1
|
Tereshko Y, Belgrado E, Lettieri C, Dal Bello S, Merlino G, Gigli GL, Valente M. Pulsed Radiofrequency for Auriculotemporal Neuralgia: A Case Report. Neurol Int 2024; 16:349-355. [PMID: 38525705 PMCID: PMC10961751 DOI: 10.3390/neurolint16020025] [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: 02/05/2024] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024] Open
Abstract
Auriculotemporal neuralgia is a rare facial pain disorder with no therapeutic evidence for refractory cases. We described a male patient with right auriculotemporal neuralgia, refractory to anesthetic nerve blocks and botulinum toxin type A injections, who was successfully treated with pulsed radiofrequency without adverse events. Pulsed radiofrequency may be an effective and safe treatment for refractory auriculotemporal neuralgia.
Collapse
Affiliation(s)
- Yan Tereshko
- Clinical Neurology Unit, Department of Head-Neck and Neurosciences, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Enrico Belgrado
- Clinical Neurology Unit, Department of Head-Neck and Neurosciences, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Christian Lettieri
- Clinical Neurology Unit, Department of Head-Neck and Neurosciences, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Simone Dal Bello
- Clinical Neurology Unit, Department of Head-Neck and Neurosciences, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Giovanni Merlino
- Clinical Neurology Unit, Department of Head-Neck and Neurosciences, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
- Department of Medicine (DMED), University of Udine, 33100, Udine, Italy
| | - Gian Luigi Gigli
- Department of Medicine (DMED), University of Udine, 33100, Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Department of Head-Neck and Neurosciences, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
- Department of Medicine (DMED), University of Udine, 33100, Udine, Italy
| |
Collapse
|
2
|
Xu X, Chen R, Yu Y, Yang J, Lin C, Liu R. Pulsed radiofrequency on DRG inhibits hippocampal neuroinflammation by regulating spinal GRK2/p38 expression and enhances spinal autophagy to reduce pain and depression in male rats with spared nerve injury. Int Immunopharmacol 2024; 127:111419. [PMID: 38141406 DOI: 10.1016/j.intimp.2023.111419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 12/17/2023] [Accepted: 12/17/2023] [Indexed: 12/25/2023]
Abstract
Evidence indicates that microglial G protein-coupled receptor kinase 2 (GRK2) is a key regulator of the transition from acute to chronic pain mediated by microglial products via the p38 mitogen-activated protein kinase (MAPK) pathway in the spinal cord dorsal horn (SCDH). Increasing studies have shown that autophagic dysfunction in the SCDH and neuroinflammation in the hippocampus underlie NeP. However, whether GRK2/p38MAPK and autophagic flux in the SCDH and hippocampal neuroinflammation are involved in NeP and depression comorbidity has not been determined. Here, we explored the effects of high-voltage pulsed radiofrequency (PRF) (85 V-PRF; HV-PRF) to the dorsal root ganglion (DRG) on pain phenotypes in Wistar male rats with spared nerve injury (SNI) and the underlying mechanisms. The exacerbation of pain phenotypes was markedly relieved by PRF-DRG. The SNI-induced reduction in GRK2 expression, elevation of p-p38 MAPK levels in the SCDH, and increase in IL-1β and TNF-α levels in the hippocampus were reversed by PRF, which was accompanied by an increase in autophagic flux in spinal microglia. The beneficial effect of 85 V-PRF was superior to that of 45 V-PRF. In addition, the improvements elicited by 85 V-PRF were reversed by intrathecal injection of GRK2 antisense oligonucleotide, and these changes were accompanied by GRK2 downregulation and p-p38 upregulation in the SCDH, increased pro-inflammatory factor levels in the hippocampus, and excessive autophagy in spinal microglia. In conclusion, our data indicate that the application of HV-PRF to the DRG could serve as an excellent therapeutic technique for regulating neuroimmunity and neuroinflammation to relieve pain phenotypes.
Collapse
Affiliation(s)
- Xueru Xu
- Department of Pain Management, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou City, Fujian Province, China
| | - Ri Chen
- Department of Pain Management, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou City, Fujian Province, China
| | - Youfen Yu
- Department of Pain Management, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou City, Fujian Province, China
| | - Jing Yang
- Department of Pain Management, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou City, Fujian Province, China
| | - Chun Lin
- Institute of Pain Research, School of Basic Medical Sciences, Fujian Medical University, Fuzhou City, Fujian Province, China
| | - Rongguo Liu
- Department of Pain Management, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou City, Fujian Province, China.
| |
Collapse
|
3
|
Laksono RM, Siswagama TA, Nery FRP, van der Weegen W, Halim W. Pulsed Radiofrequency 2 Hz Preserves the Dorsal Root Ganglion Neuron Physiological Ca 2+ Influx, Cytosolic ATP Level, Δψm, and pERK Compared to 4 Hz: An Insight on the Safety of Pulsed Radiofrequency in Pain Management. J Pain Res 2023; 16:3643-3653. [PMID: 37928061 PMCID: PMC10625322 DOI: 10.2147/jpr.s424489] [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: 07/11/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Background Pulsed radiofrequency (PRF) is beneficial for radicular pain and is commonly administered at pulse frequencies of 2 or 4 Hz. However, its effects on healthy neurons have not yet been widely studied. This study aims to determine the effect of PRF at 2 Hz and 4 Hz on the physiology of healthy dorsal root ganglion (DRG) neurons. Methods An in vitro experimental study was conducted using DRG neuron cultures divided into three groups. Control cells received no treatment, one cell group received 20 ms 2 Hz PRF for 360 s, and one cell group received a 4 Hz PRF 10 ms pulse for 360 s with similar energy. Ca2+ influx, mitochondrial membrane potential (Δψm), cytosolic Adenosine triphosphate (ATP), and phosphorylated extracellular signal-regulated kinase (pERK) levels were measured. The data were analyzed using the One-Way ANOVA variance with α=5%. Results DRG neurons exposed to PRF 2 Hz did not experience a significant change in Ca2+ influx, whereas PRF 4 Hz caused a significant decrease in Ca2+ influx compared to the basal level. PRF at 2 Hz did not cause a change in Δψm, whereas PRF at 4 Hz caused a significant decrease in Δψm (p<0.05). Both 2 and 4 Hz PRF resulted in a significant elevation in cytosolic ATP concentration, but the 2 Hz PRF had a higher cytosolic ATP than the 4 Hz group (p<0.05). Both 2 and 4 Hz did not show a significant difference in pERK intensity with respect to the control (p>0.05), indicating that there was no significant neuron activation. Conclusion Both frequencies did not significantly activate DRG neurons, but with similar energy delivery, PRF 2 Hz preserved the physiological properties of healthy neurons better than PRF 4 Hz did. A 2 Hz PRF is the preferred frequency in clinical applications for neuron-targeted therapy.
Collapse
Affiliation(s)
- Ristiawan Muji Laksono
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Brawijaya University, Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | - Taufiq Agus Siswagama
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Brawijaya University, Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | - Fa’urinda Riam Prabu Nery
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Brawijaya University, Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | | | - Willy Halim
- Medical Department, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| |
Collapse
|
4
|
Liang Y, Zhong S, Wang H, Wu D, Gong Q. Comparisons of the analgesic effect of different pulsed radiofrequency targets in SNI-induced neuropathic pain. Neuroreport 2023; 34:720-727. [PMID: 37577901 DOI: 10.1097/wnr.0000000000001946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
An injury of the peripheral nerve may lead to neuropathic pain, which could be treated with pulsed radiofrequency to the dorsal root ganglion (DRG) or peripheral nerve [the nerve trunk (NT) or proximal to the injury site (NI)]. However, it is not clear whether there is any difference in analgesic effect or maintenance among the three targets. PRF was applied to the ipsilateral L5 DRG, peripheral nerve (NT or NI) 5 days after spared nerve injury (SNI). Triptolide (10 µg/kg) or vehicle was intrathecally administered 5 days after SNI for 3 days. Mechanical withdrawal thresholds were tested after treatment at different time points. Furthermore, microglia and the P2X7 receptor (P2X7R) in the ipsilateral spinal cord were measured with immunofluorescence and western blotting, respectively. PRF + NI exerted a more remarkable analgesic effect than PRF + DRG and PRF + NT at the early stage, but PRF + DRG had a stronger analgesic effect than PRF + NI and PRF + NT at the end of our study. In addition, PRF + DRG showed no significant difference from intrathecal administration of triptolide. Moreover, SNI-induced microglia activation and upregulation of P2X7R in spinal dorsal horn could be markedly inhibited by PRF + DRG. The results suggest that the analgesic effect of PRF + DRG increased with time whereas the other two not and microglia and P2X7R in the ipsilateral spinal dorsal horn may be involved in the process.
Collapse
Affiliation(s)
- Ying Liang
- Department of Pain Medicine, The Second Affiliated Hospital of Guangzhou Medical University
- Department of Anesthesiology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province
| | - Shuotao Zhong
- Department of Pain Medicine, The Second Affiliated Hospital of Guangzhou Medical University
| | - Honghua Wang
- Department of Anesthesiology and Perioperative Medicine, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, China
| | - Danlei Wu
- Department of Pain Medicine, The Second Affiliated Hospital of Guangzhou Medical University
| | - Qingjuan Gong
- Department of Pain Medicine, The Second Affiliated Hospital of Guangzhou Medical University
| |
Collapse
|
5
|
Yang F, Lin L, Xia Y, Wu C. Ultrasound-guided pulsed radiofrequency for neuromyelitis optica spectrum disorder-associated neuropathic pain: A case report. Medicine (Baltimore) 2022; 101:e32417. [PMID: 36595742 PMCID: PMC9794213 DOI: 10.1097/md.0000000000032417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Neuropathic pain (NP) is one of the most prevalent and troublesome symptoms of neuromyelitis optica spectrum disorder (NMOSD), seriously affecting the patient's life. At present, effective treatment for NP induced by NMOSD does not exist. Pulsed radiofrequency (PRF), an emerging microinvasive therapy, alleviates pain and is widely used to treat various types of NP. This is the first report describing a patient with NMOSD-associated NP treated with PRF on the left cervical 6 nerve root. METHODS A 49-year-old female with NMOSD-associated severe NP in the left upper limb and left shoulder tried several medications, but none were effective. She was diagnosed with NP caused by NMOSD.To alleviate severe pain, we performed PRF on the left cervical nerve root under the guidance of ultrasound. This treatment was repeated 3 times. RESULTS The patient's pain was significantly relieved, with a visual analog scale score decreasing from 7-8/10 to 2-3/10, which was maintained during the 3-month follow-up period, without complications. CONCLUSION PRF might be effective for the management of intractable neuropathic pain caused by NMOSD.
Collapse
Affiliation(s)
- Fei Yang
- Department of Pain, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Liheng Lin
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yu Xia
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Changxue Wu
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- * Correspondence: Changxue Wu, Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Luzhou, Sichuan Province 646000, China. (e-mail: )
| |
Collapse
|
6
|
Li A, Huang CJ, Gu KP, Huang Y, Huang YQ, Zhang H, Lin JP, Liu YF, Yang Y, Yao YX. PSD-95 in the anterior cingulate cortex contributes to neuropathic pain by interdependent activation with NR2B. Sci Rep 2022; 12:17114. [PMID: 36224339 PMCID: PMC9556829 DOI: 10.1038/s41598-022-21488-7] [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: 08/28/2021] [Accepted: 09/28/2022] [Indexed: 01/04/2023] Open
Abstract
Studies suggest that the scaffolding protein, postsynaptic density protein-95 (PSD-95), is involved in multiple neurological dysfunctions. However, the role of PSD-95 in the anterior cingulate cortex (ACC) in neuropathic pain (NP) has not been investigated. The current study addressed the role of PSD-95 in the ACC in NP and its modulating profile with NMDA receptor subunit 2B (NR2B). The NP model was established by chronic constriction injury (CCI) of the sciatic nerve, and mechanical and thermal tests were used to evaluate behavioral hyperalgesia. Protein expression and distribution were evaluated using immunohistochemistry and western blotting. The results showed that PSD-95 and NR2B were co-localized in neurons in the ACC. After CCI, both PSD-95 and NR2B were upregulated in the ACC. Inhibiting NR2B with Ro 25-6981 attenuated pain hypersensitivity and decreased the over-expression of PSD-95 induced by CCI. Furthermore, intra-ACC administration of PSD-95 antisense oligonucleotide not only attenuated pain hypersensitivity but also downregulated the NR2B level and the phosphorylation of cyclic AMP response element-binding protein. These results demonstrated that PSD-95 in the ACC contributes to NP by interdependent activation of NR2B.
Collapse
Affiliation(s)
- Ang Li
- grid.13402.340000 0004 1759 700XDepartment of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003 China
| | - Chang-Jun Huang
- grid.13402.340000 0004 1759 700XDepartment of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003 China ,Department of Anesthesia, First People’s Hospital of Linping District, Hangzhou, China
| | - Kai-Peng Gu
- grid.13402.340000 0004 1759 700XDepartment of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003 China
| | - Yan Huang
- grid.13402.340000 0004 1759 700XDepartment of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003 China
| | - Ya-Qin Huang
- grid.13402.340000 0004 1759 700XDepartment of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003 China
| | - Hui Zhang
- grid.13402.340000 0004 1759 700XDepartment of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003 China
| | - Jia-Piao Lin
- grid.13402.340000 0004 1759 700XDepartment of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003 China
| | - Yu-Fan Liu
- grid.13402.340000 0004 1759 700XDepartment of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003 China
| | - Yan Yang
- grid.13402.340000 0004 1759 700XDepartment of Neurobiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yong-Xing Yao
- grid.13402.340000 0004 1759 700XDepartment of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003 China
| |
Collapse
|
7
|
Park D, Chang MC. The mechanism of action of pulsed radiofrequency in reducing pain: a narrative review. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2022; 39:200-205. [PMID: 35385898 PMCID: PMC9273139 DOI: 10.12701/jyms.2022.00101] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/14/2022] [Indexed: 12/17/2022]
Abstract
Pain from nervous or musculoskeletal disorders is one of the most common complaints in clinical practice. Corticosteroids have a high pain-reducing effect, and their injection is generally used to control various types of pain. However, they have various adverse effects including flushing, hyperglycemia, allergic reactions, menstrual changes, immunosuppression, and adrenal suppression. Pulsed radiofrequency (PRF) is known to have a pain-reducing effect similar to that of corticosteroid injection, with nearly no major side effects. Therefore, it has been widely used to treat various types of pain, such as neuropathic, joint, discogenic, and muscle pain. In the current review, we outlined the pain-reducing mechanisms of PRF by reviewing previous studies. When PRF was first introduced, it was supposed to reduce pain by long-term depression of pain signaling from the peripheral nerve to the central nervous system. In addition, deactivation of microglia at the level of the spinal dorsal horn, reduction of proinflammatory cytokines, increased endogenous opioid precursor messenger ribonucleic acid, enhancement of noradrenergic and serotonergic descending pain inhibitory pathways, suppression of excitation of C-afferent fibers, and microscopic damage of nociceptive C- and A-delta fibers have been found to contribute to pain reduction after PRF application. However, the pain-reducing mechanism of PRF has not been clearly and definitely elucidated. Further studies are warranted to clarify the pain-reducing mechanism of PRF.
Collapse
Affiliation(s)
- Donghwi Park
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
- Corresponding Author: Min Cheol Chang, MD Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea Tel: +82-53-620-4682 • Fax: +0504-231-8694 • E-mail:
| |
Collapse
|
8
|
Sam J, Pastrak M, Duda L, Vladicic N, Vrooman B, Ma F, Khandwalla F, Abd-ElSayed A, Catapano M, McGilvray S, Khan JS, Visnjevac O. Clinical Radiofrequency Ablation Outcomes of Combined Sensory Nerve Branch and Dorsal Entry Root Zone Complex Lesions for Sacroiliac Joint Complex Pain. Adv Ther 2022; 39:3539-3546. [PMID: 35678997 DOI: 10.1007/s12325-022-02183-5] [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: 02/20/2022] [Accepted: 05/06/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Chronic lower back pain (LBP) with or without leg pain (LP) is the most commonly reported anatomical site of pain among Canadian adults with chronic pain. A common cause for LBP and LP arises from dysfunction of the sacroiliac joint (SIJ) complex. When conventional medical management or rehabilitative efforts for SIJ-related LBP and LP fail to provide analgesia, pulsed radiofrequency (PRF) and/or radiofrequency ablation (RFA) of the dorsal entry root zone complex lesions (DREZC) and/or their more peripheral branches can also be a suitable means for treatment. Both PRF and RFA are interventional techniques that utilize heat to attenuate or ablate transmission of painful signals, respectively. The purpose of this chart review is to explore the clinical outcomes of patients experiencing SIJ-related pain who have undergone procedures with combined sensory nerve branch RFA and DREZC PRF lesions targeting the SIJ complex. METHODS Following institutional review board approval, a retrospective chart review was performed from June 2018 to February 2021 for patients with LBP and/or LP refractory to physical rehabilitative efforts and medical management that underwent combined PRF and RF treatments for a diagnosis of SIJ complex pain. RF and PRF procedures were anatomically guided with the addition of sensory stimulation to ensure appropriate needle placement. Charts were reviewed for percentage of analgesia at final follow-up, duration of effect, degree of analgesia, patients' functional improvements, and changes in medication use patterns. RESULTS Data was reviewed from 180 patients with LBP or LP who underwent combined PRF and RF treatments for a diagnosis of SIJ complex pain. The group consisted of 69 men and 111 women with a mean age of 59 years. All patients had lesions to their dorsal roots and/or branches (lumbar medial and sacral lateral), as determined using their pain profile as well as sensory stimulation. In the sample of 180 patients a total of 276 SIJs were treated over the period of data collection. Overall, 85.0% (n = 234) of procedures were considered successful with more than 50% analgesic relief at final follow-up. Of 234 successful outcomes, 110 reported ongoing analgesia (mean = 80.3% pain relief, SD ± 18.0) on the last date of follow up (mean = 53.2 days, SD ± 41.8) prior to being lost to follow-up. For patients not lost to follow-up, the mean amount of analgesia was reported to be 83.9% with an average duration of 86.3 days. Among all treatments, 6.9% (n = 19) provided no analgesic effect. Among the successful procedure outcomes, 54.4% (n = 150) reported increased activity/mobility, 24.3% (n = 67) reported improved sleep, 49.3% (n = 136) reported improved mood, and 11.6% (n = 32) reported decreased medication usage. Nine patients reported complications following the procedure. Complications included transient soreness, bruising, tenderness, myofascial pain, and two mild vagal responses without lasting sequelae. CONCLUSION This review suggests that combined sensory nerve branch RFA and DREZC PRF lesions targeting the SIJ complex is a suitable intervention to treat SIJ-related LBP and/or LP refractory to physical rehabilitative efforts and medical management. Approximately 85% of these cases were successfully treated with the majority of patients report lasting analgesic effects with minimal complications, supporting the use of sensory stimulation-guided combined RF and PRF lesions for treatment of refractory SIJ complex pain.
Collapse
Affiliation(s)
- Jordan Sam
- Pinnacle Health Sciences Centre Scarborough, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | | | | | - Nikola Vladicic
- St. George's University School of Medicine, True Blue, Grenada
| | - Bruce Vrooman
- Dartmouth Hitchcock Medical Centre, Lebanon, NH, USA
| | | | | | - Alaa Abd-ElSayed
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
| | - Michael Catapano
- Bloor Pain Specialists, Toronto, ON, Canada.,Physical Medicine and Rehabilitation, Massachusetts General Hospital and Spaulding Rehabilitation Hospital, Harvard University, Boston, MA, USA
| | | | | | - Ognjen Visnjevac
- Pinnacle Health Sciences Centre Scarborough, Toronto, ON, Canada.,McMaster University, Hamilton, ON, Canada.,Bloor Pain Specialists, Toronto, ON, Canada.,Cleveland Clinic Canada, Toronto, ON, Canada
| |
Collapse
|
9
|
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.
Collapse
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.
| |
Collapse
|
10
|
Li B, Huang Y, Zhang Y, Das SK, Zhang C, Li Y, Xu X, Yang H, Du Y. Utilizing pre-operative MR imaging and adapting optimal needle puncture approach to improve radiofrequency ablation fraction of thoracic dorsal root ganglia. Sci Rep 2021; 11:18589. [PMID: 34545137 PMCID: PMC8452772 DOI: 10.1038/s41598-021-98050-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/02/2021] [Indexed: 11/09/2022] Open
Abstract
This experimental study evaluates the location of thoracic dorsal root ganglions (DRGs) through magnetic resonance imaging (MRI) scans, and evaluates the radiofrequency ablation (RFA) fraction of different puncture approaches on distinct DRG locations. Eight normal adult corpse specimens were used as thoracic spine specimens. An MRI examination was performed on each specimen using the following MRI sequences: STIR T2WI, fs-FRFSE T2WI, and 3D FIESTA-c. Then thoracic spine specimens (n = 14) were divided into three groups for RFA: Group A, using a transforaminal approach irrespective of DRG location; Group B, using a transforaminal, trans-lateral-zygapophysial or translaminar approach according to the DRG location; and Group C using a combination of puncture approaches. The quality of visualization of thoracic DRGs on STIR T2WI, fs-FRFSE T2WI, and 3D FIESTA-c scans were 53.5% (77/144), 88.2% (127/144), and 93.1% (134/144), respectively. In group A, the RFA fractions of the extraforaminal DRGs (N = 29), intraforaminal DRGs (N = 12) and intraspinal DRGs (N = 7) via a transforaminal approach were 72.6 ± 18.9%, 54.2 ± 24.8% and 32.9 ± 28.1% respectively. In group B, RFA of extraforaminal DRGs via a transforaminal approach (N = 43) or a trans-lateral zygapophysial approach (N = 45) led to ablation fractions of 71.9 ± 15.2% and 72.0 ± 17.9%, respectively; RFA of intraforaminal DRGs via a transforaminal approach (N = 14) or a translaminar approach (N = 16) led to ablation fractions of 57.1 ± 18.0% and 52.5 ± 20.6%, respectively; RFA of intraspinal DRGs via a transforaminal approach (N = 12) or a translaminar approach (N = 14) led to ablation fractions of 34.8 ± 24.6% and 71.8 ± 16.0%, respectively. In group C, the combined approach led to an ablation fraction for extraforaminal DRGs (N = 69) of 82.5 ± 14.1%, for intraforaminal DRGs (N = 39) of 81.5 ± 11.8%, and for intraspinal DRGs (N = 36) of 80.8 ± 13.3%. MRI can accurately assess DRG location before RFA. Adopting different and combined puncturing approaches tailored to different DRG locations can significantly increase the DRG RFA fraction.
Collapse
Affiliation(s)
- Bing Li
- The First Affiliated Hospital, Jinan University, Guangzhou, 510630, People's Republic of China.,Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong, 637000, Sichuan, People's Republic of China
| | - Yayong Huang
- Department of Radiology, Xuzhou City Center Hospital, 199 South Jiefang Road, Xuzhou, 221009, Jiangsu, People's Republic of China
| | - Yong Zhang
- Department of Radiology, People's Hospital of Deyang City, 173 North Taishan Road, Deyang, 618000, Sichuan, People's Republic of China
| | - Sushant Kumar Das
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong, 637000, Sichuan, People's Republic of China
| | - Chuan Zhang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong, 637000, Sichuan, People's Republic of China
| | - Yang Li
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong, 637000, Sichuan, People's Republic of China
| | - Xiaoxue Xu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong, 637000, Sichuan, People's Republic of China
| | - Hanfeng Yang
- The First Affiliated Hospital, Jinan University, Guangzhou, 510630, People's Republic of China. .,Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong, 637000, Sichuan, People's Republic of China.
| | - Yong Du
- The First Affiliated Hospital, Jinan University, Guangzhou, 510630, People's Republic of China. .,Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong, 637000, Sichuan, People's Republic of China.
| |
Collapse
|
11
|
Dai Z, Xu X, Chen Y, Lin C, Lin F, Liu R. Effects of High-Voltage Pulsed Radiofrequency on the Ultrastructure and Nav1.7 Level of the Dorsal Root Ganglion in Rats With Spared Nerve Injury. Neuromodulation 2021; 25:980-988. [PMID: 34487572 DOI: 10.1111/ner.13527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/18/2021] [Accepted: 08/03/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the analgesic effect of high-voltage pulsed radiofrequency (HV-PRF) on the dorsal root ganglion (DRG) for neuropathic pain induced by spared nerve injury (SNI) in rats, especially the influence of this treatment on the DRG ultrastructure and voltage-gated sodium channel 1.7 (Nav1.7) level in the DRG. MATERIALS AND METHODS One hundred fifty adult male Sprague-Dawley rats were randomly divided into five groups: Sham, SNI, Free-PRF, standard-voltage PRF (SV-PRF), and HV-PRF. The 45V-PRF and 85V-PRF procedures applied to the left L5 DRG were performed in SV-PRF group and the HV-PRF group respectively on day 7 after SNI, whereas no PRF was concurrently delivered in Free-PRF group. The paw mechanical withdrawal threshold (PMWT) was detected before SNI (baseline) and on days 1, 3, 7, 8, 10, 14, and 21. The changes of left L5 DRG ultrastructure were analyzed with transmission electron microscopy on days 14 and 21. The expression levels of Nav1.7 in left L5 DRG were detected by immunofluorescence and Western blot. RESULTS Compared with the Free-PRF group, PMWT in the SV-PRF group and HV-PRF group were both significantly increased after PRF (all p < 0.05). Meanwhile, the PMWT was significantly higher in the HV-PRF group than that in the SV-PRF group on days 14 and 21 all (p < 0.05). There were statistically significant differences between the SV-PRF and Free-PRF groups (p < 0.05). Similarly, statistically significant difference was found between the HV-PRF and Free-PRF groups (p < 0.05). Especially, comparison of the SV-PRF group and the HV-PRF group revealed statistically significant difference (p < 0.05). The Nav1.7 levels were significantly down-regulated in the SV-PRF group and HV-PRF groups compared to that in the Free-PRF group (all p < 0.01). A significantly lower Nav1.7 level was also found in the HV-PRF group compared to that in the SV-PRF group (p < 0.05). CONCLUSIONS The HV-PRF produces a better analgesic effect than SV-PRF applied to the DRG in SNI rats. The underlying mechanisms may be associated with improving the histopathological prognosis and the downregulation of Nav1.7 levels in the DRG.
Collapse
Affiliation(s)
- Zhisen Dai
- Department of Pain Management, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Xueru Xu
- Department of Pain Management, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yanqin Chen
- Department of Pain Management, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Chun Lin
- Laboratory of Pain Research, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Fan Lin
- Fujian Key Laboratory of Geriatrics, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Rongguo Liu
- Department of Pain Management, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| |
Collapse
|
12
|
Yang S, Boudier-Revéret M, Chang MC. Use of Pulsed Radiofrequency for the Treatment of Discogenic Back Pain: A Narrative Review. Pain Pract 2020; 21:594-601. [PMID: 33296544 DOI: 10.1111/papr.12978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/17/2020] [Accepted: 11/23/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Low-back pain (LBP) is one of the most frequently reported symptoms of patients who visit pain clinics, and a significant proportion of them have discogenic pain. Pulsed radiofrequency (PRF) stimulation is an effective treatment for various types of pain. PURPOSE We reviewed articles which investigated the effectiveness of intradiscal PRF for controlling discogenic LBP. METHODS AND MATERIALS We searched PubMed for papers published prior to August 7, 2020, in which intradiscal PRF was used for treating discogenic LBP. The key search phrase was (intradiscal PRF) for identifying potentially relevant articles. We included articles in which intradiscal PRF was used for controlling LBP. Review articles were excluded. RESULTS Nine publications were included in this review. Except for one study, all other studies showed positive therapeutic outcomes after treating discogenic LBP using intradiscal PRF. However, the quality of these studies was not high. CONCLUSIONS This review showed that intradiscal PRF appears to be a helpful treatment method for patients with discogenic LBP. Our review provides insights into the degree of evidence of the therapeutic effects of intradiscal PRF for alleviating discogenic LBP. For confirmation of the effectiveness of intradiscal PRF on discogenic LBP, more high-quality studies are necessary.
Collapse
Affiliation(s)
- Seoyon Yang
- Department of Rehabilitation Medicine, Ewha Woman's University Seoul Hospital, Ewha Woman's University School of Medicine, Seoul, Korea
| | - Mathieu Boudier-Revéret
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| |
Collapse
|
13
|
Zhu J, Fei Y, Deng J, Huang B, Yao M. Application and Therapeutic Effect of Puncturing of the Costal Transverse Process for Pulsed Radiofrequency Treated T1-T3 Herpes Zoster Neuralgia. J Pain Res 2020; 13:2519-2527. [PMID: 33116793 PMCID: PMC7548316 DOI: 10.2147/jpr.s266481] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/19/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose In CT-guided dorsal root ganglion puncture, especially T1–T3, it is often difficult to reach the target due to obstruction of the lamina, transverse process, and ribs. Therefore, a safe and effective puncture method with high success rate is urgently needed to guide us in our clinical work. Patients and Methods A total of 44 patients with dorsal root ganglion underwent pulsed radiofrequency therapy for pain T1–T3 herpes zoster neuralgia at the pain department of Affiliated Hospital of Jiaxing University from January 2019 to February 2020 were retrospectively reviewed. Each patient underwent the same surgical method. The patient’s operation time, CT filming times, nerve electrophysiological tests, the NRS scores before and after operation at one, four, eight, and 12 weeks, Pittsburgh Sleep Disorder Index (PSQI), dosage of gabapentin capsules and tramadol hydrochloride sustained-release tablets, surgical complications and incidence of postherpetic neuralgia (PHN) were recorded. Results The success rate of 44 patients who underwent puncturing of the costal transverse process to T1 target was 88.46%, to T2 target was 90.68%, and to T3 target was 90.68%, respectively. The NRS score of patients before surgery was 5.48±0.59, and those at one, four, eight, and 12 weeks after surgery were 3 (3,3), 1 (1,2), 0 (0, 1), and 0 (0, 0). The difference of NRS score between preoperation and postoperation is statistically significant. No intraoperative and postoperative complications occurred. Two patients developed PHN after standard treatment, and the incidence of it was 4.55%. Conclusion CT-guided puncturing of the costal transverse process in the dorsal root ganglion of patients who underwent pulsed radiofrequency treatment of T1–T3 herpes zoster neuralgia showed a high success rate and is considered to be safe and effective.
Collapse
Affiliation(s)
- Jianjun Zhu
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China.,Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China
| | - Yong Fei
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China
| | - Jiajia Deng
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China
| | - Bin Huang
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China
| | - Ming Yao
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China
| |
Collapse
|
14
|
Ding Y, Li H, Hong T, Yao P. Efficacy of Pulsed Radiofrequency to Cervical Nerve Root for Postherpetic Neuralgia in Upper Extremity. Front Neurosci 2020; 14:377. [PMID: 32372914 PMCID: PMC7186594 DOI: 10.3389/fnins.2020.00377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/27/2020] [Indexed: 11/23/2022] Open
Abstract
Background Postherpetic neuralgia (PHN) seriously affects a patient’s quality of life, and it is urgent to find a method that can effectively alleviate the PHN of the upper extremity. Objective To observe the Efficacy of pulsed radiofrequency (PRF) to cervical nerve root for PHN in upper extremity under CT guidance. Study Design Retrospective comparative study. Setting Shengjing Hospital of China Medical University. Methods Fifty patients with PHN in upper extremity were enrolled in Pain Management. Patients were randomized into two groups: cervical nerve root block (A group, n = 25) and cervical nerve root PRF (B group, n = 25). At each observation time, the general characteristics, visual analog scale (VAS), quality of life scores assessment (SF-36), the total efficacy rate, dosage of antiepileptic and narcotic analgesics, and the incidence of complications were followed up. Results Compared with the preoperative, the postoperative VAS decreased, the physical component summary (PCS) and the mental component summary (MCS) increased in both groups (P < 0.05). The differences between group B and group A were statistically significant after 1 month, which could be maintained for 1 year (P < 0.05). The total efficacy rate of group A and group B was 52.0% and 80.0% at 1 Year, respectively. The total efficacy rate of group B was higher than that of group A (P < 0.05). The dosage of antiepileptic and narcotic analgesics in group B decreased significantly, and the decline was significant compared with group A (P < 0.05). The incidence of complications between the two groups were similar (P > 0.05). Conclusion CT-guided PRF to cervical nerve root for the treatment of PHN in the upper extremity is safe and effective. PRF can replicate the location of pain, precise positioning, reduce trauma, and increased pain relief rate.
Collapse
Affiliation(s)
- Yuanyuan Ding
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hongxi Li
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tao Hong
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Peng Yao
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|