Efficacy and Safety of Pulsed Radiofrequency as a Method of Dorsal Root Ganglia Stimulation in Patients with Neuropathic Pain: A Systematic Review

Abstract

Objective Pulsed radiofrequency (PRF) is a nonablative pain treatment that uses radiofrequency current in short high-voltage bursts, resulting in interruption of nociceptive afferent pathways. We conducted a systematic review with the aim to create a synthesis of evidence about the efficacy and safety of PRF applied to the dorsal root ganglion (DRG) for the treatment of neuropathic pain. Methods We searched MEDLINE, CINAHL, Embase, and PsycINFO through January 8, 2019, as well as ClinicalTrials.gov and the clinical trial register of the World Health Organization. All study designs were eligible. We assessed risk of bias using the Cochrane tool for randomized controlled trials and the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I). We assessed level of evidence using the Oxford tool and quality of evidence with GRADE. Results We included 28 studies with participants suffering from lumbosacral, cervical, or thoracic radicular pain, post-herpetic neuralgia, neuropathicbone pain in cancer patients, or carpal tunnel syndrome. Only five studies were randomized controlled trials (RCTs), while others were of nonrandomized designs, predominantly before and after comparisons. A total of 991 participants were included, with a median number (range) of 31 (1–101) participants. Only 204 participants were included in the RCTs, with a median number (range) of 38 (23–62) participants. The overall quality of evidence was low, as the majority of the included studies were rated as evidence level 4 or 5. The quality of evidence was very low. Conclusions Evidence about the efficacy and safety of PRF of the DRG for the treatment of neuropathic pain is based mainly on results from very small studies with low evidence quality. Current research results about the benefits of PRF of the DRG for the treatment of neuropathic pain should be considered preliminary and confirmed in high-quality RCTs with sufficient numbers of participants.

Efficacy and safety of pulsed radiofrequency modulation of thoracic dorsal root ganglion or intercostal nerve on postherpetic neuralgia in aged patients: a retrospective study

“…PHN is a kind of pain that persists 1 month after an acute herpes zoster event, and the pain in some patients may last more than 10 years [ 1 , 2 ]. Varicella-zoster virus, which causes herpes zoster, persists in the spinal nerve DRG of patients for a long time after infecting the human body.…”

“…Postherpetic neuralgia (PHN) is a chronic pain caused by varicella-zoster virus infection, which always occurs among older adults. People suffer from PHN over 50 years old accounts for 12.5% patients with PHN [ 1 ]. And PHN prevalence increases with advancing age [ 1 , 2 ].…”

CT-Guided Pulsed Radiofrequency at Different Voltages in the Treatment of Postherpetic Neuralgia

“…This energy transfer does not destroy the anatomical basis of pain impulse transmission and does not cause nerve damage and protein coagulation. It is currently believed that PRF is neuromodulation for pain relief (Ding et al, 2019;Vuka et al, 2020;Wu et al, 2020). The RF electrode produces a high-voltage electric field at the target nerve, and controlled heat is generated from ion friction, which is dissipated during the relatively long pause between pulses (Cahana et al, 2010).…”

Dorsal Root Ganglion Pulsed Radiofrequency Treatment for Chronic Radicular Pain: A Narrative Mini Review

“…Most of the studies conducted in PRF-treated patients with lumbar and radicular pain are safe, as described by Vuka I. et al [60].…”