and epidural steroid injection (ESI) to identify their safety and efficacy in managing patients with cervicogenic headaches and neck pain. Three databases - PubMed, Cochrane CENTRAL Library, and Embase were searched, and 110 studies were identified. Nine screening processes were included for review and meta-analysis. Statistical evaluation was conducted through STATA version 17 (College Station, TX: StataCorp LLC) and effect measures were reported through random effects model risk ratios. The main subject of focus included three following outcomes: incidences of pain relief, degree and duration of pain, and incidences of adverse effects. The findings showed both interventions relieved pain by a factor of >50%, demonstrating a relative effects risk ratio of 1.45 (-0.50, 3.39) for RFA: pain relief, 84.76 (82.82, 86.69) RFA: adverse effects, and 19.46 (18.80, 20.11) ESI: pain relief at 95% confidence interval. The efficacy of RFA and ESI differ. Both interventions are effective in the reduction of cervicogenic headache pain intensity. However, their complication rates and pain duration are considerably different. With ESI, the headaches can still recur weekly, demanding the use of oral analgesics to deal with them. On the other hand, RFA has a low complication rate. Improving guidance from imaging technologies, RFA has the potential to be the most effective interventional treatment.
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Affiliation(s)
- Chukwuyem Ekhator
- Neuro-Oncology, New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, USA
| | - Alyssa Urbi
- Neuro-Oncology, Brandeis University, Boston, USA
| | - Basil N Nduma
- Internal Medicine, Merit Health Wesley, Hattiesburg, USA
| | - Solomon Ambe
- Neurology, Baylor Scott and White Health, Mckinney, USA
| | - Ekokobe Fonkem
- Neuro-Oncology, Baylor Scott and White Health, Temple, USA
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8
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Hu JQ, Zhang J, Ru B, Cai WJ, Liu WL, Guo R, Ji ZW, Wan Q, Xu LH, Cheng Y, Zhang J, Li S. Computed tomography-guided radiofrequency ablation of cervical intervertebral discs for the treatment of refractory cervicogenic headache: A retrospective chart review. Headache 2022; 62:839-847. [PMID: 35864604 DOI: 10.1111/head.14361] [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: 01/23/2022] [Revised: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the feasibility and efficacy of computed tomography (CT)-guided radiofrequency ablation (RFA) of cervical intervertebral discs for the treatment of discogenic cervicogenic headache (CEH). BACKGROUND Some patients with CEH experience no obvious therapeutic effect after conventional therapy, particularly patients with refractory CEH originating from abnormal cervical intervertebral discs. Treatment for this type of CEH remains poorly characterized. METHODS Using a single intervention arm, pretest/posttest design, we retrospectively analyzed the data of patients who underwent CT-guided RFA of cervical intervertebral discs for CEH at the Pain Medicine Center of Zhejiang Provincial People's Hospital from January 2017 to April 2021. If conservative treatment failed in patients with discogenic CEH, we classified the patients as having refractory CEH and performed RFA of cervical intervertebral discs. We used a numeric rating scale (NRS) to assess pain intensity for 6 months. We also compared therapeutic outcome of patients with different characteristics. RESULTS A total of 44 patients who underwent CT-guided RFA of cervical intervertebral discs were enrolled and 41 of them were analyzed in the present study. The preoperative median (25th, 75th) NRS score was 4 (4, 5), and it was significantly reduced to 1 (0, 4) 6 months after RFA (p < 0.001). The number of patients with ≥50% of their pain relieved after 6 months was 28 of 41 (68%). No serious treatment-related complications occurred in this study. Compared with single-level RFA, multi-level RFA shows greater effects on pain intensity reduction (p = 0.032) and pain relief rate (p = 0.047) of patients. CONCLUSION In patients who have discogenic CEH, CT-guided RFA of the cervical intervertebral discs appears to be a promising treatment with no serious complications.
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Affiliation(s)
- Jia-Qi Hu
- Department of Pain, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Juan Zhang
- Department of Pain, Zhejiang University of Traditional Chinese Medicine First Affiliated Hospital, Zhejiang University of Traditional Chinese Medicine, Hangzhou, China
| | - Bin Ru
- Department of Pain, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Wen-Jun Cai
- Department of Pain, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Wen-Long Liu
- Department of Pain, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Ran Guo
- Department of Pain, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Zhong-Wei Ji
- Department of Pain, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Quan Wan
- Department of Pain, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Lang-Hai Xu
- Department of Pain, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Yan Cheng
- Department of Pain, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Jie Zhang
- Department of Orthopedics, Lu'an Hospital of Chinese Medicine, Anhui College of Traditional Chinese Medicine, Lu'an, China
| | - Shun Li
- Department of Pain, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
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Pastrak M, Visnjevac O, Visnjevac T, Ma F, Abd-Elsayed A. Safety of Conventional and Pulsed Radiofrequency Lesions of the Dorsal Root Entry Zone Complex (DREZC) for Interventional Pain Management: A Systematic Review. Pain Ther 2022; 11:411-445. [PMID: 35434768 PMCID: PMC9098700 DOI: 10.1007/s40122-022-00378-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022] Open
Abstract
Study Design Systematic literature review. Objective The goal of this systematic review is to assess the clinical safety and potential complications of conventional and pulsed radiofrequency ablations targeting dorsal root entry zone complex (DREZC) components in the treatment of chronic pain. Background There is a growing popularity for the use of radiofrequency ablation (RFA) techniques targeting DREZC components by pain management physicians for an increasing variety of indications. To date, we lack a systematic review to describe the safety and the type of complications associated with these procedures. Methods This was a systematic literature review. This systematic search was limited to peer-reviewed literature using “radiofrequency ablation” as a search keyword using PubMed’s database for manuscripts published between inception and December 2020. Abstracts that involved the application of radiofrequency currents, of any modality, to DREZC components for the treatment of pain were included for full-text review. Search was limited to original data describing clinical outcomes following RFA performed for pain indications only, involving the DREZC components outlined above, in human subjects, and written in English. The primary outcomes were complications associated with conventional RFA and pulsed radiofrequency ablation (PRF). Complications were categorized as type 1 (persistent neurological deficits or other serious adverse events, defined as any event that resulted in permanent of prolonged injury; type 2 (transient neuritis or neurological deficits, or other non-neurological non-minor adverse event); type 3 (minor adverse events (e.g., headache, soreness, bruising, etc.). Results Of the 62 selected manuscripts totaling 3157 patients, there were zero serious adverse events or persistent neurological deficits reported. A total of 36 (1.14%) transient neurological deficits, cases of transient neuritis, or non-minor adverse events like uncomplicated pneumothorax were reported. A total of 113 (3.58%) minor adverse events were reported (bruising, transient site soreness, headache). Conclusions This systematic review indicates that the use of RFA lesion of the DREZC for interventional pain management is very safe. There were no serious adverse effects with a sizable sample of randomized controlled trial (RCT), prospective observational, and retrospective studies.
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Affiliation(s)
- Mila Pastrak
- School of Medicine, University College Cork, Cork, Ireland
| | - Ognjen Visnjevac
- Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
- Bloor Pain Specialists, Toronto, ON Canada
- Cleveland Clinic Canada, Toronto, ON Canada
| | - Tanja Visnjevac
- Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
| | - Frederick Ma
- Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
| | - Alaa Abd-Elsayed
- Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
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10
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Chazen JL, Roytman M, Yoon ES, Mullen TK, Lebl DR. CT-Guided C2 Dorsal Root Ganglion Radiofrequency Ablation for the Treatment of Cervicogenic Headache: Case Series and Clinical Outcomes. AJNR Am J Neuroradiol 2022; 43:575-578. [PMID: 35332024 PMCID: PMC8993197 DOI: 10.3174/ajnr.a7471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/14/2022] [Indexed: 11/07/2022]
Abstract
Cervicogenic headache is a secondary headache syndrome attributable to upper cervical spine pathology. Osteoarthritis of the lateral atlantoaxial joint with resultant C2 dorsal root ganglion irritation is an important and potentially treatable cause of cervicogenic headache. In this case series, we present 11 patients with cervicogenic headache who underwent C2 dorsal root ganglion thermal radiofrequency ablation. Radiologists should be familiar with this efficacious procedure and technical considerations to avoid complications.
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Affiliation(s)
- J L Chazen
- From the Departments of Radiology (J.L.C., E.S.Y.)
| | - M Roytman
- Department of Radiology (M.R., T.K.M.), New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - E S Yoon
- From the Departments of Radiology (J.L.C., E.S.Y.)
| | - T K Mullen
- Department of Radiology (M.R., T.K.M.), New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - D R Lebl
- Orthopedics (D.R.L.), Hospital for Special Surgery, New York, New York
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11
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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] [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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Goyal S, Kumar A, Mishra P, Goyal D. Efficacy of interventional treatment strategies in the management of patients with cervicogenic headache- A systematic review. Korean J Anesthesiol 2021; 75:12-24. [PMID: 34592806 PMCID: PMC8831436 DOI: 10.4097/kja.21328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/27/2021] [Indexed: 11/10/2022] Open
Abstract
Cervicogenic headache (CeH) is caused by the disorder of the cervical spine and its anatomical structures. Patients who fail to respond to conservative therapies can undergo interventional treatment. The purpose of this review is to describe the various interventions and compare their relative efficacies. Although a few reviews have been published focusing on individual interventions, reviewing studies on other available treatments and establishing the most efficacious approach is still necessary. We performed a systematic review of studies available on the various interventions for CeH. The PubMed, Embase, and Cochrane databases were searched for literature published between January 2001 and March 2021. Based on the inclusion criteria, 23 articles were included. Two reviewers independently extracted the data from the studies and summarized them in a table. Eleven of twenty-three studies evaluated the effect of radiofrequency ablation (RFA), 5 evaluated occipital nerve blocks, 2 each for facet joint injections and deep cervical plexus blocks, and 1 study each evaluated atlantoaxial (AA) joint injections, cervical epidural injection, and cryoneurolysis. Most of the studies reported pain reduction except 2 studies on RFA. In conclusion, based on the available literature, occipital nerve blocks, cervical facet joint injection, AA joint injection, deep cervical plexus block, cervical epidural injection may be reasonable options in refractory cases of CeH. RFA was found to have favorable long-term outcomes, while better safety has been reported with pulsed therapy. However, our review revealed only limited evidence, and more randomized controlled trials are needed to provide more conclusive evidence.
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Affiliation(s)
- Sonal Goyal
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India 249203
| | - Ajit Kumar
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India 249203
| | - Priyanka Mishra
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India 249203
| | - Divakar Goyal
- Department of Trauma Surgery and Critical Care All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India 249203
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