Application Of Pulsed Radiofrequency Research Articles

Comparison of the Efficacy of Dorsal Root Ganglion Pulsed Radiofrequency for 2 Minutes versus 4 Minutes in the Treatment of Chronic Lumbosacral Radicular Pain

Objective: Pulsed radiofrequency (PRF) treatment of the dorsal root ganglion (DRG) has been increasingly used to treat lumbosacral radicular pain (LRP) in recent decades. However, there is no consensus in the literature regarding issues such as PRF application duration. This study aimed to determine the efficacy and incidence of adverse events between 2-minute and 4-minute PRF applications. Material and Method: This retrospective study included 160 patients who underwent 2-minute or 4-minute DRG PRF treatment (Group-2 minute 82 patients and Group-4 minute 78 patients). The Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI) scores before and 1 and 6 months after the interventions were evaluated to assess the effectiveness of the procedures. The rate of intervention-related adverse events was determined for both durations. Results: Both the 2-minute and 4-minute PRF procedures provided effective analgesia at 1 and 6 months compared with baseline. There was no difference in the NRS and ODI scores between the two groups at the measurement times. At the 1-month follow-up, 50% or greater pain relief was achieved in 39% of patients in the 2-minute group compared to 50% in the 4-minute group, with no difference between the groups. There was no significant difference in the rate of procedure-related adverse events between the groups. Conclusion: Although a higher success rate was achieved with 4-minute PRF, there was no significant difference, and both 2 and 4-minute PRF provided safe and effective analgesia compared with baseline. Prospective studies with larger sample sizes are needed.

Comparing the effectiveness of pulsed radiofrequency treatment to lumbar dorsal root ganglion according to application times in patients with lumbar radicular pain: protocol for a randomised controlled trial

IntroductionLumbar radicular pain (LRP) is a common symptom characterised by a sharp, shooting or lancinating sensation localised to one or more dermatomes of the lumbar spine. Despite its high prevalence...

Pulsed radiofrequency of lumbar dorsal root ganglion for lumbar radicular pain: A systematic review and meta-analysis.

Pulsed radiofrequency (PRF) of the lumbar dorsal root ganglion (DRG) has been widely used as a method to relieve lumbar radicular pain (LRP). However, the value of PRF application in LRP patients remains uncertain. This systematic review aimed to compare the effects of PRF of lumbar DRG and LEI in patients with LRP. A literature search was performed using well-known databases for articles published up to May 2023. We included randomized controlled trials (RCTs) that evaluated the effects of PRF compared to LEI with or without steroids. We screened articles, extracted data, and assessed risk of bias in duplicate. The pain scores and Oswestry Disability Index (ODI) scores at 1, 3, and 6 months after procedures were obtained. A random-effects meta-analysis model was applied for outcomes. We evaluated evidence certainty for each outcome using the GRADE scoring system. This review was registered in the PROSPERO (ID: CRD42021253628). A total of 10 RCTs were included and data of 613 patients were retrieved. We assessed the overall quality of the evidence as very low to moderate. PRF showed no difference in pain scores at 1 (mean difference [MD] -0.80, 95% confidence interval [CI] -1.59 to 0.00, low certainty) and 6 months (MD -2.37, 95% CI -4.79 to 0.05, very low certainty), and significantly improved pain scores at 3 months (MD -1.31, 95% CI -2.29 to -0.33, low certainty). There was no significant difference in ODI score at any interval (very low to low certainty). In the subgroup who underwent a diagnostic block, did not use steroids, and PRF duration greater than 360 s, PRF significantly reduced pain scores at 3 months after procedures. We found low quality of the evidence supporting adjuvant PRF to the lumbar DRG has a greater analgesic effect at 3 months after procedures in patients with LRP than LEI. We identified no convincing evidence to show that this treatment improves function. High-quality evidence is lacking, and data were largely derived from short-term effects. Given these limitations, high-quality trials with data on long-term effects are needed.

Efficacy of Paravertebral Injection of Interferon-α2b Combined with High-Voltage, Long-Term Pulsed Radiofrequency in DRG in Mitigation of Postherpetic Neuralgia: A Retrospective Study

ObjectiveThis investigation aims to evaluate the effectiveness of the paravertebral injection of recombinant human interferon-α2b in conjunction with high-voltage, long-term pulsed radiofrequency (PRF) in DRG in the mitigation of postherpetic neuralgia (PHN). MethodsThis retrospective study was performed on 84 individuals suffering from acute PHN. The participants were divided into three groups. Group H: Treat with interferon-α2b combined with high-voltage long-term PRF; Group C: Treat with high-voltage long-term PRF; Group I: Treat with the interferon-α2b. All patients in the three groups were orally administered 5 mg of morphine hydrochloride quick-release tablets when there was a burst of pain during the treatment. The pain numerical rating score (NRS), IL-6, Gal-3, and the incidence of PHN were documented prior to and following therapy. ResultsThe pain intensity of all individuals decreased following therapy. In comparison with group C, the group H NRS scores significantly reduced at 4, 8, and 12 weeks following therapy, and the PHN incidence was significantly lesser. In comparison with that prior treatment, the recommended dosage of gabapentin capsules and morphine hydrochloride tablets with an immediate release was reduced in group H. In comparison with group C, the gabapentin orally administrated capsule and morphine hydrochloride in group H reduced significantly after treatment. There were no serious adverse reactions in the three groups. ConclusionWithin the context of treatment of acute PHN, the injection of interferon-α2b in conjunction with high-voltage, long-term application of PRF is more effective than the PRF or injection of interferon-α2b alone.

Output Current and Efficacy of Pulsed Radiofrequency of the Lumbar Dorsal Root Ganglion in Patients With Lumbar Radiculopathy: A Prospective, Double-blind, Randomized Pilot Study

BACKGROUND: Lumbar radicular pain (LRP) is a common but challenging clinical symptom. Pulsed radiofrequency (PRF), a neuromodulation technique that uses short pulses of radiofrequency current, is effective in treating various pain disorders. However, few studies have been conducted on the effects of PRF and its modifying parameters. OBJECTIVES: Our study aimed to determine the intraoperative parameters of PRF of the lumbar dorsal root ganglion (DRG) that are related to clinical effects in patients with LRP unresponsive to transforaminal epidural steroid injections (TFESI). STUDY DESIGN: Prospective double-blind randomized controlled trial, pilot study. SETTING: Single medical center in the Republic of Korea. METHODS: Patients were allocated to one of 2 groups, high-voltage (60 V) or standard-voltage (45 V), according to the preset maximum voltage at which the active tip temperature does not exceed 42°C. Intraoperative parameters, such as output current, sensory threshold, and impedance, were measured. The primary outcomes were radicular pain intensity, physical functioning, global improvement and satisfaction with treatment, and adverse events. The assessments were performed up to 3 months postprocedure. RESULTS: The patients in the standard-voltage group showed significant improvements in the Numeric Rating Scale pain score (P = 0.007) and Oswestry Disability Index (ODI) (P = 0.008) scores at 3 months post-PRF; however, no difference was observed in the high-voltage group. Among the intraoperative parameters, the output current showed a significant negative linear relationship with analgesic efficacy. The output current also showed a significant association with pain intensity (P = 0.005, R2 = 0.422) and ODI score (P = 0.004, R2 = 0.427) at 3 months postprocedure in a multiple regression analysis. The optimal cut-off value of the output current to lower pain intensity after 3 months was 163.5 mA with a sensitivity of 87.5%, specificity of 100%, and an area under the receiver operating characteristic curve value of 0.92 (95% CI. 0.76 – 1.00). LIMITATIONS: Limitations of our study include an imbalance of baseline characteristics, small sample sizes, and short follow-up periods CONCLUSIONS: Lower output currents during PRF application to the lumbar DRG were associated with greater analgesic effects in patients who did not respond to therapeutic TFESI. KEY WORDS: Lumbar radicular pain, pulsed radiofrequency, dorsal root ganglion

The treatment of persistent spinal pain syndrome with epidural pulsed radiofrequency: improvement of the technique.

In Persistent Spinal Pain Syndrome (PSPS), Pulsed Radiofrequency (PRF) is a used procedure. The results of PRF in PSPS performed with an electrode placed through the sacral hiatus were reported to be successful on pain in only 32% of patients. We have tried to improve the results by applying a new system to PRF. Ten patients were treated with PRF application through a steerable epidural catheter with a reference electrode outside the foramen. This method was named "Optimization Current Flow" (OCF). The duty cycle of PRF was 2 × 10 msec and total exposure time was 150 s. Follow up was planned for 1, 3, and 6 months. The NRS score was considered to be the primary outcome. In the first 10 patients treatment was successful (69% of the patients) at 6 months follow-up. This new modality of PRF in patients with PSPS seems to be superior to procedures done with a needle. Further prospective double-blind randomized long-term studies with a significant number of patients are required to validate this technique as there is a need to improve PRF results in PSPS.

The role of radiocontrast agents in the pulsed radiofrequency treatment of lumbar dorsal root ganglion

Objective: The aim of this study was to investigate the effect of contrast agent use on procedure time and accuracy in pulsed
 radiofrequency treatment of the lumbar dorsal root ganglion.
 Patients and Methods: Patients aged 23–79 years with lumbar radicular pain due to disc herniation for at least 3 months were randomized
 into two groups of 35 patients each. Patients in both groups underwent fluoroscopy-guided pulsed radiofrequency treatment of the
 dorsal root ganglion at the level of the L5 foramen. In the radiocontrast group, unlike the control group, the location of the ganglion
 was determined by administering the contrast agent before the radiofrequency treatment.
 Results: Procedure time in the radiocontrast group was significantly longer than in the control group (P< 0.05). In 50 cases ganglion
 was detected in the extraforaminal or intraforaminal location, the excitation of the ganglion in the range of 0.4–0.6 V was significantly
 higher in the radiocontrast group (95.8%) than in the control group (69.2%) (P< 0.05).
 Conclusion: The use of radiocontrast material in pulsed radiofrequency application on the dorsal root ganglion prolongs the procedure
 time. However, for ganglia that cannot be detected by stimulation, contrast injection is useful on procedural accuracy

Comparison of the Effectiveness of Pulse Radiofrequency in the Treatment of Suprascapular Nerve in Chronic Shoulder Pain

Objectives: To investigate the effects of various durations of pulsed radiofrequency (PRF) application on pain and functional limitation in the short term in patients suffered from chronic shoulder pain Methods: 83 patients, 50 women (60.2%) and 33 men (39.8%) were included in the study. Treatment of PRF was implemented to the suprascapular nerve for 8 min in 44 (53.1%) and 10 min in 39 (46.9%) patients. The pain intensity of the patients was evaluated using the visual analog scale (VAS). The Shoulder Pain and Disability Index (SPADI) was utilized to define shoulder function and pain. VAS and SPADI measurements before and four weeks after treatment were recorded. Results: The VAS and SPADI scores showed a significant improvement in both treatment groups (P < 0.05); however, no significant difference was observed between the groups. Conclusion: Therefore, PRF is a beneficial treatment method in patients suffered from chronic shoulder pain; furthermore, the duration of PRF treatment of 8 or 10 minutes does not affect the effectiveness of the treatment.

Ultrasound-guided Shoulder Intraarticular Ozone Injection Versus Pulsed Radiofrequency Application for Shoulder Adhesive Capsulitis: A Randomized Controlled Trial

BACKGROUND: A diseased shoulder due to pain, stiffness, or weakness negatively affects patients’ quality of life and their ability to carry out activities of daily living. Adhesive capsulitis is a disease characterized by shoulder pain and global limitation of movement in the shoulder joint. Many interventions have been proposed for the treatment of primary adhesive capsulitis. The current study compares the effect of ultrasound-guided intraarticular injection of ozone versus steroid versus intraarticular application of pulsed radiofrequency. OBJECTIVES: The primary outcome of the current study was to compare the improvement in the Visual Analog Scale (VAS) after the 3 treatment modalities. The secondary outcomes included functional improvement measured by the Shoulder Pain and Disability Index (SPADI) and level of inflammatory biomarkers measured by serum intercellular adhesion molecule (ICAM-1) and high-sensitivity C-reactive protein(hs-CRP). STUDY DESIGN: The current study is a prospective, double blinded, randomized controlled trial. We employed a double blinding technique for both the patients and the outcome assessors. SETTING: Our study was carried out at the Medical Research Institute, Alexandria University, Egypt, after approval of the local ethical committee (IORG0008812). The study was registered in the “clinical trials library for protocol registration and results system” with number NCT04724317. The study included 45 patients with a diagnosis of primary adhesive capsulitis. METHODS: Patients were randomly assigned to 3 equal groups: steroid group, ozone group, and pulsed radiofrequency group. Pain and global shoulder functions were assessed using the VAS at rest and with movement, range of motion (ROM), and the SPADI. Moreover, ICAM-1 and hs-CRP were measured as inflammatory markers. RESULTS: The results of the current study reveal that all patients in all groups have had a statistically significant improvement after their intervention regarding pain, disability, ROM, and inflammatory markers. Pairwise comparisons revealed that improvement of the VAS during movement had a statistically significant improvement starting from the second week and continuing to the fourth and eighth week. VAS during rest had a significant improvement starting from follow-up week one in the steroid group. Moreover, improvement in the ROM and SPADI scores started from the second week follow-up. Percent improvement was calculated for each group and there was a statistically significant difference between groups in VAS at rest and ROM in the pulsed radiofrequency group compared to the steroid group. Regarding inflammatory markers, both ICAM-1 and hs-CRP had a significant improvement after all 3 interventions with no statistically significant difference among the groups. LIMITATIONS: This study is a single-center study. A shortage of previously published data, and heterogeneity in the published methodology of the 3 interventions limited our discussion data for comparison with the previous literature. CONCLUSION: Ultrasound-guided shoulder joint intraarticular injection of steroid, ozone, or pulsed radiofrequency application all result in a significant improvement in pain, disability, and ROM in primary adhesive capsulitis. They can be used as an effective treatment modality for this condition. Comparing groups statistically, the pulsed radiofrequency group had a more delayed, but statistically better long-term improvement compared to the other 2 groups. KEY WORDS: Adhesive capsulitis, pulsed radiofrequency, ozone, shoulder, glenohumeral joint, pain, hs-CRP, triamcinolone acetonide

Spinal Interferon Regulatory Factor 8 and Brain-derived Neurotrophic Factor in the Prefrontal Cortex are Involved in Pain-induced Depression Relief via Ultrasound-guided Pulsed Radiofrequency in a Rat Spared Nerve Injury Model

BACKGROUND: Pain-depression comorbidity has become a great burden to individuals and society. Nevertheless, the mechanisms underlying comorbid diseases have still not been fully revealed. Ultrasound-guided pulsed radiofrequency (PRF) on peripheral nerves, which produces remarkable analgesia via high-frequency electromagnetic energy, has become a main, minimally invasive treatment for chronic neuropathic pain. OBJECTIVES: The aim of this study was to explore the effect of ultrasound-guided PRF on the sciatic nerve of spared nerve injury (SNI) rats to relieve pain-induced depression. STUDY DESIGN: Experimental trial in rats. SETTING: The research took place in the Laboratory of The First Affiliated Hospital of Wenzhou Medical University. METHODS: Sixty male Wistar rats were randomly divided into a sham group, an SNI group, an SNI + free-PRF group, and an SNI + PRF group. Ultrasound-guided PRF was applied to the sciatic nerve on day 7 after SNI. The basal paw mechanical withdrawal threshold (PMWT) was evaluated as a measure for pain-related behavior, and a sucrose preference test was performed as a measure for depression-related behavior. The expression levels of spinal interferon regulatory factor 8 (IRF8) and of brain-derived neurotrophic factor (BDNF) in the prefrontal cortex (PFC) were also studied on days 21 and 42. RESULTS: The results showed that the PMWT was significantly decreased in rats following SNI operation; the decreased levels of PMWT were reversed in the SNI + PRF group after the application of PRF on the sciatic nerve on day 7. There were no statistically significant differences among the groups in the sucrose preference rate on day 21 after SNI operation. The sucrose preference rate on day 42 was higher in the SNI + PRF group than in the SNI + free-PRF group. Western blot and reverse transcription polymerase chain reaction also demonstrated that ultrasound-guided PRF on the sciatic nerve downregulated overexpression of spinal IRF8 and increased the levels of BDNF in the PFC. LIMITATIONS: This study was performed using only an SNI rat model which cannot represent all rodent neuropathic pain models. Only the short-term effectiveness of ultrasound-guided PRF on the sciatic nerve of SNI rats was investigated. The BDNF changes of other important brain areas were not taken into consideration in this study. CONCLUSIONS: These findings suggest that ultrasound-guided PRF on sciatic nerve could alleviate pain-induced depression. The mechanisms of this treatment may be involved in the downregulated spinal IRF8 and the increased BDNF in PFC. KEY WORDS: Neuropathic pain, depression, ultrasound, pulsed radiofrequency, interferon regulatory factor 8, brain-derived neurotrophic factor, spinal cord, prefrontal cortex

Results of sphenopalatine ganglion pulsed radio- frequency treatment in patients suffering from episodic cluster headache

Background & Objective: The aim of this study was to investigate the short- to medium-term effects of pulsed radiofrequency (PRF) of the sphenopalatine ganglion on episodic cluster headache. Methods: This is a retrospective observational study, 26 patients who underwent PRF of the sphenopalatine ganglion were retrospectively evaluated. The Visual Analogue Scale (VAS) score, number of headache attacks per week, autonomic symptoms and medication use were recorded at 1, 3 and 6 months after the procedure. Results: The mean VAS scores were significantly lower at the 1-, 3-, and 6-month evaluations compared with pre-procedure values (P < 0.001). At the 6th month after the procedure, the proportion of subjects who completely stopped using medications was 26.9%, and the proportion with a decrease in autonomic symptoms was 61.5%. No complications were encountered as a result of the procedure. Conclusion: The application of PRF to the sphenopalatine ganglion is an effective and safe treatment option for episodic cluster headache in the short to medium term.

Pulsed Radiofrequency Ablation for Orchialgia-A Literature Review.

Pulsed radiofrequency, short bursts of radiofrequency energy, has been used by pain practitioners as a non- or minimally neurodestructive technique, an alternative to radiofrequency heat lesions. The clinical advantages and mechanisms of this treatment remain unclear. To review the current clinical implication of the pulsed radiofrequency technique for male patients with chronic scrotal pain. We systematically searched the English literature available at the EMBASE, MEDLINE/PubMed, Google Scholar, and Cochrane Library from inception to 22 November 2022. Only reports on a pulsed radiofrequency application on male patients with chronic scrotal pain were included. The final analysis yielded six reports on the clinical use of pulsed radiofrequency applications in male patients with chronic scrotal pain: six full publications, three case reports, one case series, one prospective uncontrolled pilot study, and one prospective randomized, controlled clinical trial. The accumulation of these data shows that using pulsed radiofrequency generates an increasing interest in pain physicians, radiologists, and urologists for managing chronic scrotal pain. No side effects related to the pulsed radiofrequency technique were reported to date. Further research on the clinical and biological effects is justified. Large sample sizes and randomized clinical trials are warranted.

Pulsed Radiofrequency Application on Sacral Nerve Roots for Pudendal Neuralgia: Two Case Reports and Review of the Literature

Pudendal neuralgia is a common cause of pelvic pain, often difficult to treat with medical management. Nerve blocks can be effective in the short term. Pulsed Radiofrequency application on the pudendal has been investigated in several studies with positive results, however, locating the nerve can be tricky, particularly in overweight patients. We describe two case reports of pudendal neuralgia where, after a procedure on the pudendal nerve without effect, pulsed radiofrequency was applied to the sacral nerve roots S2-S3 with a combined caudal epidural and intraforaminal approach under fluoroscopic guidance. Our results suggest that radiofrequency application with this combined approach can be a feasible technique to treat pudendal neuralgia.

The effect of pulsed radiofrequency application on nerve healing after sciatic nerve anastomosis in rats

ABSTRACT The Effect of Pulsed Radiofrequency Application on Nerve Healing After Sciatic Nerve Anastomosis in Rats. In this study, we aimed to evaluate the histomorphological and functional effect of Pulsed Radiofrequency (PRF) application on regeneration after experimental nerve damage in rats. Forty Sprague-Dawley male rats were used in the study. Sciatic nerve incision was applied to all rats and then anastomosis was performed. Twenty rats were separated as the control group, and the remaining 20 rats underwent PRF every day at 42oC, for 120 seconds. The groups were divided into two further subgroups to be sacrificed on the 15th and 30th days. Tissue samples were obtained from all groups at 24 hours and 72 hours after the injury. Sections of sciatic nerve samples were stained with hematoxylin-eosin for light microscopic investigation and prepared for evaluation of ultrastructural changes with transmission electron microscopy. In the evaluation of axon numbers and diameters were seen that the 30th-day RF group had an increase compared to the control group. In the electron microscopic examination, it was observed that myelinated and unmyelinated nerve fiber sheaths had borders that are more regular in the RF group, the nucleus structures of schwann cells were better preserved, mitochondrial damage was less, and the extensions of fibroblast and collagen fibers were smoother than the control group. The findings suggested that PRF application has a positive contribution histologically on nerve healing in the early period after full-layer incision nerve injury anastomosis surgery.

The mechanism of action of pulsed radiofrequency in reducing pain: a narrative review

Pain from nervous or musculoskeletal disorders is one of the most common complaints in clinical practice. Corticosteroids have a high pain-reducing effect, and their injection is generally used to control various types of pain. However, they have various adverse effects including flushing, hyperglycemia, allergic reactions, menstrual changes, immunosuppression, and adrenal suppression. Pulsed radiofrequency (PRF) is known to have a pain-reducing effect similar to that of corticosteroid injection, with nearly no major side effects. Therefore, it has been widely used to treat various types of pain, such as neuropathic, joint, discogenic, and muscle pain. In the current review, we outlined the pain-reducing mechanisms of PRF by reviewing previous studies. When PRF was first introduced, it was supposed to reduce pain by long-term depression of pain signaling from the peripheral nerve to the central nervous system. In addition, deactivation of microglia at the level of the spinal dorsal horn, reduction of proinflammatory cytokines, increased endogenous opioid precursor messenger ribonucleic acid, enhancement of noradrenergic and serotonergic descending pain inhibitory pathways, suppression of excitation of C-afferent fibers, and microscopic damage of nociceptive C- and A-delta fibers have been found to contribute to pain reduction after PRF application. However, the pain-reducing mechanism of PRF has not been clearly and definitely elucidated. Further studies are warranted to clarify the pain-reducing mechanism of PRF.

The Clinical Efficacy of High-Voltage Long-Duration Pulsed Radiofrequency Treatment in Pudendal Neuralgia: A Retrospective Study

BackgroundPatients with pudendal neuralgia (PN) experience long-lasting chronic pain, hyperalgesia, and comorbid emotional disorders, such as depression and anxiety. Treatment via conventional pulsed radiofrequency (PRF) current carries a significantly high rate of failure. ObjectiveTo determine the safety and clinical efficacy of high-voltage, long-duration PRF application to the pudendal nerve in patients with PN. Study DesignObservational retrospective design, self before-after controlled clinical trial. Materials and MethodsWe analyzed the records of 70 patients of our hospital with diagnosed PN. Treatment consisted of PRF application to the pudendal nerve, using computed tomography guidance to target the pudendal nerve at the level of the ischial spine or ischial tuberosity of the affected side. PRF was applied with the following parameters: temperature 42 °C, frequency 2 Hz, pulse width 20 ms, field intensity ramped gradually from 40 to 90 V, duration 900 sec. The therapeutic effect was evaluated by collecting patient scores for the visual analog scale (VAS), SF-36 health survey questionnaire (SF-36), and patient health questionnaire (PHQ-9) before treatment and at 1-, 4-, and 12-week follow-ups after PRF treatment. Data were analyzed by paired t-test with p < 0.05 considered to be statistically significant. ResultsVAS, SF-36, and PHQ-9 scores at 1, 4, and 12 weeks after high-voltage long-duration PRF treatment were significantly improved relative to their respective pretreatment baseline scores (p < 0.05 for all). The effective rate at 12 weeks after high-voltage long-duration PRF was up to 88.6%. LimitationsA small sample size and lack of a control group. ConclusionsHigh-voltage long-duration PRF provided significant short-term (at least 12 weeks) pain relief to most patients with PN; it also improved subjective measures of depression and quality of life over the same duration of time.

The Immediate Adverse Events of Lumbar Interventional Pain Procedures in 4,209 Patients: An Observational Clinical Study.

Lumbar interventional pain procedures (LIPPs) are frequently used in low back pain and have shown an increasing trend in recent years. LIPPs are highly effective when performed by properly trained physicians. However, some adverse events are seen during interventional procedures. Our aim in this study is to determine the immediate adverse event rates of LIPPs and to inform our colleagues about possible adverse events. Retrospective, observational study. A university hospital pain management center. After approval by the institutional ethics committee, a retrospective evaluation of patients who received fluoroscopy-guided LIPPs between January 2015 and December 2020 was performed. This observational study was conducted with 4,209 patients who underwent LIPPs, including epidural steroid injection, sacroiliac and facet joint injection, medial branch block or radiofrequency ablation, application of pulsed radiofrequency to the dorsal root ganglion, epidural catheter placement, or spinal cord stimulator application. No major adverse events were detected during the procedures. Minor adverse events were detected in 60 patients, and the adverse events rate was found to be 1.4% (95% confidence interval: 1.0-1.8%). Minor adverse events rates varied between 0.7% and 2.3% according to the procedure type. The most common adverse events were determined to be vasovagal reactions (26/60). Facial numbness, cramps, and seizures were detected as rare adverse events. No major adverse events were seen in 4,209 patients. The rate of minor adverse events was 1.4%, with no sequelae in any of the events. When evidence-based guidelines are followed, interventional pain procedures can be performed safely.

Intra-Articular Application of Sluijter-Teixera Poisson Pulsed Radiofrequency in Symptomatic Patients with Knee Osteoarthritis: Focus upon Clinical Efficacy and Safety.

Purpose To retrospectively evaluate the effectiveness of intra-articular application of Sluijter-Teixera Poisson pulsed radiofrequency (STP PRF) in knee osteoarthritis symptomatic patients with chronic pain refractory to conservative therapies. Materials and Methods Institutional database research of two centers identified 39 cases of knee osteoarthritis patients treated with intra-articular STP PRF. Pain prior and one-week and one-, three-, six-, and twelve-month post-STP PRF was compared by means of a numeric visual scale (NVS) questionnaire. Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system was used for complications reporting. Mean patient age was 71.59 ± 11.99 years, mean body mass index was 30.23 ± 4.69, and male/female ratio was 9/30. Results Mean baseline pain score was 8.31 ± 1.70 NVS units. This was reduced to a mean value of 0.90 ± 1.50 NVS units one-week post-RF, 1.08 ± 1.53 at one month, 1.54 ± 1.88 at three months, 2.33 ± 2.17 at six months, and 3.23 ± 2.23 at 12 months of follow-up (p < 0.01). Pain decrease of more than 4 NVS units was noticed in 35/39 knees (89.7%) at first week, 36/39 knees (92.3%) at first month, 35/39 knees (89.7%) at three months, 32/39 knees (82.1%) at six months, and 25/39 knees (64.1%) at one year. There was no recurrence during the follow-up. No complication was observed. Conclusions Percutaneous, intra-articular application of STP PRF is an effective and safe technique for chronic pain reduction in patients with knee osteoarthritis. Results seem to be reproducible and long lasting with significant patient satisfaction at 12-month follow-up.

Thermographic follow-up of postherpetic neuralgia (PHN) subsequent to Ramsay Hunt syndrome with multicranial nerve (V, VII, VIII and IX) involvement: a case report

BackgroundRamsay Hunt syndrome (RHS) is caused by a reactivation of varicella-zoster virus (VZV) infection, and it is characterized by the symptoms of facial paralysis, otalgia, auricular rash, and/or an oral lesion. Elderly patients or immunocompromised patients, deep pain at the initial visit and no prompt treatment are significant predictors of postherpetic neuralgia (PHN). When PHN occurs, especially involved cranial polyneuropathy, multiple modalities should be administered for patients with the intractable PHN. The use of thermography in the follow-up of PHN secondary to RHS with multicranial nerve involvement has not yet been described yet in the literature.Case presentationThe patient was a 78-year-old man with the chief complaint of a 3-month history of PHN secondary to RHS with polycranial nerve (V, VII, VIII, and IX) involvement. Multimodality therapy with oral gabapentin, pulsed radiofrequency (PRF) application to the Gasserian ganglion for pain in the trigeminal nerve region, linear-polarized near-infrared light irradiation for pain in the facial nerve region, and 2% lidocaine spray for pain in the glossopharyngeal nerve region was used to the treat patient, and follow-up evaluations included thermography. This comprehensive treatment obviously improved the quality of life, resulting in considerable pain relief, as indicated by a decrease in the numerical rating scale (NRS) score from 9 to 3 and a decrease in thermal imaging temperature from higher to average temperature on the ipsilateral side compared with the contralateral side. Lidocaine spray on the tonsillar branches of the glossopharyngeal nerve resulted in an improvement in odynophagia, and the NRS score decreased from 9 to 0 for glossopharyngeal neuralgia after three applications.ConclusionAlthough the use of thermography in the follow-up of RHS with multiple cranial nerve (V, VII, VIII, and IX) involvement is very rare, in this patient, thermal imaging showed the efficacy of combination therapy (oral gabapentin, 2% lidocaine sprayed, PRF application and linear-polarized near-infrared light irradiation) and that is a good option for treatment.

The effect of combined pulsed radiofrequency treatment to dorsal root ganglion with transforaminal epidural steroid injection on pain.

We aimed to compare the treatment response with simultaneous application of transforaminal epidural steroid injection (TESI) and pulsed radiofrequency (PRF) to the lumbar dorsal root ganglion (DRG) with TESI in patients with chronic lumbar radicular pain. A total of 129 patients were enrolled. TESI was performed to 67 patients and TESI+DRG-PRF was performed to 62 patients. Demographic data, surgical records, and medications, side, and level of the procedure were recorded. Patients were evaluated on the pre-operative and post-operative 10th day, 1st and 3rd month follow-up visits, and visual analog scale (VAS, 0-10) scores, and patients' satisfaction assessment on the 3rd month follow-up were collected. A successful therapeutic response was defined as a 50% or more reduction in VAS scores. In both groups, post-operative VAS scores were significantly lower than the pre-operative levels (p<0.001). VAS scores in the TESI+DRG-PRF group were significantly lower than the TESI group at all follow-up periods (p˂0.001). Reduction ratios in VAS scores were significantly higher in the TESI+DRG-PRF group in all follow-up visits (p˂-0.001). Satisfaction levels were significantly higher in the TESI+DRG-PRF group (p˂0.01). According to our study, TESI provides short-moderate pain relief in patients with chronic lumbar radicular pain. A simultaneous application of PRF in the same session with TESI should be considered as an option to improve the treatment response.