Abstract
BackgroundWe systematically reviewed the evidence on the efficacy and safety of dorsal root ganglion (DRG) targeted pulsed radiofrequency (PRF) versus any comparator for treatment of non-neuropathic pain.MethodsWe searched MEDLINE, CINAHL, Embase, PsycINFO, clinicaltrials.gov and WHO clinical trial register until January 8, 2019. All study designs were eligible. Two authors independently conducted literature screening. Primary outcomes were pain intensity and serious adverse events (SAEs). Secondary outcomes were any other pain-related outcome and any other safety outcome that was reported. We assessed the risk of bias using the Cochrane tool and Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I). We conducted narrative evidence synthesis and assessed the conclusiveness of included studies regarding efficacy and safety.ResultsWe included 17 studies with 599 participants, which analyzed various pain syndromes. Two studies were randomized controlled trials; both included participants with low back pain (LBP). Non-randomized studies included patients with the following indications: LBP, postsurgical pain, pain associated with herpes zoster, cervicogenic headache, complex regional pain syndrome type 1, intractable vertebral metastatic pain, chronic scrotal and inguinal pain, occipital radiating pain in rheumatoid arthritis and chronic migraine. In these studies, the PRF was usually initiated after other treatments have failed. Eleven studies had positive conclusive statements (11/17) about efficacy; the remaining had positive inconclusive statements. Only three studies provided conclusiveness of evidence statements regarding safety – two indicated that the evidence was positive conclusive, and one positive inconclusive. The risk of bias was predominantly unclear in randomized and serious in non-randomized studies.ConclusionPoor quality and few participants characterize evidence about benefits and harms of DRG PRF in patients with non-neuropathic pain. Results from available studies should only be considered preliminary. Not all studies have reported data regarding the safety of the intervention, but those that did, indicate that the intervention is relatively safe. As the procedure is non-destructive and early results are promising, further comparative studies about PRF in non-neuropathic pain syndromes would be welcomed.
Highlights
We systematically reviewed the evidence on the efficacy and safety of dorsal root ganglion (DRG) targeted pulsed radiofrequency (PRF) versus any comparator for treatment of non-neuropathic pain
Non-randomized studies included patients with the following indications: low back pain (LBP) [16,17,18], postsurgical pain [19,20,21], pain associated with herpes zoster [6], cervicogenic headache [22, 23], complex regional pain syndrome type 1 [24, 25], intractable vertebral metastatic pain [26], chronic scrotal and inguinal pain [27], occipital radiating pain in rheumatoid arthritis [28] and chronic migraine [29] (Table 1)
Lumbar pain intensity by visual analogue scale (VAS) presented as percentage of relative difference 2
Summary
We systematically reviewed the evidence on the efficacy and safety of dorsal root ganglion (DRG) targeted pulsed radiofrequency (PRF) versus any comparator for treatment of non-neuropathic pain. Estimates on the prevalence of chronic pain in the general population vary, ranging from 11% [2] up to 64% [3]. Besides its major clinical impact and costs for the healthcare system, chronic pain impairs patients’ quality of life, as well as their ability to work and function, causing massive indirect socioeconomic costs worldwide [5]. Chronic pain asserts this major impact on individuals, health systems and society because of inadequate treatment modalities. PRF is a minimally invasive intervention, which involves the application of pulses of electric current, created at the tip of an electrode, without a harmful increase in the temperature [9]
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