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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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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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Chen S, Zhang J, Fei Y, Cui X, Shen L, Huang Y. Proposal of a Route Map for Cervical Spinal Ultrasonography: A Simple and Clear Learning Tool for Beginners. Pain Ther 2023; 12:1293-1305. [PMID: 37517030 PMCID: PMC10444723 DOI: 10.1007/s40122-023-00545-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023] Open
Abstract
Spinal ultrasonography has increasingly been used to image axial structures from the cervical to sacral region in recent years. In this work, we propose a comprehensive, systematic cervical scanning protocol that we refined as a route map, especially for beginners, to facilitate teaching, learning, diagnosis, and treatment in clinical pain practice. As a simple and clear tool to demonstrate the scanning protocol, the route map is delineated with rectangles, lines, and arrows. The rectangles represent the positions of the transducer, the arrows indicate route directions, and the lines show the routes of transducer movement. In this article, we describe cervical spinal ultrasonography to illustrate the route map interpretation, scanning protocol and target anatomical structures in detail. We believe that this comprehensive, clear, systematic, and portable route map will be beneficial for inexperienced pain clinicians and ultrasound beginners.
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Affiliation(s)
- Si Chen
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Jiao Zhang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yuda Fei
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Xulei Cui
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
| | - Le Shen
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
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Real-time ultrasound-guided stellate ganglion block for migraine: an observational study. BMC Anesthesiol 2022; 22:78. [PMID: 35331152 PMCID: PMC8944155 DOI: 10.1186/s12871-022-01622-8] [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: 11/29/2021] [Accepted: 03/21/2022] [Indexed: 11/22/2022] Open
Abstract
Objective To observe whether ultrasound-guided stellate ganglion block (SGB) can effectively relieve migraine pain and improve the quality of migraine patients’ life. Methods 81 patients with migraines were enrolled in this study. The patients received SGB with 6 ml of 0.15% ropivacaine once every week for four times. Migraine was assessed with the Migraine Disability Assessment Scale (MIDAS) at baseline and three-months follow-up (Tm). The numerical rating scale (NRS) score at baseline, one day after treatment (Td) and Tm, the frequency of analgesic use in 3 months and the side effects were also recorded at the same time. Results The NRS score of migraine subjects decreased significantly from 7.0 (2.0) to 3.0 (1.0) at Td and 2.0 (2.0) at Tm (vs baseline, P < 0.01). The MIDAS total scores were 14.0 (10.5) at baseline and 7.0 (4.5) at Tm (P < 0.001). During the three months, the frequency of analgesic consumption was decreased from 6.2 ± 2.8 to 1.9 ± 1.8. There were no serious side effects. Conclusions This study confirmed that ultrasound-guided SGB is an effective method to treat migraines. This technique can reduce pain and disability and then improve the quality of life of patients with migraines.
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Belgrado E, Surcinelli A, Gigli GL, Pellitteri G, Dalla Torre C, Valente M. A Case Report of Pulsed Radiofrequency Plus Suboccipital Injection of the Greater Occipital Nerve: An Easier Target for Treatment of Cluster Headache. Front Neurol 2021; 12:724746. [PMID: 34650507 PMCID: PMC8508784 DOI: 10.3389/fneur.2021.724746] [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: 06/14/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: In cluster headache, the efficacy of suboccipital steroid injection is notable within a few days, although few data are available about the duration of efficacy. A combination treatment, consisting of suboccipital steroid injection plus pulsed radiofrequency, could potentially lead to long-term benefit. Evidence about pulsed radiofrequency of the greater occipital nerve is lacking. Patients and Methods: We retrospectively describe a series of four cluster headache patients treated with suboccipital steroid injection plus pulsed radiofrequency of the greater occipital nerve. Results: All patients achieved a 50% reduction in attack frequency in the 7 days after the first treatment. Moreover, a long pain-free remission period up to 15 months was noted. Conclusion: Suboccipital steroid injection plus pulsed radiofrequency of the greater occipital nerve might have both acute and prophylactic effects in cluster headache. The greater occipital nerve is more accessible to pulsed radiofrequency than other targets.
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Affiliation(s)
- Enrico Belgrado
- Neurology Unit, Department of Neuroscience, Udine University Hospital, Udine, Italy
| | - Andrea Surcinelli
- Clinical Neurology Unit, Department of Neuroscience, Udine University Hospital, Udine, Italy
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Department of Neuroscience, Udine University Hospital, Udine, Italy
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Gaia Pellitteri
- Clinical Neurology Unit, Department of Neuroscience, Udine University Hospital, Udine, Italy
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Chiara Dalla Torre
- Neurology Unit, Department of Neuroscience, Udine University Hospital, Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Department of Neuroscience, Udine University Hospital, Udine, Italy
- Department of Medical Area (DAME), University of Udine, Udine, Italy
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Vuka I, Došenović S, Marciuš T, Ferhatović Hamzić L, Vučić K, Sapunar D, Puljak L. Efficacy and safety of pulsed radiofrequency as a method of dorsal root ganglia stimulation for treatment of non-neuropathic pain: a systematic review. BMC Anesthesiol 2020; 20:105. [PMID: 32366286 PMCID: PMC7199300 DOI: 10.1186/s12871-020-01023-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/26/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND We systematically reviewed the evidence on the efficacy and safety of dorsal root ganglion (DRG) targeted pulsed radiofrequency (PRF) versus any comparator for treatment of non-neuropathic pain. METHODS We searched MEDLINE, CINAHL, Embase, PsycINFO, clinicaltrials.gov and WHO clinical trial register until January 8, 2019. All study designs were eligible. Two authors independently conducted literature screening. Primary outcomes were pain intensity and serious adverse events (SAEs). Secondary outcomes were any other pain-related outcome and any other safety outcome that was reported. We assessed the risk of bias using the Cochrane tool and Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I). We conducted narrative evidence synthesis and assessed the conclusiveness of included studies regarding efficacy and safety. RESULTS We included 17 studies with 599 participants, which analyzed various pain syndromes. Two studies were randomized controlled trials; both included participants with low back pain (LBP). Non-randomized studies included patients with the following indications: LBP, postsurgical pain, pain associated with herpes zoster, cervicogenic headache, complex regional pain syndrome type 1, intractable vertebral metastatic pain, chronic scrotal and inguinal pain, occipital radiating pain in rheumatoid arthritis and chronic migraine. In these studies, the PRF was usually initiated after other treatments have failed. Eleven studies had positive conclusive statements (11/17) about efficacy; the remaining had positive inconclusive statements. Only three studies provided conclusiveness of evidence statements regarding safety - two indicated that the evidence was positive conclusive, and one positive inconclusive. The risk of bias was predominantly unclear in randomized and serious in non-randomized studies. CONCLUSION Poor quality and few participants characterize evidence about benefits and harms of DRG PRF in patients with non-neuropathic pain. Results from available studies should only be considered preliminary. Not all studies have reported data regarding the safety of the intervention, but those that did, indicate that the intervention is relatively safe. As the procedure is non-destructive and early results are promising, further comparative studies about PRF in non-neuropathic pain syndromes would be welcomed.
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Affiliation(s)
- Ivana Vuka
- Laboratory for Pain Research, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia
| | - Svjetlana Došenović
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Split, Spinčićeva 1, 21000, Split, Croatia
| | - Tihana Marciuš
- Laboratory for Pain Research, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia
| | - Lejla Ferhatović Hamzić
- Center for Translational and Clinical Research, Department of Proteomics, University of Zagreb School of Medicine, Šalata 3, 10000, Zagreb, Croatia
| | - Katarina Vučić
- Department for Safety and Efficacy Assessment of Medicinal Products, Agency for Medicinal Products and Medical Devices, Ksaverska cesta 4, 10000, Zagreb, Croatia
| | - Damir Sapunar
- Laboratory for Pain Research, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Ilica 242, 10000, Zagreb, Croatia
| | - Livia Puljak
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Ilica 242, 10000, Zagreb, Croatia.
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Lee HJ, Cho HH, Nahm FS, Lee PB, Choi E. Pulsed Radiofrequency Ablation of the C2 Dorsal Root Ganglion Using a Posterior Approach for Treating Cervicogenic Headache: A Retrospective Chart Review. Headache 2020; 60:2463-2472. [PMID: 32052873 DOI: 10.1111/head.13759] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate the efficacy and complications of C2 dorsal root ganglion (DRG) pulsed radiofrequency ablation (RFA) for cervicogenic headache (CEH) and to identify factors related to the outcome of the procedure in this retrospective analysis. BACKGROUND Although conventional high-temperature C2 DRG RFA was effective in patients with CEH in previous studies, the effect of pulsed RFA on C2 DRG in cases of CEH has not yet been evaluated. METHODS We examined the electronic medical records of consecutive patients who underwent C2 DRG block for CEH from January 2012 to May 2018 at a pain center. Consequent C2 DRG pulsed RFA was performed for patients in whom the headache recurred after an initial period of relief 24 hours after the C2 DRG block. A successful outcome was defined as at least 50% pain relief at 6 months after C2 DRG pulsed RFA. We also examined variables associated with the outcome and prognostic factors of CEH. RESULTS Fluoroscopy-guided C2 DRG block was performed in 114 patients with CEH. Forty-five patients received C2 DRG pulsed RFA and 40.0% among them (18/45, success group) had ≥50% pain relief after 6 months. There were no post-procedure complications throughout the study period. Significantly more patients in the success group than in the failure group had a definite positive response (≥50% pain relief) to a previous C2 DRG block (P < .001). CONCLUSION C2 DRG pulsed RFA may be an effective treatment for patients with CEH, particularly for patients who have previously experienced definite pain reduction after C2 DRG block. However, the limitations of our study design and small number of patients preclude firm conclusions.
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Affiliation(s)
- Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun Hoo Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seongnam, Republic of Korea
| | - Francis Sahngun Nahm
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seongnam, Republic of Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University, Seoul, Republic of Korea
| | - Pyung-Bok Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seongnam, Republic of Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University, Seoul, Republic of Korea
| | - Eunjoo Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seongnam, Republic of Korea
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Li J, Yin Y, Ye L, Zuo Y. Pulsed Radiofrequency of C2 Dorsal Root Ganglion Under Ultrasound-Guidance and CT Confirmed for Chronic Headache: Follow-Up of 20 Cases and Literature Review. J Pain Res 2020; 13:87-94. [PMID: 32021398 PMCID: PMC6968801 DOI: 10.2147/jpr.s229973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/24/2019] [Indexed: 02/05/2023] Open
Abstract
Background Chronic headache is common but difficult to treat. Most patients respond poorly to drugs. Nerve block is an effective treatment but has no continuous effect. The pulsed radiofrequency (PRF) technique has been shown to be effective in relieving head pain and extending the effect of nerve block. Objective The purpose of this study is to evaluate the long-term efficacy of C2 dorsal root ganglion after pulsed radiofrequency (PRF) guided by ultrasound for chronic headache. Setting The Department of Pain Management, West China Hospital. Methods Twenty patients who did not respond to medications and peripheral nerve blocks underwent ultrasound-guided PRF of the C2 dorsal root ganglion. The patients were followed up for 6 months. Visual analog scale (VAS) score was evaluated at 1 week, 1 month, 3 months, and 6 months. The quality of life (QOL) was assessed by Brief Pain Inventory (BPI) scores which were rated at pre-procedure and 1 month, 3 months, and 6 months after the procedure. The occurrence of complications was evaluated and reported. Results Mean VAS scores were significantly decreased at 1 week, 1 month, 3 months and 6 months compared to the pre-procedure mean VAS score. Mean BPI scores decreased significantly at each postoperative time point compared to the preoperative baseline and low scores remained throughout the follow-up period: 45.05±3.44 at pre-procedure, 10.60 ± 2.37 at 1 weeks, 12.50 ± 2.46 at 1 month, 12.90 ± 2.62 at 3 months, and 11.63 ± 2.98 at 6 months. Mild complications occurred, including 1 case (4.7%) of transient cervicalgia (lasting for 24 hrs) and 3 cases (14.2%) of transient dizziness (lasting for 30 mins). Limitations Firstly, it included a small sample of patients. Another is the short duration of the follow-up. Conclusion C2 PRF may be considered as an alternative treatment for chronic headache.
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Affiliation(s)
- Jun Li
- National Clinical Research Center for Geriatrics and Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, People's Republic of China.,Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, People's Republic of China
| | - Yan Yin
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, People's Republic of China
| | - Ling Ye
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, People's Republic of China
| | - Yunxia Zuo
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, People's Republic of China
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