Pulsed Radiofrequency Lesioning Research Articles

Effect of pulsed radiofrequency to the suprascapular nerve (SSN) in treating frozen shoulder pain: A randomised controlled trial.

Treatment for frozen shoulder (FS) focuses on pain control and restoring movement and strength through physical therapy. We aimed to evaluate the efficacy of pulsed radiofrequency (PRF) lesioning of the suprascapular nerve for the treatment of FS pain. Forty patients with FS were enrolled and randomly assigned into the intervention group (n = 20) that received PRF and a control group (n = 20) which received medical treatment (NSAIDs). Patients were followed-up for a total of three months. The primary outcome was the pain intensity, measured by the Numeric Pain Rating Scale (NRS). The secondary outcomes included shoulder range of motion (ROM) evaluation measured by simple shoulder test (SST); Likert-type-based patient satisfaction scale; and any adverse events (AEs) throughout the treatment period. All results were measured at baseline, at the end of one week, four weeks and 12 weeks after treatment. At 12 weeks post-procedure, the intervention group significantly improved their pain (NRS dropped to 2.80 ± 0.5) and there was significant improvement in range of motion (SST from 6.55% ± 2.0% to 76.50% ± 6.5) compared to control group. PRF lesioning of the SSN is a fast and effective modality in treating frozen shoulder pain and improving ROM for three months.

The Impact of Suprascapular Nerve Interventions in Patients with Frozen Shoulder: A Systematic Review and Meta-Analysis.

Frozen shoulder is a common condition resulting in severe pain and restricted range of motion. An assessment of the effectiveness of interventions may provide an improved understanding of the development and management of frozen shoulder. A literature search was conducted using Embase, the Cumulative Index of Nursing and Allied Health (CINAHL), the Cochrane Central Register of Controlled Trials (CENTRAL), and National Center for Biotechnology Information PubMed using relevant terms. Studies were included if they assessed the outcomes of interventions on the suprascapular nerve that aim to improve the symptoms of frozen shoulder. A database search returned 196 articles. After review, 9 articles met the inclusion criteria and were included in the analysis. Suprascapular nerve interventions (nerve block, pulsed radiofrequency lesioning) are associated with improvement in pain, motion, and function. Meta-analysis showed that pain (Hedges g, -3.084 [95% confidence interval (CI), -4.273 to -1.894]; p < 0.001) and range of motion (Hedges g, 2.204 [95% CI, 0.992 to 3.415]; p < 0.001) improved significantly following suprascapular nerve block (SSNB). SSNB is associated with significant improvements in shoulder pain and range of motion in patients with frozen shoulder. Further randomized controlled trials comparing SSNB with intra-articular injection and other nonoperative treatments are required to fully define its role in the management of frozen shoulder. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

The synergistic effects of applying pulsed radiofrequency lesioning of the suprascapular nerve plus physical therapy on pain and function in patients with adhesive capsulitis: A protocol of a prospective, randomized, controlled trial.

Background:To our knowledge, there have been no published clinical trials to assess the synergistic effects of applying pulsed radiofrequency (PRF) stimulation of the suprascapular nerve (SSN) plus physical therapy on pain and function in patients with adhesive capsulitis. Therefore, we will conduct this present randomized, double-blind study to evaluate the synergistic effects of applying PRF stimulation of the SSN plus physical therapy on pain and function in patients with adhesive capsulitis.Methods:The study protocol is a randomized, controlled, double-blind design. Recruitment will be started in March 2021 and completed in October 2022. The treating surgeon will assess 90 patients for eligibility. The study protocol was approved through Institutional Review Board in the People's Hospital of Beilun district of Ningbo. Each patient will be randomized into 3 treatment groups, receiving PRF stimulation of the SSN or physical therapy or both of them. After baseline examination, all patients will be given a full explanation of the treatment protocol and will be required to sign a written informed consent for study participation and for publication of the results. All the data collectors, surgeons, statistical analysts, as well as result assessors are not aware of grouping assignment. The outcomes include Constant score, visual analog scale score, range of motion, and strength.Results:This protocol will provide a reliable theoretical basis for the following research.Conclusion:It is assumed that there will be a remarkable difference in postoperative outcomes between the intervention and control groups.Trial registration number:10.17605/OSF.IO/PZ9ES.

Pulsed radiofrequency lesioning of the lumbosacral dorsal root ganglion in a patient with lumbosacral plexopathy due to locally advanced pelvic liposarcoma

Neoplastic lumbosacral plexopathy can be associated with pelvic malignancies where patients present with severe lumbosacral radicular pain (LSP) involving the lower extremities, leading to weakness of the affected limb. We hereby report the case of a 34-year male who presented with pain in low back radiating to left lower limb for the past 2 months. MR imaging, histopathological examination after debulking surgery confirmed it as a liposarcoma involving the anterior aspect of the left side of sacrum extending toward left neural foramina of S1-S2, left greater sciatic notch and left piriformis muscle. As the LSP was refractory to previous neuropathic medications it was planned to perform pulsed radiofrequency lesioning (PRFL) of lumbosacral Dorsal root ganglion (DRG) from L3 to S1 before further oncological management. Each DRG was treated with PRFL at 42°C for 120 s. Postprocedure, the patient had a satisfactory pain relief and underwent further oncological management.

The Neurosurgeons' Armamentarium for the Management of Refractory Post-Herpetic Neuralgia

Abstract INTRODUCTION Post-herpetic neuralgia (PHN) can be refractory to medical treatment. Its complex pathophysiology explains the numerous neurosurgical procedures available. The present study summarizes all available neurosurgical strategies for the management of resistant PHN and evaluates respective safety and efficacy. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The PubMed and Cochrane Library databases were searched up to October 2018. RESULTS A total of 38 studies comprising 811 patients with refractory PHN were included. Ten studies with 243 patients reported use of spinal cord stimulation. The mean visual analog scale (VAS) score was 7.6 and 2.7 before and after the procedure. Dorsal root entry zone (DREZ) lesioning was performed in 85 patients. The mean VAS score before and after the procedure was 8.6 and 3.7. During the postoperative period, 42.3% of patients developed motor deficits. Five studies investigated intrathecal (IT) injections or pump insertions. The combined IT injections demonstrated a strong analgesic effect 87% of patients reported pain reduction &gt;50%. Spinal trigeminal nucleotomy was reported in 4 studies with a total of 60 patients with 78.3% of patients pain-free during long-term follow-up. However, motor and sensory deficits occurred in 75% to 100%. DRG pulsed radiofrequency lesioning was reported by 2 studies (69 patients) with mean VAS before and after was 6.9 and 2.7, respectively. Peripheral nerve simulation was reported by 3 studies comprising 10 patients in total. This strategy was among the safest and most effective, demonstrating a VAS pain reduction from 8.6 to 2 without any complications. CONCLUSION Neurosurgical approaches for recalcitrant PHN include neuromodulatory and ablative procedures. Patients with resistant PHN should undergo minimally invasive procedures first, including SCS, PNS, or DRG radiofrequency lesioning. More invasive procedures should be reserved for refractory cases. Comparative studies are needed in order to construct a PHN neurosurgical management algorithm.

Clinical observations on selective dorsal root ganglion pulsed radiofrequency lesioning combined with gabapentin in the treatment of postherpetic neuralgia.

This study investigated the clinical effects of selective dorsal root ganglion pulsed radiofrequency lesioning in combination with oral administration of gabapentin in the treatment of postherpetic neuralgia (PHN). One hundred and sixteen consecutive cases of initially diagnosed patients with PHN were randomly divided into the control and the observation groups, with each group consisting of 58 patients. The control group was treated with oral gabapentin (2400 mg/d, tid), while the observation group received gabapentin and pulsed radiofrequency lesioing of the dorsal root ganglion. The clinical efficacy of both the regimens was compared after a follow up period of 6 months. The observation group had a significantly lower score on the visual analog scale than the control group (P ≤ 0.05, with no significant complications occurring in both the groups) at a 1, 2, and 4 week posttreatment duration. The percentage of cluster of differentiation (CD) 4+ cells and the CD4+/CD8+ ratio increased gradually, while the percentage of CD8 + cells decreased in the observation group (P ≤ 0.05). No significant alterations were observed in the control group (P > 0.05). The observation group had significantly lower serum interleukin-6, C-reactive protein, and tumor necrosis factor-α levels than the control group (P < 0.05) at 1, 2, and 4 weeks after the treatment was instituted. The observation group also demonstrated a superior total effective rate and efficiency than the control group (P ≤ 0.05). Our study demonstrated that radiofrequency combined with gabapentin in the treatment of PHN has a good safety and efficacy profile. The effects of this treatment may be related to an increased T-cell immunity and an inhibited inflammatory response.

Pulsed radiofrequency lesioning of saphenous nerve and adductor canal in lower limb pain due to metastatic nodule.

Pulsed radiofrequency lesioning of saphenous nerve and adductor canal in lower limb pain due to metastatic nodule.

Selective dorsal root ganglion pulsed radiofrequency lesioning combined with gabapentin in the treatment of postherpetic neuralgia: The unanswered questions.

Selective dorsal root ganglion pulsed radiofrequency lesioning combined with gabapentin in the treatment of postherpetic neuralgia: The unanswered questions.

The Effect of Pulsed Radiofrequency Combined with a Transforaminal Epidural Steroid Injection on Chronic Lumbar Radicular Pain: A Randomized Controlled Trial

Background. Pulsed radiofrequency lesioning (PRFL) of the dorsal root ganglion (DRG) can modulate neural pathways and provide prolonged relief of neuropathic pain, with limited evidence for chronic lumbosacral radicular pain (CLRP). Objective. This study compared the effect of PRFL combined with transforaminal epidural steroid injection (TFESI) to TFESI alone on CLRP. Methods. Forty adults with chronic radicular pain of at least six-month duration were randomly allocated to undergo either a PRFL of the affected DRG followed by a TFESI (treatment group) or a TFESI alone (control group). Participants and assessors were blinded to the allocation and outcomes were assessed at 1, 2, 3, and 4 months. Outcomes. Pain intensity (visual analog score, VAS) was the primary outcome and quality of life (QOL) as measured by the SF-36 was a secondary outcome. Results. There was no difference in baseline characteristics between groups. VAS was significantly lower in the treatment group at 2-month and 3-month but not 4-month follow-up. QOL measurements did not differ between groups. Conclusions. PRFL of the lumbosacral DRG combined with TFESI showed a modest advantage over TFESI alone in reducing pain intensity; however, this did not persist beyond the 3-month follow-up. There was no effect on QOL.

Treatment of chronic lumbosacral radicular pain using adjuvant pulsed radiofrequency: a randomized controlled study.

The objective of this study was to determine the effects of combining pulsed radiofrequency (PRF) treatment and transforaminal epidural injection (TFEI) to treat patients with chronic refractory lumbar radicular pain caused by lumbar spinal stenosis. Randomized control trial. Interventional pain management practice. Sixty-two patients were assigned to the study groups (PRF group = 31; control group = 31). Under fluoroscopic guidance, the RF needle was positioned close to the lumbar dorsal root ganglion. The PRF group received 3 cycles of PRF treatment, and sensory stimulation without RF lesioning was applied to the control group. After PRF or sham lesioning, a local anesthetic with steroid was injected. The primary outcome of a successful response was defined as: 1) ≥50% or 4-point pain reduction in the numerical rating scale (NRS) without an increase in the Oswestry disability index (ODI) or medication quantification scale (MQS), or mean score <4 in the global perceived effect (GPE) scale; or 2) ≥30% or 2-point pain reduction in NRS with a simultaneous decrease in ODI, MQS, or ≥6 points in the GPE scale. The number of patients with successful treatment results was higher in the PRF group at 2 months (P = 0.032) and 3 months (P = 0.018). No significant differences were observed in terms of the secondary outcome variables between the 2 groups. The TFEI provided significant short-term pain relief and PRF can be applied in conjunction with TFEI to achieve higher treatment efficacy compared with TFEI alone.

Tratamento com radiofrequência pulsada para gânglio esfenopalatino em pacientes com dor crônica de face e cabeça

PurposeThere are various facial pain syndromes including trigeminal neuralgia, trigeminal neuropathic pain and atypical facial pain syndromes. Effectiveness of the pulsed radiofrequency in managing various pain syndromes has been clearly demonstrated. There are a limited number of studies on the pulsed radiofrequency treatment for sphenopalatine ganglion in patients suffering from face and head pain. The purpose of this study is to evaluate the satisfaction of pulsed radiofrequency treatment at our patients retrospectively. MethodsInfrazygomatic approach was used for the pulsed radiofrequency of the sphenopalatine ganglion under fluoroscopic guidance. After the tip of the needle reached the target point, 0.25‐0.5ms pulse width was applied for sensory stimulation at frequencies from 50Hz to 1V. Paraesthesias were exposed at the roof of the nose at 0.5–0.7V. To rule out trigeminal contact that led to rhythmic mandibular contraction, motor stimulation at a frequency of 2Hz was applied. Then, four cycles of pulsed radiofrequency lesioning were performed for 120s at a temperature of 42°C. ResultsPain relief could not be achieved in 23% of the patients (unacceptable), whereas pain was completely relieved in 35% of the patients (excellent) and mild to moderate pain relief could be achieved in 42% of the patients (good) through sphenopalatine ganglion‐pulsed radiofrequency treatment. ConclusionPulsed radiofrequency of the sphenopalatine ganglion is effective in treating the patients suffering from intractable chronic facial and head pain as shown by our findings. There is a need for prospective, randomized, controlled trials in order to confirm the efficacy and safety of this new treatment modality in chronic head and face pain.

Sphenopalatine ganglion pulsed radiofrequency treatment in patients suffering from chronic face and head pain

PurposeThere are various facial pain syndromes including trigeminal neuralgia, trigeminal neuropathic pain and atypical facial pain syndromes. Effectiveness of the pulsed radiofrequency in managing various pain syndromes has been clearly demonstrated. There are a limited number of studies on the pulsed radiofrequency treatment for sphenopalatine ganglion in patients suffering from face and head pain. The purpose of this study is to evaluate the satisfaction of pulsed radiofrequency treatment at our patients retrospectively. MethodsInfrazygomatic approach was used for the pulsed radiofrequency of the sphenopalatine ganglion under fluoroscopic guidance. After the tip of the needle reached the target point, 0.25–0.5ms pulse width was applied for sensory stimulation at frequencies from 50Hz to 1V. Paraesthesias were exposed at the roof of the nose at 0.5–0.7V. To rule out trigeminal contact that led to rhythmic mandibular contraction, motor stimulation at a frequency of 2Hz was applied. Then, four cycles of pulsed radiofrequency lesioning were performed for 120s at a temperature of 42°C. ResultsPain relief could not be achieved in 23% of the patients (unacceptable), whereas pain was completely relieved in 35% of the patients (excellent) and mild to moderate pain relief could be achieved in 42% of the patients (good) through sphenopalatine ganglion-pulsed radiofrequency treatment. ConclusionPulsed radiofrequency of the sphenopalatine ganglion is effective in treating the patients suffering from intractable chronic facial and head pain as shown by our findings. There is a need for prospective, randomized, controlled trials in order to confirm the efficacy and safety of this new treatment modality in chronic head and face pain.

Ultrasound-guided pulsed radiofrequency stimulation of the suprascapular nerve for adhesive capsulitis: a prospective, randomized, controlled trial.

The treatment of adhesive capsulitis (AC) is a well-known, complicated, and long process. Recent studies have shown that pulsed radiofrequency (PRF) lesioning of the suprascapular nerve (SSN) using a fluoroscopy- or computed tomography-guided technique can alleviate shoulder pain. However, there are no studies of PRF lesioning of the SSN in patients with AC using ultrasound-guided (UG) techniques, except for 2 case reports. In this study, we compared the effect of physical therapy alone with physical therapy and PRF lesioning of the SSN using a UG technique. Sixty patients with AC were included in the study. Patients were randomized into the following 2 groups: the intervention group containing patients who received 12 weeks of physical therapy after 1 treatment of PRF lesioning of the SSN, and the control group containing patients who received 12 weeks of physical therapy alone. All outcome measurements including visual analog scale (VAS), shoulder pain and disability index, and passive range of motion (PROM) were performed at 1, 4, 8, and 12 weeks after treatment. Forty-two patients (21 patients in each group) completed the study. The intervention group had a notably shorter time to onset of significant pain relief (6.1 ± 3.4 vs 28.1 ± 9.2 days; P < 0.001) and noticeable reduction of VAS score at week 1 (40% vs 4.7%) than the control group (P < 0.001). All measured variables in the intervention group and most variables in the control group showed significant improvement from the baseline (P < 0.05). A comparison of the 2 groups indicated significantly greater improvement in the intervention group at all times in VAS and shoulder pain and disability index scores (all P < 0.05), and for most gain of PROM (P < 0.05). There were no serious adverse effects or complications in either group. This study indicates that the application of PRF lesioning of the SSN using a UG technique combined with physical therapy provided better and faster relief from pain, reduced disability, and improved PROM when compared with physical therapy alone in patients with AC, an effect that persisted for at least 12 weeks.

Endoscopically guided foraminal and dorsal rhizotomy for chronic axial back pain based on cadaver and endoscopically visualized anatomic study.

Background Conventional fluoroscopically guided continuous radiofrequency (CRF) and pulsed Radiofrequency (PRF) lesioning of the medial branch, dorsal ramus, a standard technique to treat facet pain, is compared to an endoscopic visually guided technique. The endoscopic technique (Figure 1) is designed to ablate a larger area of the transverse process where the medial branch crosses to innervate the facet. Endoscopically guided visualization provides confirmation of nerve ablation or transection in the most common location of the branches of the dorsal ramus innervating the facet joint. Materials and Method A retrospective non randomized study of 50 initial patients assessed the efficacy of endoscopic rhizotomy. Patients with lumbar spondylosis and facet arthrosis who had at least 50% pain relief by medial branch blocks met the inclusion criteria for the visualized, surgically directed endoscopic technique. A specially designed cannula and endoscope (Richard Wolf, GmBh) (Figure 2) was developed specifically for this purpose. After completion of the initial 50 patient pilot study in 2005, utilizing a low-temperature, ultra-high frequency (1.7-4.0 MHz) bipolar energy radiofrequency source (Elliquence Int, Hewlett, NY) that demonstrated efficacy, 400 subsequent patients were added to this retrospective study by May 2013. The surgical technique refinement was guided by cadaveric variations observed from additional cadaver dissections (Figure 3) and endoscopic visualization of foraminal nerves that revealed variable locations of the dorsal ramus, including the medial branch. The anatomic variations supported a need for visualized rhizotomy. The inclusion criteria also involved increasing the percentage of back pain relief from medial branch blocks to a base of 75% estimated improvement in order to overcome the variable subjectiveness of a 50% improvement threshold that served to disappoint a small percentage of patients who overestimated the reported 50% improvement in hopes that they would qualify for the endoscopic guided procedure. Results At one year follow-up in the initial study design, VAS improved 6.2-2.5, and ODI 48-28. All patients had VAS improvement equal or greater than injection. The results remained constant with additional surgical cases that continued to improve when technique and visualized rhizotomy allowed for greater surgical exploration and ablation of the targeted zone where more than just the medial branch could be ablated. Approximately 10 percent of the patients returned at one and two year follow-up with mild recurrence of their axial back pain, but none to the original level of pain. Additional rhizotomy of the upper lumbar facets provided additional relief in selected patients. Conclusions / level of evidence 3 The cadaver studies demonstrated considerable variability in the location of the medial and lateral branches of the dorsal ramus. Variability was most common cephalad to L3-4. The dorsal ramus and its nerve branches can also be visualized in the foramen ventral to the intertransverse ligament. Neuromas and entrapment of the dorsal ramus has been identified endoscopically, and confirmed by H and E slides (Figure 4). In the upper lumbar spine, we were not able to find the medial branch to the facets consistently at same location. The nerve to the facet joint did not always cross the transverse process. Some branches enter the facet joint before crossing the transverse process adjacent to the tip of the SAP (Figure 5). The nerve can be mistaken for a furcal nerve or foraminal ligament. Nerve Ablation at above L3-4 levels may require lesioning of the dorsal ramus or targeting the nerve innervation on the facet wall, pedicle or capsule. Clinical Relevance Endoscopically guided facet rhizotomy provides more consistent ablation of the medial and lateral branches of the lumbar dorsal ramus compared to radiographically guided pulsed radiofrequency. The variations in the location of facet innervation can explain the variability of clinical results in fluoroscopically guided RF lesioning. This observation dictates a need for visually guided MIS procedure for best results.

Pulsed Radiofrequency Lesioning of the Axillary and Suprascapular Nerve in Calcific Tendinitis

The patient was a 45-year-female who presented with pain at right shoulder and right upper arm. The patient suffered from right shoulder and arm pain for 3 years and had pain management which was performed using medication and conservative management after she had been diagnosed with calcific tendinitis. However, substantial pain relief was not consistently achieved, and recurrence of pain was reported. Therefore, we performed right axillary nerve and suprascapular nerve block through pulsed radiofrequency. Two months after the procedure, the shoulder pain gradually subsided with the size reduction of the calcified nodule and she needed no more pain management.

Intraarticular Pulsed Mode Radiofrequency Lesioning of Glenohumeral Joint in Chronic Shoulder Pain: 3 Cases

Invasive treatment of chronic pain emanating from joints is often difficult because of the complex anatomy of nerve supply. In most joints, the innervation is derived from several segmental levels, with multiple peripheral nerve branches entering the joint capsule [1]. Radiofrequency treatment has been used empirically for the management of different chronic pain syndromes, based on the assumption that thermocoagulation of the nerve fibers will interrupt pain conduction [2]. This report describes three cases in which patients experienced little or moderate satisfaction with pulsed radiofrequency lesioning of the glenohumeral joint. All 3 patients were referred from the physical medicine or orthopedics departments to our pain clinic. None had experienced trauma to the shoulder or undergone surgery, and all 3 were taking oral opioid medication. They suffered from pain throughout the day, particularly aggravated at night and by movement. The pain was moderately responsive to oral analgesics, but all 3 patients had severe restrictions on activities of daily living. Despite physical therapy, they experienced little improvement in range of motion.

Retrospective Review of the Efficacy and Safety of Repeated Pulsed and Continuous Radiofrequency Lesioning of the Dorsal Root Ganglion/Segmental Nerve for Lumbar Radicular Pain

Background: Chronic lumbosacral radicular pain is a common source of radiating leg pain seen in pain management patients. These patients are frequently managed conservatively with multiple modalities including medications, physical therapy, and epidural steroid injections. Radiofrequency has been used to treat chronic radicular pain for over 30 years; however, there is a paucity of literature about the safety and efficacy of repeat radiofrequency lesioning. Objectives: To determine the safety, success rate, and duration of pain relief of repeat pulsed radiofrequency (PRF) and continuous radiofrequency (CRF) lesioning of the dorsal root ganglion (DRG)/ sacral segmental nerves (SN) in patients with chronic lumbosacral radicular pain. Study Design: Retrospective chart review Setting: Outpatient multidisciplinary pain center Methods: Medical record review of patients who were treated with pulsed and continuous radiofrequency lesioning of the lumbar dorsal root ganglia and segmental nerves and who reported initial success were evaluated for recurrence of pain and repeat radiofrequency treatment. Responses to subsequent treatments were compared to initial treatments for success rates, average duration of relief, and adverse neurologic side-effects. Limitations: Retrospective chart review without a control group. Results: Twenty-six women and 24 men were identified who received 50% pain relief or better after PRF and CRF of the lumbar DRG/ sacral SN for lumbosacral radicular pain. The mean age was 62 years (range, 25-86). The mean duration of relief for the 40 patients who had 2 treatments was 4.7 months (range 0-24; Se [standard error] 0.74). Twenty-eight patients had 3 treatments with an average duration of relief of 4.5 months (range 0-19 months; Se 0.74). Twenty patients had 4 treatments with a mean duration of relief of 4.4 months (range 0.5-18; Se 0.95) and 18 patients who had 5 or more treatments received an average duration of relief of 4.3 months (range 0.5-18; Se 1.03). The average duration of relief and success frequency remained constant after each subsequent radiofrequency treatment. Of the 50 total patients, there was only 1 reported complication, specifically, transient thigh numbness which resolved after one week. Conclusions: Repeated pulsed and continuous radiofrequency ablation of the lumbar dorsal root ganglion/segmental nerve shows promise to be a safe and effective long-term palliative management for lumbosacral radicular pain in some patients. Key words: Pulsed radiofrequency lesioning, dorsal root ganglion, segmental nerve, continuous radiofrquency elsioning, chronic lumbosacral radicular pain

Treating Frozen Shoulder with Ultrasound-Guided Pulsed Mode Radiofrequency Lesioning of the Suprascapular Nerve: Two Cases

Many approaches to treatment of frozen shoulder, or adhesive capsulitis, including use of steroid injections, provide only short-term relief. We present a method for pulsed mode radiofrequency (PRF) lesioning of the suprascapular nerve using ultrasound guidance in patients with severe pain from frozen shoulder. Patients with frozen shoulder were treated by using real-time, high-resolution ultrasound guidance to facilitate PRF lesioning of the suprascapular nerve. Two patients with frozen shoulder of a tertiary hospital were reported. Pain intensity and shoulder movement before and after procedure were recorded. Results. In the two cases presented, both patients experienced pain relief and increased shoulder flexibility for 5-6 months. Ultrasound can not only quickly and effectively identify the suprascapular notch and nerve, but also helps the operator manipulate and advance the needle to a more precise position.

Ultrasound-guided Pulsed Radiofrequency Lesioning of the Phrenic Nerve in a Patient with Intractable Hiccup

Persistent and intractable hiccups (with respective durations of more than 48 hours and 1 month) can result in depression, fatigue, impaired sleep, dehydration, weight loss, malnutrition, and aspiration syndromes. The conventional treatments for hiccups are either non-pharmacological, pharmacological or a nerve block treatment. Pulsed radiofrequency lesioning (PRFL) has been proposed for the modulation of the excited nervous system pathway of pain as a safe and nondestructive treatment method. As placement of the electrode in close proximity to the targeted nerve is very important for the success of PRFL, ultrasound appears to be well suited for this technique. A 74-year-old man suffering from intractable hiccups that had developed after a coronary artery bypass graft and had continued for 7 years was referred to our pain clinic. He had not been treated with conventional methods or medications. We performed PRFL of the phrenic nerve guided by ultrasound and the hiccups disappeared.

Pulsed radiofrequency lesioning for treatment of chronic breast neuropathic pain after breast reduction -A case report-

Breast surgery is a common procedure performed in women. Many women who undergo breast surgery suffer from ill-defined pain syndromes. A nerve block is used in the treatment of the acute and chronic pain, but the effectiveness of the treatment has been limited because of its short duration. Recently, the advent of pulsed radiofrequency lesioning (PRF) has proved a successful treatment for chronic refractory pain involving the peripheral nerves. We experienced a case of a 52-year-old female patient complaining of chronic breast neuropathic pain after breast reduction, which was relieved after PRF lesioning of the 4th thoracic spinal nerve and its root.