Pulsed radio frequency: a non-neurodestructive therapy in pain management

Snidvongs, Saowarat; Mehta, Vivek

doi:10.1097/spc.0b013e328339628a

Cited by 29 publications

(30 citation statements)

References 22 publications

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“…PRF is a technique whereby radio frequency oscillations are gated at a rate of 2 Hz with an output voltage of 45 V, frequency of 500 kHz, 20 ms duration and 480 ms interval. The heat generated during treatment could dissipate during the interval and the temperature of the needle is maintained at less than 42°C, thereby avoiding degeneration of the local tissue during treatment …”

Section: Discussionsupporting

confidence: 93%

3D CT‐Guided Pulsed Radiofrequency Treatment for Trigeminal Neuralgia

et al. 2013

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Trigeminal neuralgia (TN) is a pain syndrome characterized by pain in the trigeminal area often accompanied by a brief facial spasm or tic. The purpose of our study was to investigate the efficacy and clinical utility of CT-guided pulsed radiofrequency (PRF) for treatment of TN. Patients who were diagnosed with severe TN between September 2010 and October 2010 at Beijing Tiantan Hospital were included. Pulsed radiofrequency treatment (PRFT) was employed to treat TN. To verify the accurate needle position, a thin-section cranial CT scan was performed by using a multidetector CT scanner. Three-dimensional reconstruction was performed to visualize the location of the needle and the foramen ovale. A total of 20 patients were included in the study. Seven patients (35%) had favorable outcome 1 year after the PRFT. The numeric rating scale in the 7 patients with good outcome was significantly lower than the 13 patients with bad outcome at 1 day, 1 week, and 2 weeks after the treatment. The remaining 13 patients had residual pain 2 weeks after the PRFT and had to receive radiofrequency thermocoagulation (RFTC). In conclusion, the results of our study demonstrate that CT-guided PRFT is not an effective method of pain treatment for idiopathic TN as compared with conventional RFTC. However, CT-guided PRFT is associated with less complication than RFTC.

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Section: Discussionsupporting

confidence: 93%

3D CT‐Guided Pulsed Radiofrequency Treatment for Trigeminal Neuralgia

et al. 2013

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“…described a novel kind of RF, namely pulsed RF. Alternating current (2 Hz impulse frequency, and 45 V output voltage) of 20‐msecond duration and 480‐msecond intervals is generated by a RF instrument . The heat caused by output voltage will dissipate during the interval, and the temperature of the electrode tip will not exceed 42°C and will not cause tissue degeneration …”

Section: Introductionmentioning

confidence: 99%

Comparison of High‐voltage‐ with Standard‐voltage Pulsed Radiofrequency of Gasserian Ganglion in the Treatment of Idiopathic Trigeminal Neuralgia

Luo

Wang

et al. 2014

Pain Practice

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Although pulsed radiofrequency treatment (PRFT) has been used to treat trigeminal neuralgia (TN) safely, satisfactory improvement is lacking. Recently, much attention has been paid to the PRFT dose and intra-operative parameters. It has been reported that high-voltage PRFT could significantly reduce discogenic pain. However, there is no study investigating the effects of high-voltage PRFT on TN. The aim of this prospective, randomized, double-blinded study was to evaluate the efficacy and safety of high-voltage PRFT in comparison with standard-voltage PRFT for idiopathic TN. Sixty severe TN patients were randomly assigned to 2 groups treated with CT-guided standard- or high-voltage-pulsed radiofrequency (RF) of Gasserian ganglion, respectively, between January 2012 and July 2012. Numeric Rating Scales (NRS), carbamazepine dose, and side effects were evaluated at day 1, weeks 1 and 2, months 1, 3, and 6, and 1 year postoperative. There were 27 patients in the standard-voltage group and 26 patients in the high-voltage group who completed the 1-year follow-up study. The effective rates in the standard-voltage and high-voltage PRFT groups were 41% and 69%, respectively, at 1, 3, and 6 months postoperative (P = 0.037). The effective rate in the standard-voltage group decreased to 19% at 1-year postoperative, while in the high-voltage group remained at 69% (P = 0.000). No significant side effects were detected in both groups. In conclusion, CT-guided high-voltage PRFT is an effective and safe interventional therapeutic choice for idiopathic TN patients.

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“…[26] However, despite of its increasing use, the exact mechanism of PRF stimulation is not clearly elucidated. However, Erdine et al [27] reported structural alteration of sensory nociceptive nerve fibers after PRF stimulation using electron microscopy.…”

Section: Discussionmentioning

confidence: 99%

Effect of bipolar pulsed radiofrequency on refractory chronic cervical radicular pain

Lee

2017

Medicine

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Rationale:Despite undergoing transforaminal epidural steroid injection (TFESI), many patients complain of persisting cervical radicular pain. For the management of chronic cervical radicular pain, clinicians are widely applying pulsed radiofrequency (PRF) stimulation to dorsal root ganglions (DRGs). To enhance the effect of PRF stimulation, we conducted bipolar PRF stimulation in 2 patients with chronic cervical radicular pain that was refractory to monopolar PRF and repeated TFESIs.Patient concerns:Patients 1 and 2 presented with a numeric rating scale (NRS) score of 7 and 6 for chronic cervical radicular pain, respectively, despite undergoing monopolar PRF and 2 TFESIs.Diagnoses:On cervical magnetic resonance imaging, foraminal stenosis at the right C6–7 and right central to right foraminal disc protrusion on C6–7 were observed in patients 1 and 2, respectively. Two patients showed a positive response on diagnostic right C7 selective nerve root block with 0.5 mL of 1% lidocaine.Interventions:Bipolar PRF stimulation was performed under C-arm fluoroscopy. Two parallel RF cannulas (less than 1 cm apart) were used for DRG stimulation. The PRF treatment was administered at 5 Hz and a 5-ms pulsed width for 360 seconds at 45 V with the constraint that the electrode tip temperature did not exceed 42°C.Outcomes:At the 2-week and 1-month follow-up, after undergoing bipolar PRF, the pain of patient 1 was completely relieved, and at 2, 3, and 6 months, the pain was scored as NRS 2. In patient 2, at the 2-week follow-up after undergoing bipolar PRF, pain severity was reduced from NRS 6 to 2. The effect of bipolar PRF on patient 2 lasted for at least 6 months. No adverse effects were observed in either patient.Lessons:Application of bipolar PRF to DRGs seems to be an effective and safe technique for treating refractory chronic cervical radicular pain.

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Pulsed radio frequency: a non-neurodestructive therapy in pain management

Abstract: At present very few well designed randomized controlled trials have been carried out on patients comparing PRF to another technique. Further scientific research and clinical trials are required to confirm whether PRF has a significant role in the future of chronic pain management.

Cited by 29 publications

References 22 publications

3D CT‐Guided Pulsed Radiofrequency Treatment for Trigeminal Neuralgia

3D CT‐Guided Pulsed Radiofrequency Treatment for Trigeminal Neuralgia

Comparison of High‐voltage‐ with Standard‐voltage Pulsed Radiofrequency of Gasserian Ganglion in the Treatment of Idiopathic Trigeminal Neuralgia

Effect of bipolar pulsed radiofrequency on refractory chronic cervical radicular pain

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