Pulsed radiofrequency adjacent to the cervical dorsal root ganglion in chronic cervical radicular pain: A double blind sham controlled randomized clinical trial

Abstract

Cervical radicular pain affects approximately 1 on 1000 adults per year. Although many treatment modalities are described in the literature, the available evidence for efficacy is not sufficient to allow definitive conclusions on the optimal therapy to be made. The effect of pulsed radiofrequency treatment for this type of patients was evaluated in a prospective audit that showed satisfactory pain relief for a mean period of 9.2 months, justifying a randomized sham controlled trial. Twenty-three patients, out of 256 screened, met the inclusion criteria and were randomly assigned in a double blind fashion to receive either pulsed radiofrequency or sham intervention. The evaluation was done by an independent observer. At 3 months the pulsed radiofrequency group showed a significantly better outcome with regard to the global perceived effect (>50% improvement) and visual analogue scale (20 point pain reduction). The quality of life scales also showed a positive trend in favor of the pulsed radiofrequency group, but significance was only reached in the SF-36 domain vitality at 3 months. The need for pain medication was significantly reduced in the pulsed radiofrequency group after six months. No complications were observed during the study period. These study results are in agreement with the findings of our previous clinical audit that pulsed radiofrequency treatment of the cervical dorsal root ganglion may provide pain relief for a limited number of carefully selected patients with chronic cervical radicular pain as assessed by clinical and neurological examination.

Changes in pain behavior and glial activation in the spinal dorsal horn after pulsed radiofrequency current administration to the dorsal root ganglion in a rat model of lumbar disc herniation

“…Recently, PRF has been advocated for the treatment of acute and chronic neuropathic pain of spinal nerve root origin. 4,46 However, the mechanisms underlying the efficacy of PRF treatment for pain control remain unclear.…”

“…Although the mechanism is poorly understood, the clinically demonstrated effectiveness of PRF makes it an alternative modality for the delivery of radiofrequency current. 1,4,9,25,45,46 Neurobiology studies have demonstrated early and late temperature-independent cellular activity in the rat dorsal horn after exposure of the cervical DRG to PRF. In particular, after PRF administration, the numbers of cfos immunoreactive neurons increase substantially in the superficial laminae of the dorsal horn.…”

Servikal diskojenik ağrılar

“…[26] Başka bir çalışma, servikal dorsal kök gangliyonunun atımlı radyofrekans tedavisinin, kronik servikal radikü-ler ağrısı olan ve özenle seçilmiş sınırlı sayıda hasta için ağrı rahatlaması sağlayabileceği sonucuna varmıştır. [27] …”

Radiofrequency Treatments for Neuropathic Pain: Review and New Approaches

“…Two RCTs have examined PRF of DRG for neuropathic pain (Simopoulos et al, 2008;Van Zundert et al, 2007). These studies presented limited evidence that PRF of the cervical DRG could produce short-term relief of cervical radicular pain; however, there is limited evidence against its use existed in treatment of lumbar radicular pain (Malik & Benzon, 2008).…”

“…Van Zundert et al (Van Zundert et al, 2007) compared PRF of the cervical DRG to sham treatment at 3 months after treatment; PRF of the cervical DRG showed significantly better outcome on both the global perceived effect (> 50% improvement) index and visual analog scale (20-point pain reduction).…”