Randomized controlled trials between dorsal root ganglion thermal radiofrequency, pulsed radiofrequency and steroids for the management of intractable metastatic back pain in thoracic vertebral body

Abstract

Background: Bone metastasis is a complication of various cancers causing severe pain. The current modalities for the treatment of metastatic axial pain include pharmacological, surgical and vertebral augmentation techniques, each of which has its own challenges. Objectives: To evaluate the effectiveness of pulsed radiofrequency (PRF), thermal radiofrequency (RF) and steroids on dorsal root ganglion (DRG) in patients with thoracic axial pain due to vertebral metastasis. Methods: In this randomized controlled prospective study, 140 patients were assessed for eligibility, of which only 69 fulfilled the criteria. Patients were randomly divided into three equal groups, PRF, RF and steroid. Results: During the assessment of pain using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Opioid consumption using oral Morphine Equivalence (OME) and Analgesic Quantification Algorithm (AQA) – at baseline, 1 week, 1 month and 3 months – 81 patients were assessed for final eligibility, of which 12 were excluded before intervention due to drop-out. The remaining 69 were randomized (mean age: 53.87 ± 10.55, 55.78 ± 7.34 and 59.39 ± 13.72) for PRF, RF and steroid, respectively with no statistical difference. VAS% and ODI% decreased significantly at 3 months in RF group ( p <0.001, 0.014, respectively), as did the AQA ( p <0.027). Steroid group was the worst. Discussion: RF on DRG is the main stay for controlling intractable metastatic pain. PRF is a good alternative.

The American Society of Pain and Neuroscience (ASPN) Best Practices and Guidelines for the Interventional Management of Cancer-Associated Pain

“…166 The only RCT concluded superior efficacy of RFA lesioning over steroid treatment when applied to the dorsal root ganglion in patients experiencing axial thoracic pain from vertebral metastases. 167 Nerve blocks using corticosteroids targeting the glossopharyngeal nerve in patients with tongue cancer can be considered if the pain is refractory to conventional medical therapy. 168 Evidence Evaluation and Best Practice Statement…”