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Abstract
PURPOSE OF REVIEW Chronic pain of the lower extremity remains challenging to manage. Radiofrequency ablation procedure applies heat to nerve fibers with the goal of mitigating chronic pain conditions of the knee. However, the clinical efficacy has not yet been adequately established. The goal of this review paper is to report the use of radiofrequency ablations in the treatment of osteoarthritis of the knee. RECENT FINDINGS PubMed and the Cochrane Controlled Trials Register were searched (final search 28 February 2018) using the MeSH terms "radiofrequency ablation," "neurolysis," "radiofrequency therapy," "pain syndrome," "analgesia," and "pain" in the English literature. Bibliographies of the published papers were screened for relevance to lower extremity radiofrequency ablation therapies. The quality of selected publications was assessed using the Cochrane risk of bias instrument. Of the 923 papers screened, 317 were further investigated for relevance. Our final search methodology yielded 19 studies that investigated the use of radiofrequency ablation at the knee. Of these 19 studies, there were four randomized control trials, two non-randomized control trials, three prospective studies, two retrospective studies, one case-control study, one technical report, and seven case reports. In summary, the data available suggests radiofrequency ablation as a promising and efficacious with all 19 studies revealing significant short- and long-term pain reductions in patients with knee pain.
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A Systematic Review of Radiofrequency Treatment of the Ankle for the Management of Chronic Foot and Ankle Pain. Curr Pain Headache Rep 2019; 23:4. [PMID: 30661127 DOI: 10.1007/s11916-019-0745-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic pain of the lower extremity remains challenging to manage. Radiofrequency treatment applies heat to nerve fibers with the goal of mitigating chronic pain conditions. The clinical efficacy has not yet been adequately established for pathologies of the ankle and foot. In this review paper, we report the use and efficacy of radiofrequency treatment applied to foot and ankle pain. RECENT FINDINGS PubMed and the Cochrane Controlled Trials Register were searched (final search 30 March 2018) using the MeSH terms "radiofrequency ablation," "neurolysis," "radiofrequency therapy," "pain syndrome," "analgesia," "plantar heel pain," "plantar fascitis," and "chronic pain" in the English literature. Of the 23 papers screened, 18 were further investigated for relevance. Our final search methodology yielded 15 studies that investigated the use of radiofrequency treatment at the ankle. Of these 15 studies, there were three randomized control trials, four prospective studies, three retrospective studies, and five case reports. The quality of selected publications was assessed using the Cochrane risk of bias instrument. The evidence from our studies suggests that radiofrequency treatment can be used safely for the management foot and ankle pain. The technique (continuous vs pulsatile), temperature, location of treatment, and duration of administration need more thorough evaluation. Randomized control trials are needed to establish the efficacy and safety profile of radiofrequency ablation and its long-term benefits in patients with chronic pain of the foot and ankle. CONCLUSION The evidence from our studies suggests that radiofrequency treatment can be used safely for the management foot and ankle pain. The technique (continuous vs pulsatile), temperature, location of treatment, and duration of administration need more thorough evaluation. Randomized control trials are needed to establish the efficacy and safety profile of radiofrequency ablation and its long-term benefits in patients with chronic pain of the foot and ankle.
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Zhu Q, Wang S, Chen R, Cai X, Jiang C, Zhong B, Sun T. Continuous radiofrequency thermocoagulation under CT-guidance for glossopharyngeal neuralgia: Two case reports. Medicine (Baltimore) 2018; 97:e11079. [PMID: 29901619 PMCID: PMC6023660 DOI: 10.1097/md.0000000000011079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Glosssopharyngeal neuralgia (GPN) is a painful syndrome characterized by paroxysmal neuropathic pain in the pharynx, tonsil, posterior base of tongue, inner ear, and mandibular angle. The traditional therapies of GPN, including medication and surgical operation, are not always effective in pain controlling. Radiofrequency therapy is a minimally interventional technique to provide analgesia in chronic pain. PATIENT CONCERNS Two patients who were refractory to medical treatment were hospitalized for primary GPN. DIAGNOSES Two patients were diagnosed by symptoms, physical signs and imaging examination. INTERVENTIONS The first patient underwent pulsed radiofrequency of the glossopharyngeal nerve under CT-guidance as a preferred method. The pulsed radiofrequency (PRF) was performed at 42°C for 10 minutes with a pulsed frequency of 2 Hz and a pulse width 20 ms. There is no symptom improvement after PRF procedure. Three days later, continuous radiofrequency (CRF) thermocoagulation was performed. The pain disappeared after CRF within 36 months followed-up. CRF thermocoagulation under CT-guidance was accepted by the second patient as the first choice. OUTCOMES An overall reduction of pain was reported after the procedure and telephone consult for 24-months follow-up confirmed the persistence of the pain relief. LESSONS The CRF thermocoagulation produced no complications or side effects in the two cases, and was proved effective in the treatment of GPN.
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Affiliation(s)
- Qing Zhu
- Department of Pain Management, The Affiliated Ganzhou Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Shulan Wang
- Department of Pain Management, Orthopaedic Hospital of Gao’an City, Jiang Xi Province, Gao An, Jiangxi, China
| | - Rui Chen
- Department of Pain Management, The Affiliated Ganzhou Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xianbin Cai
- Department of Pain Management, The Affiliated Ganzhou Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Cuihua Jiang
- Department of Pain Management, The Affiliated Ganzhou Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Baolin Zhong
- Department of Pain Management, The Affiliated Ganzhou Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Tao Sun
- Department of Pain Management, Orthopaedic Hospital of Gao’an City, Jiang Xi Province, Gao An, Jiangxi, China
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Thapa D, Ahuja V, Verma P, Das C. Successful management of a refractory case of postoperative herniorrhaphy pain with extended duration pulsed radiofrequency. Saudi J Anaesth 2016; 10:107-9. [PMID: 26955321 PMCID: PMC4760029 DOI: 10.4103/1658-354x.169488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chronic postsurgical pain (CPSP) is a distressful condition following hernia surgery. A 25-year-old, 55 kg male patient presented with severe pain on the right side of the lower abdomen that radiated to the testicle and the inner side of the thigh. Patient was symptomatic since 5 months following inguinal herniorrhaphy surgery. The pain was not relieved with pharmacological and interventional nerve blocks. An ultrasound-guided ilioinguinal-iliohypogastric (II-IH) block with extended duration (42°C, four cycles of 120 s each) pulsed radiofrequency (PRF) and a diagnostic genital branch of genitofemoral nerve (GGFN) block provided pain relief. After 1-month, an extended duration PRF in GGFN resulted in complete resolution of symptoms. During a regular follow-up of 9 months, patient reported an improved quality-of-life. We believe the successful management of CPSP following hernia repair with single extended duration PRF of II-IH and GGFN has not been described in the literature.
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Affiliation(s)
- D Thapa
- Department of Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - V Ahuja
- Department of Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - P Verma
- Department of Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - C Das
- Department of Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
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Thapa D, Ahuja V, Verma P, Dass C. Extra articular management of knee osteoarthritis pain. PAIN MEDICINE 2015; 16:1846-7. [DOI: 10.1111/pme.12762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Halim W, Wullems JA, Lim T, Aukes HA, van der Weegen W, Vissers KC, Gültuna I, Chua NHL. The Long-term Efficacy and Safety of Percutaneous Cervical Nucleoplasty in Patients with a Contained Herniated Disk. Pain Pract 2012; 13:364-71. [DOI: 10.1111/papr.12003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 09/04/2012] [Indexed: 01/22/2023]
Affiliation(s)
- Willy Halim
- Department of Anesthesia and Pain Management; St. Anna Hospital; Geldrop; The Netherlands
| | - Jorgen A. Wullems
- Department of Orthopedic Surgery; St. Anna Hospital; Geldrop; The Netherlands
| | - Toine Lim
- Department of Anesthesia and Pain Management; St. Anna Hospital; Geldrop; The Netherlands
| | - Hans A. Aukes
- Department of Anesthesia and Pain Management; Albert Schweitzer Hospital; Sliedrecht; The Netherlands
| | | | - Kris C. Vissers
- Department of Anesthesiology, Pain Therapy and Palliative Care; UMC St. Radboud; Nijmegen; The Netherlands
| | - Ismail Gültuna
- Department of Anesthesia and Pain Management; Albert Schweitzer Hospital; Sliedrecht; The Netherlands
| | - Nicholas H. L. Chua
- Department of Anesthesia, Surgical Intensive Care and Pain Management; Tan Tock Seng Hospital; Singapore; Singapore
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Shanthanna H, Chan P, McChesney J, Paul J, Thabane L. Assessing the effectiveness of 'pulse radiofrequency treatment of dorsal root ganglion' in patients with chronic lumbar radicular pain: study protocol for a randomized control trial. Trials 2012; 13:52. [PMID: 22540851 PMCID: PMC3404908 DOI: 10.1186/1745-6215-13-52] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 04/28/2012] [Indexed: 11/17/2022] Open
Abstract
Background Chronic lumbar radicular pain can be described as neuropathic pain along the distribution of a particular nerve root. The dorsal root ganglion has been implicated in its pathogenesis by giving rise to abnormal impulse generation as a result of irritation, direct compression and sensitization. Chronic lumbar radicular pain is commonly treated with medications, physiotherapy and epidural steroid injections. Epidural steroid injections are associated with several common and rarer side effects such as spinal cord infarction and death. It is essential and advantageous to look for alternate interventions which could be effective with fewer side effects. Pulse radio frequency is a relatively new technique and is less destructive then conventional radiofrequency. Safety and effectiveness of pulse radio frequency in neuropathic pain has been demonstrated in animal and humans studies. Although its effects on dorsal root ganglion have been studied in animals there is only one randomized control trial in literature demonstrating its effectiveness in cervical radicular pain and none in lumbar radicular pain. Our primary objective is to study the feasibility of a larger trial in terms of recruitment and methodology. Secondary objectives are to compare the treatment effects and side effects. Methods/designs This is a single-center, parallel, placebo-controlled, triple-blinded (patients, care-givers, and outcome assessors), randomized control trial. Participants will have a history of chronic lumbar radicular pain for at least 4 months in duration. Once randomized, all patients will have an intervention involving fluoroscopy guided needle placement to appropriate dorsal root ganglion. After test stimulation in both groups; the study group will have a pulse radio frequency treatment at 42°C for 120 s to the dorsal root ganglion, with the control group having only low intensity test stimulation for the same duration. Primary outcome is to recruit at least four patients every month with 80% of eligible patients being recruited. Secondary outcomes would be to assess success of intervention through change in the visual analogue scale measured at 4 weeks post intervention and side effects. Allocation to each group will be a 1:1 ratio with allocation block sizes of 2, 4, and 6. Trial registration ClinicalTrials.gov NCT01117870
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Affiliation(s)
- Harsha Shanthanna
- Department of Anesthesia and Pain Medicine (D-149), St Joseph's Hospital, 50 Charlton Avenue East Hamilton, Ontario, L8N 4A6, Canada.
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Imani F. Using pulsed radiofrequency for chronic pain. Anesth Pain Med 2012; 1:155-6. [PMID: 24904784 PMCID: PMC4018683 DOI: 10.5812/kowsar.22287523.4047] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 12/28/2011] [Accepted: 12/30/2011] [Indexed: 11/29/2022] Open
Affiliation(s)
- Farnad Imani
- Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Corresponding author: Farnad Imani, Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center, Niyayesh St., Sattar Khaan Av., P O. Box: 1445613131, Tehran, Iran. Tel: +98-2166509059, Fax: +98-2166515758, E-mail:
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Pulsed Radiofrequency in the Treatment of Persistent Pain After Inguinal Herniotomy. Reg Anesth Pain Med 2012; 37:340-3. [DOI: 10.1097/aap.0b013e31824bea4e] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Water-cooled radiofrequency: a neuroablative or a neuromodulatory modality with broader applications? Case Rep Anesthesiol 2011; 2011:263101. [PMID: 22606384 PMCID: PMC3350264 DOI: 10.1155/2011/263101] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 12/04/2011] [Indexed: 11/18/2022] Open
Abstract
We report the successful use of water-cooled radiofrequency where more traditional forms of neuroablation—conventional and pulsed radiofrequency—had failed to achieve adequate pain relief. We also discuss the mechanism of neural damage with water cooled radiofrequency and discuss why this technique may have a broader role in the management of a wide array of pain syndromes.
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Chua NHL, Vissers KC, Sluijter ME. Pulsed radiofrequency treatment in interventional pain management: mechanisms and potential indications-a review. Acta Neurochir (Wien) 2011; 153:763-71. [PMID: 21116663 PMCID: PMC3059755 DOI: 10.1007/s00701-010-0881-5] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 11/12/2010] [Indexed: 12/27/2022]
Abstract
Background The objective of this review is to evaluate the efficacy of Pulsed Radiofrequency (PRF) treatment in chronic pain management in randomized clinical trials (RCTs) and well-designed observational studies. The physics, mechanisms of action, and biological effects are discussed to provide the scientific basis for this promising modality. Methods We systematically searched for clinical studies on PRF. We searched the MEDLINE (PubMed) and EMBASE database, using the free text terms: pulsed radiofrequency, radio frequency, radiation, isothermal radiofrequency, and combination of these. We classified the information in two tables, one focusing only on RCTs, and another, containing prospective studies. Date of last electronic search was 30 May 2010. The methodological quality of the presented reports was scored using the original criteria proposed by Jadad et al. Findings We found six RCTs that evaluated the efficacy of PRF, one against corticosteroid injection, one against sham intervention, and the rest against conventional RF thermocoagulation. Two trials were conducted in patients with lower back pain due to lumbar zygapophyseal joint pain, one in cervical radicular pain, one in lumbosacral radicular pain, one in trigeminal neuralgia, and another in chronic shoulder pain. Conclusion From the available evidence, the use of PRF to the dorsal root ganglion in cervical radicular pain is compelling. With regards to its lumbosacral counterpart, the use of PRF cannot be similarly advocated in view of the methodological quality of the included study. PRF application to the supracapular nerve was found to be as efficacious as intra-articular corticosteroid in patients with chronic shoulder pain. The use of PRF in lumbar facet arthropathy and trigeminal neuralgia was found to be less effective than conventional RF thermocoagulation techniques.
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Affiliation(s)
- Nicholas H L Chua
- Department of Anaesthesiology, Tan Tock Seng Hospital, Singapore, Singapore.
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Mechanisms of analgesic action of pulsed radiofrequency on adjuvant-induced pain in the rat: roles of descending adrenergic and serotonergic systems. Eur J Pain 2008; 13:249-52. [PMID: 18539061 DOI: 10.1016/j.ejpain.2008.04.013] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2007] [Revised: 04/02/2008] [Accepted: 04/27/2008] [Indexed: 11/23/2022]
Abstract
Pulsed radiofrequency (PRF) has been reported to be effective in the treatment of several types of pain. The mechanism of action, however, is not well known. In a recent study, the antinociceptive effects of acute thermal pain were shown to be mediated via descending pain inhibitory pathways. In this study we observed an analgesic effect of PRF treatment in an adjuvant induced inflammatory pain model in rats. In this model, sciatic nerves were treated with PRF at 37 degrees and 42 degrees , which inhibited hyperalgesia in the inflammatory groups when compared to RF and sham treatment. This effect was attenuated after intrathecal administration of the alpha2-adrenoceptor antagonist yohimbine, the selective 5-HT3 serotonin receptor antagonist MDL72222, and the non-selective serotonin receptor antagonist methysergide. All three drugs were found to significantly inhibit the analgesic effect of PRF. The results suggest that the analgesic action of PRF involves the enhancement of noradrenergic and serotonergic descending pain inhibitory pathways.
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