Incidence of neuropathic pain after radiofrequency denervation of the third occipital nerve

Abstract

The purpose of this study was to identify the incidence of neuropathic pain occurring after radiofrequency neurotomy of the third occipital nerve (TON). This study was conducted at a teaching hospital from January 1, 2008, to March 31, 2010. With institutional review board approval, Current Procedural Terminology codes were used to identify patients who received radiofrequency ablation (RFA) of the nerves supplying the C2-3 facet joint and the TON. The C3 dorsal ramus provides innervation to the C2-3 facet joint and the suboccipital cutaneous region, and procedures that included ablation to this region were reviewed for complications. Postprocedural data were collected by reviewing follow-up appointment notes and telephone calls. Included were patients who had new neuropathic pain in the distribution of the TON after RFA. They described what they were feeling as burning, tingling, or numbness. All patients who presented with complaints had normal neurologic findings and no secondary cause for their symptoms. The included patient medical records were then reviewed for severity and duration of symptoms and the need for treatment with pain medication. Sixty-four patients underwent C2-3 RFA or TON RFA, and 12 patients were identified as experiencing ablation-induced third occipital neuralgia, an incidence rate of 19%. This finding suggests that patients undergoing RFA of the nerves supplying the C2-3 joint or TON are at risk for postprocedural third occipital neuralgia. This possibility may affect providing informed consent as well as anticipating and managing postprocedural pain.

Hyperhidrosis and Dysautonomia in a Patient With a History of Tetraplegia Following Cervical Facet Radiofrequency Ablation

“…Post-RFA neuritis, which has been reported to occur in up to 19% of patients, is described as "sunburn-like" pain. 6 The exact mechanism is unknown, but is thought to be deafferentation neuralgia from the ablation of the sensory nerves. 6 However, neuritis alone would likely not be consistent with the extent and severity of the reported symptoms.…”

Cryoneurolysis for the treatment of cervical facet joint syndrome: a technical note

“…In a recent study on 64 patients who had undergone third occipital nerve radiofrequency, 12 patients (19%) recorded new pain secondary to the procedure, with seven of the 12 patients showing persistent symptoms for an average of 2.6 months. 36 There are no studies to date reporting on the occurrence of neuropathic pain secondary to cryoneurolysis.…”

Radiofrequency techniques: Complications and troubleshooting

“…However, neuropathic pain may appear in 19%-55% of the cases, depending on the series, with a highly variable duration. 26,27 Thus, although Govind et al found that none of the reported adverse effects required intervention, 83% of the patients with neuropathic pain in the series by Gazelka et al needed drug treatment.…”