Pulsed radiofrequency treatment for idiopathic trigeminal neuralgia: A retrospective analysis of the causes for ineffective pain relief

Abstract

We retrospectively analyzed the reasons for ineffective pain relief in patients with idiopathic trigeminal neuralgia (TN) who had undergone pulsed radiofrequency (PRF) treatment guided by computed tomography scan. We found that intraoperative PRF output voltage and electrical field intensity was significantly higher (p < 0.05) in the group who had received effective treatment than in the ineffective group. These findings suggest that optimizing PRF parameters and increasing the intraoperative output voltage (electric field intensity) may therefore, provide better pain relief in patients with TN.

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

“…No obvious side effect was described while treating TN with PRFT in previous reports . Similarly, we did not observe any side effects in patients who underwent 42°C standard‐ and high‐voltage PRFT.…”

“…No obvious side effect was described while treating TN with PRFT in previous reports. 10,11,13,17 Similarly, we did not observe any side effects in patients who underwent 42°C standard-and high-voltage PRFT. The results of the present study indicate that increased output voltage properly was fairly safe, suggesting that if the temperature is no more than 42°C, well-tolerated higher output voltage will not increase the risk of nerve tissue injury.…”

“…Two studies have hypothesized that electric fields, not thermal effect, can relieve pain during PRFT . Indeed, our recent study showed that the voltages received by patients differed from each other (27 to 50 V) during standard‐voltage PRFT, and the voltages were higher in patients who responded to the treatment than in those with poor therapeutic effects . Teixeira and Sluijter reported that 8 patients with discogenic pain who received high‐voltage PRFT (60 V) achieved significant NRS decreases .…”

“…4,21 Indeed, our recent study showed that the voltages received by patients differed from each other (27 to 50 V) during standard-voltage PRFT, and the voltages were higher in patients who responded to the treatment than in those with poor therapeutic effects. 17 Teixeira and Sluijter reported that 8 patients with discogenic pain who received high-voltage PRFT (60 V) achieved significant NRS decreases. 16 According to a previously mentioned study, the results in this study verified that the efficacy of PRFT on TN patients improved significantly by increasing the pulsed output voltage.…”

“…Teixeira and Sluijter suggested that PRFT with high intradiscal voltage (60 V) could significantly reduce discogenic pain severity . In our previous studies, we described how output voltage could be adjusted (from 27 to 50 V) according to target tissue resistance and specific anatomy characteristics when 42°C automatic pulsed RF mode of Baylis pain management RF generator was used; efficacy was positively correlated with output voltages during PRFT, suggesting that higher efficacy could be achieved by increasing the output voltage . However, to our knowledge, there are no studies investigating the effects of 42°C high‐voltage PRFT obtained by manual mode of the RF generator on TN, which we did in the present study.…”