Can Pulsed Radiofrequency of the Occipital Nerves Cause Sedation? A New Perspective of Existing Knowledge

Arvaniti, Chrysa; Madi, Alia Ibrahim; Kostopanagiotou, Georgia; Batistaki, Chrysanthi

doi:10.5812/aapm.96418

Cited by 5 publications

(7 citation statements)

References 19 publications

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“…According to the literature, the operation is successful in about 90% -97% of cases. However, the success rate in RF ablation in previous studies was reported to be approximately 75% (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23); nonetheless, the success rate of 85% -95% was observed in the present case report. Nevertheless, surgical intervention is not usually performed as it is invasive, and general anesthesia is necessary and is associated with considerable pain in the postoperative period.…”

Section: Discussioncontrasting

confidence: 65%

“…The RF therapy can be applied to relieve different chronic pain syndromes, such as post-amputation phantom limb pain, radicular pain in lumbar herniated disc prolapse, occipital neuralgia, and cluster headache (16)(17)(18)(19)(20), some of which described lumbar and thoracic sympatholysis (21). Herein, we report the case of a male patient with an age of 22 years undergoing thermal RF sympathectomy therapy for palmar hyperhidrosis of his right hand.…”

Section: Introductionmentioning

confidence: 99%

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Safety of Radiofrequency Ablation of Thoracic T2 and T3 Sympathectomy in Palmar Hyperhidrosis: A Case Report

et al. 2021

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Introduction: Hyperhidrosis is the maladjustment of excess sweating in specific parts of the body. Radiofrequency (RF) therapy has been successfully used to treat hyperhidrosis with a success rate of 85% - 95% in patients refractory to sympathectomy. The main hypothesis was the association between reduced palmar hyperhidrosis and radiofrequency RF therapy. The RF therapy is a less invasive technique, including the utilization of electromagnetic energy that is deposited near the nerve tissue. The mechanism of action of continuous RF could be explained by the destruction of afferent nerve fibers on their way from a nociceptive focus to the central nervous system. Pulsed RF was invented to explore this possibility, with the sole purpose of finding a less destructive and equally effective technique for the application of RF to afferent pathways. Herein, we further evaluated whether the procedure was safe without any complications in routine follow-up in palmar hyperhidrosis. Case Presentation: Herein, we report the case of a male patient with an age of 22 years undergoing thermal RF sympathectomy therapy of thoracic T2 and T3 sympathetic ganglia for the palmar hyperhidrosis of his right hand observed for 3 months. The patient developed a contraction of the flexor involving the small muscles of the right hand with severe pain and congestion 17 days after the procedure without any other complications. The contraction was relieved by a sonar-guided median nerve block at the wrist with two injections of 2 mL lidocaine 2% and 2 mL dexamethasone. Conclusions: This study has been the first clinical case report complicated by the development of a contraction of the flexor muscles of the right hand with severe pain and congestion. The spasm was gradually relieved by sonar-guided median nerve injection at the level of the wrist and intended to assess the role of RF ablation with a success rate of 85% - 95% in palmar hyperhidrosis.

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Section: Discussioncontrasting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Safety of Radiofrequency Ablation of Thoracic T2 and T3 Sympathectomy in Palmar Hyperhidrosis: A Case Report

et al. 2021

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“…Several studies have also shown that radiofrequency can induce changes in membranes and intracellular structures, thereby modifying the transmission of action potentials and perception of pain (1,3,(12)(13)(14).…”

Section: Discussionmentioning

confidence: 99%

The Effect of Pulsed Radiofrequency on Radicular Pain in Lumbal Herniated Nucleus Pulposus: A Systematic Review and Meta-analysis

et al. 2021

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Context: Radiofrequency therapy is a medical procedure mainly used to reduce pain with a low complication rate (less than 1%), ease of application, and low cost. This review’s objective was to (1) evaluate the pulsed radiofrequency (PRF) effectiveness in treating radicular pain and (2) assess the PRF procedure’s safety in managing radicular pain in lumbar herniated nucleus pulposus (HNP). Methods: A systematic review and meta-analysis. A tertiary care center and an academic medical center. Six full articles with the following features were selected for this review: (1) Articles published in English; (2) studies on the PRF effect on radicular pain in lumbar HNP; and (3) randomized control trials. Results: The studies showed that the PRF group had a reduction in pain scores at each evaluation. In four of the studies, the PRF group showed a more significant reduction in pain scores than the control, and in two of the studies, the reduction in pain scores was not significant in the PRF group compared to the control. An adverse effect was reported in one patient experiencing increased radicular pain after PRF. Lack of data required for statistical analysis, and lack use of a uniform duration for the PRF procedure by all the studies. Conclusions: PRF can be used as a promising clinical recommendation for pain management with minimally invasive radicular pain techniques due to lumbar HNP.

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“…Traditionally, leads are advanced to the thoracic (T8/T9) level, where they are programmed to achieve maximum paresthesia topographic coverage and leg pain alleviation. The power source, an implantable pulse generator (IPG) or radiofrequency unit, is then connected to the leads (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Improved Pain Control with Combination Spinal Cord Stimulator Therapy Utilizing Sub-perception and Traditional Paresthesia Based Waveforms: A Pilot Study

et al. 2021

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Background: Chronic back and neck pain affects 20% of Americans. Spinal cord stimulation (SCS) is an effective therapy for otherwise refractory chronic pain. Traditional SCS relies on low-frequency stimulus in the 40 - 60 Hz range causing robust paresthesia in regions overlapping with painful dermatomes. Objectives: This study aims to determine the effect of superimposing sub-perception stimulation in patients who previously had good long-term relief with paresthesia. Methods: This is a prospective observational trial examining patients who had previously been implanted with paresthesia based SCS for failed back surgery syndrome (FBSS) or complex regional pain syndrome (CRPS). These patients presented for implantable pulse generator (IPG) replacement based on battery depletion with an IPG capable of combined sub-perception and paresthesia based SCS therapy. Patients were assessed immediately following the exchange and four weeks later using a telephone survey. Their pain was assessed on each follow up using a Numerical Rating scale (NRS); the primary outcome was the change in NRS after four weeks from the exchange day. Secondary outcomes included paresthesia changes, which included the subjective quality of sensation generated, the overall subjective coverage of the painful region, subjective variation of coverage with positional changes, and global perception of the percentage improvement in pain. Results: Based on our clinic registry, 30 patients were eligible for IPG exchange, 16 were consented for follow up and underwent an exchange, and 15 were available for follow up four weeks following. The average NRS decreased from 7.47 with traditional SCS to 4.5 with combination therapy. 80% of patients reported an improvement in the quality of paresthesia over traditional SCS therapy, and in most patients, this translated to significantly improved pain control. Conclusions: Our findings suggest improved pain relief in patients who had previously had good results with paresthesia based therapy and subsequently underwent IPG exchange to a device capable of delivering combined sub-perception stimulation. The mechanism of action is unclear though there may be an additive and/or synergistic effect of the two waveforms delivered. Larger studies with long-term follow-up are needed to elucidate the durability of pain relief and the precise mechanism by which combined subperception and paresthesia based SCS may improve overall patient outcomes.

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Can Pulsed Radiofrequency of the Occipital Nerves Cause Sedation? A New Perspective of Existing Knowledge

Cited by 5 publications

References 19 publications

Safety of Radiofrequency Ablation of Thoracic T2 and T3 Sympathectomy in Palmar Hyperhidrosis: A Case Report

Safety of Radiofrequency Ablation of Thoracic T2 and T3 Sympathectomy in Palmar Hyperhidrosis: A Case Report

The Effect of Pulsed Radiofrequency on Radicular Pain in Lumbal Herniated Nucleus Pulposus: A Systematic Review and Meta-analysis

Improved Pain Control with Combination Spinal Cord Stimulator Therapy Utilizing Sub-perception and Traditional Paresthesia Based Waveforms: A Pilot Study

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