Use Of Pulsed Radiofrequency Research Articles

Management of Postherpetic Neuralgia with Pulsed Radiofrequency Dorsal Root Ganglion: A Case Report

Introduction: Radiofrequency therapy is a minimally invasive procedure that has been used for about three decades to treat various chronic pain, such as postherpetic pain. This case study aims to describe the use of PRF in postherpetic neuralgia.
 Case presentation: A woman, 71 years old, came with complaints of right low back pain. Pain that is felt like burning, burning, sometimes pain feels like being stabbed, electrocuted, throbbing, and the pain will increase if the area of the skin is touched by a cloth. The pain began to be felt approximately 11 years ago. Physical examination shows vital signs; blood pressure 140/75 mmHg, pulse 76x/minute, respiratory rate 20x/minute, oxygen saturation 97%, temperature 36,5oC, numeric rating scale (NRS) 8-9/10. On examination of the right lumbar region, hypopigmented lesions appeared around the right waist at L3, L4, and L5 levels. No hyperemia and edema were found, and no obvious sensory loss. Assessment of pain score according to the Socrates method 8/10, S-LANSS score (self-report Leeds assessment of neuropathic symptoms and signs) 16. The patient has been diagnosed with postherpetic neuralgia. Patients were treated with a pulsed radiofrequency (PRF) procedure on the dorsal root ganglion (DRG). Pulsed radiofrequency was performed on the dorsal root ganglion at L1, L2, L3, and L4 levels.
 Concussion: The pulsed radiofrequency procedure on the dorsal root ganglion is a minimally invasive procedure that is effective and safe in treating postherpetic neuralgia pain. The use of imaging guidance in this procedure can improve the accuracy of needle tip placement and prevent side effects and complications.

Pulsed Radiofrequency for Post-Covid Occipital Neuralgia: An Effective Therapeutic Proposal - Case Report

With the SARS-CoV-2 pandemic and the increased number of cases reported in the literature of post-Covid syndromes, and clinical conditions of rheumatic and cardiovascular diseases, neurological disorders have also been reported, with the description of cases of reduced memory and cerebrovascular complications post-Covid-19 virus infection. Thus, in addition to these conditions, neuropathic pain secondary to cases of novel coronavirus infection have been seen in the literature and have raised questions about the pathophysiology arising from this situation, prognostic factors, and best indications for treatment. Among the neuropathic pain reported, occipital neuralgia is one of the complications faced, characterized by a burning and paroxysmal pain of variable duration. One of the possible treatments for this condition is the use of pulsed radiofrequency on the affected nerves in cases refractory to optimized clinical treatment, being an effective measure for reducing symptoms and improving quality of life.

Наш опыт применения пульсовой радиочастотной абляции ганглиев задних спинальных корешков (PRF DRG) в лечении поясничных радикулопатий

Актуальность. Дегенеративные поражения поясничного отдела позвоночника и связанные с ними клинико-неврологические проявления — одна из наиболее важных проблем современной ортопедии. Консервативное лечение данной патологии эффективно у 60 % пациентов. В остальных случаях боль становится хронической, что приводит к инвалидизации. Эти факты стимулировали разработку малоинвазивных процедур, обладающих достаточной эффективностью при низком риске потенциальных осложнений. Наибольшую распространенность из них получило интервенционное радиочастотное лечение. Цель исследования: изучить динамику болевого синдрома и социальной адаптации у пациентов, страдающих хроническими поясничными радикулопатиями, при использовании в их лечении пульсовой радиочастотной абляции ганглиев задних спинальных корешков (pulsed radiofrequency of dorsal root ganglion — PRF DRG). Материалы и методы. В ретроспективное исследование включены 42 пациента в возрасте от 27 до 78 лет (49,7 ± 14,8 года), пролеченных в 2016–2018 годах в клинике «Нейромед» г. Киева и Институте травматологии и ортопедии НАМН Украины. В обследование были включены пациенты, страдающие реактивными пояснично-крестцовыми радикулопатиями вследствие дегенеративно-дистрофического поражения позвоночника. Болевой синдром оценивался по 10-балльной визуально-аналоговой шкале (ВАШ) перед манипуляцией, непосредственно после нее и через 6 месяцев после ее проведения. Социальную адаптацию в повседневной жизни объективизировали при помощи Oswestry Low Back Pain Disability Questionnaire (ODI). Результаты. Осложнений не зарегистрировано. Абсолютно все пациенты отмечали снижение болевого синдрома. Большинство пациентов до манипуляции характеризовали свою боль как очень сильную (ВАШ — 7,14 ± 0,68), а после процедуры такое же количество больных уже говорили о своей боли как о средней (ВАШ — 4,02 ± 0,81). Подобная же тенденция сохранялась и через полгода после лечения (ВАШ — 1,85 ± 0,78). До манипуляции индекс нарушения жизнедеятельности из-за болевого синдрома составлял 71,42 ± 6,83 балла. А спустя полгода после проведения процедуры индекс ODI уже составлял 18,57 ± 7,83 балла. Выводы. Радиочастотное пульсовое воздействие на ганглии заднего спинального корешка (PRF DRG) является безопасным и эффективным методом лечения хронических поясничных радикулопатий.

Neuromodulation in Odontogenic Pain: A Case Series

BACKGROUND: Teeth and other intraoral structures are the most frequent sources of orofacial pain. Pulsed radiofrequency (PRF) is a treatment where an intermittent electrical pulse is applied to a painful nerve. CASE REPORT: Twelve patients who reported odontogenic were enrolled. After a positive anesthetic block test at the affected nerve, a PRF procedure was performed. After the procedure, patients were asked to report the degree of tolerability of the procedure, and each patient was reevaluated after one and 6 months in terms of overall satisfaction, reduction of pain, and number of attacks. A total of 18 procedures were performed over 12 patients; 8 patients reported significant clinical improvement . Maximum and mean self-reported pain ratings decreased significantly at both the one- and 6-month follow-ups. CONCLUSION: The use of PRF in treating odontogenic pain appears to show promising results: it is feasible, safe, and associated with little discomfort for the patient. KEY WORDS: Odontogenic pain, neuromodulation, pulsed radiofrequency, interventional pain procedure

Pulsed Radiofrequency of the Vagal Nerve for Tinnitus -A Case-Study.

Vagal nerve stimulation is a promising therapy for tinnitus. Pulsed radiofrequency is a minimally invasive neuromodulator technique that could be applied repeatedly without damage to neural tissue. In this case-study we document the use of pulsed radiofrequency of the vagal nerve as a successful therapy without harm for patients with tinnitus. A 22-gauge, 60 mm-long needle with a 5 mm active tip was placed percutaneously at the inner side of the tragus. The auricular branch of the vagal nerve was subjected to pulsed radiofrequency at 42 V, 2 Hz, and 10 milliseconds for 10 minutes. Pulsed radiofrequency of the vagal nerve can reduce tinnitus and improve hearing in a patient with severe tinnitus and hearing loss. The intensity of the tinnitus was reduced to 5% of the original intensity at the left side and to 20% at the right side. An improved hearing of 20 to 30 dB from 250 Hz to 8 kHz in the left ear and from 250 Hz to 2 kHz in the right ear was objectivated in the audiogram. This case-study document that PRF of the vagal nerve can reduce tinnitus and improve hearing in a patient with severe tinnitus and hearing loss. However, further research of PRF of the vagal nerve in tinnitus patients is needed.

Precisely Synchronized NVNA Setup for Digitally Modulated Signal Generation and Measurement at 5G-Oriented Millimeter-Wave Test Bands

In this article, we present a novel nonlinear vector network analyzer (NVNA) setup for generating and measuring digitally modulated signals at millimeter-wave test bands. The first difference between this setup and commercial NVNAs is the use of a user-defined multisine signal as the phase reference, in order to enable more precise synchronization and denser spectral grid. To achieve this, a single 12.5-GHz microwave source is used for generating both the digitally modulated test signal and the phase reference, which not only offers the clock to the arbitrary waveform generator for user-defined intermediate frequency (IF) waveform generation but also provides the local oscillator drive after frequency multiplication. The second novelty of this work is the use of pulsed-radio frequency (RF) signals for NVNA phase calibration. By replacing the digitally modulated IF waveform with pulsed-RF signals, tone-by-tone phase calibration on dense spectral grids can be easily achieved under the same synchronization scheme. The validity of the proposed NVNA setup (as well as its simplified modification) and the phase calibration method is verified at the fifth-generation (5G)-oriented millimeter-wave bands of 28, 39, 43, and 70 GHz in this work, where the EVM measurements of 64-QAM test signals with a wide range of symbol rates from 0.1 to 1.5625 GSymbol/s are demonstrated reachable in practice.

A narrative review and case report of the use of pulsed radiofrequency in pain management : Intra articular application

Background/Objectives: Pulsed radiofrequency(RF) method has been introduced as a way to provide longer-term pain relief in peripheral nerve areas especially in the management of chronic pain. It is a new treatment method that complements the problems of conventional RF treatment. Methods/Statistical analysis: We describe the clinical use of pulsed RF in a patient with degenerative osteoarthritis of the knee and review of the literature related to the use of clinical practice. Findings: It showed updated information regarding the science of pulsed RF by highlighting basic science, animal study, and clinical data and to explore further the validity of the concept behind the application. Improvements/Applications: Pulsed RF may promise as an analgesic modality to treat a variety of conditions.

Effectiveness of pulsed radiofrequency treatment on cervical radicular pain: A meta-analysis.

Background:Cervical radicular pain is a challenging medical problem in terms of therapeutic management. Recently, pulsed radiofrequency (PRF) stimulation on the dorsal root ganglion (DRG) has been used to control several types of chronic pain. However, its effect on cervical radicular pain is still not well studied. To conduct a meta-analysis of available clinical studies on PRF treatment in patients with cervical radicular pain induced by cervical spine disease that was not responsive to other conservative treatments.Methods:A comprehensive database search was conducted on PubMed, Embase, Cochrane Library, and SCOPUS. We included studies published up to August 31, 2017, that fulfilled our inclusion and exclusion criteria. The pain degrees measured using visual analog scale (VAS) at pretreatment and after PRF on the DRG were collected for the meta-analysis. The Cochrane Collaboration's Handbook and Newcastle–Ottawa scale were used for the methodological quality assessments of included studies. The meta-analysis was performed using the Comprehensive Meta-analysis Version 2.Results:A total of 67 patients from one RCT study, 2 prospective observational studies, and one retrospective study were included in this meta-analysis. The pooled data of the 4 included studies showed that overall VAS after the PRF treatment was significantly reduced (P ≤ .001). In the subgroup analysis according to follow-up evaluation time points, the pain was significantly reduced at 2 weeks, 1 month, 3 months, and 6 months after the procedure (2 weeks: P = .02; 1, 3, and 6 months: P < .001).Conclusion:According to the results of the meta-analysis, the use of PRF on the DRG is effective for alleviating cervical radicular pain, which was unresponsive to oral medications, physical therapy, or epidural steroid injection.

Efficacy of Pulsed Radiofrequency Stimulation in Patients with Peripheral Neuropathic Pain: A Narrative Review

Background: Recently, clinicians have been applying pulsed radiofrequency (PRF) stimulation on various peripheral nerves to manage patients’ peripheral neuropathic pain. Objectives: To review the literature on the use and efficacy of PRF for controlling peripheral neuropathic pain. Study Design: This is a narrative review of relevant articles on the effectiveness of PRF for peripheral neuropathic pain. Methods: A PubMed search was conducted for papers published from January 1, 1980 to August 31, 2017 that used PRF to treat peripheral neuropathic pain. The key search phrase for identifying potentially relevant articles was [PRF AND pain]. The following inclusion criteria were applied for the selection of articles: 1) patients’ pain was caused by peripheral nervous system disorders; 2) PRF stimulation was applied on the peripheral nerve; and 3) after PRF stimulation, follow-up evaluation was performed to assess the reduction in pain. Review articles were excluded. Results: A total of 468 articles were found to be potentially relevant. After reading the titles and abstracts of the papers and assessing them for eligibility based on the full-text articles, 63 publications were finally included in this review. For radicular pain from spinal diseases, the evidence supports that PRF is an effective treatment. Similarly, PRF appears to be effective for postherpetic neuralgia and occipital neuralgia. On the other hand, for trigeminal neuralgia, the results of previous studies indicate that PRF is not appropriate for managing trigeminal neuralgia and less effective than conventional RF. However, data on the use of PRF for pudendal neuralgia, meralgia paresthetica, carpal tunnel syndrome, tarsal tunnel syndrome, and Morton’s neuroma, is lacking and thus the efficacy of PRF in these peripheral nerve disorders cannot be determined at this time. Limitations: This review did not include studies indexed in databases other than PubMed. Conclusions: This review will help guide clinicians in making informed decisions regarding whether PRF is the appropriate option for managing the various peripheral neuropathic pain conditions in their patients. Key words: Pulsed radiofrequency, peripheral neuropathic pain, radicular pain, postherpetic neuralgia, trigeminal neuralgia, occipital neuralgia, pudendal neuralgia, meralgia, carpal tunnel syndrome, review

Radio Frequency Ablation and Pulsed Radiofrequency for Treating Peripheral Neuralgias.

Peripheral nerve pain is common among patients with typical management including the use of pain medications, neuropathic agents, steroid injections, and nerve blocks. Additionally, the use of pulsed radiofrequency (PRF) and radiofrequency ablation (RFA) can be used in the management of chronic peripheral nerve pain. Previous studies investigating the effectiveness of RFA and PRF, typically case reports, have demonstrated that peripheral nerve RFA and PRF have the potential to provide relief of chronic pain for long duration. Our study aimed at testing efficacy of RFA/PRF for treating peripheral neuralgia. This was a retrospective review. We identified 16 patients who received 17 RFAs/PRFs. Outcomes of interest collected included pain scores before and after procedures, percent improvement in pain after each procedure, and duration of improvement until the time of data collection. In addition, demographic data including age, sex, and nerves involved were collected. Eleven patients (12 RFAs/PRFs) (80%) reported improvement after their procedure. Pain scores improved significantly from 6.3 ± 2.3 before each procedure to 3.6 ± 2.7 after each procedure (p = 0.003). Eleven patients (12 RFAs/PRFs) reported an average improvement of 60.8% ± 35% after their procedure with an average duration of improvement of 128.8 ± 106.8days. RFA and PRF can be used to treat chronic peripheral pain after conservative methods fail to do so. Large clinical trials are needed to confirm our finding.

Comparison of Intraarticular Pulsed Radiofrequency and Intraarticular Corticosteroid Injection for Management of Cervical Facet Joint Pain

Background: Disorders of the facet joints are some of the most common sources of chronic spinal pain. Facet joint pain is responsible for approximately 50% of patients with chronic neck pain. Pulsed radiofrequency (PRF) stimulation, after placing needle electrodes into the joint space, has been recently reported for the management of joint pain. Objective: The aim of this study was to evaluate the effect of intraarticular (IA) PRF for the management of cervical facet joint (CFJ) pain. In addition, we compared the effect of IA PRF to IA corticosteroid injection. Study Design: Prospective observational study. Setting: University hospital. Methods: Forty patients with CFJ pain were included in the study and randomly assigned to one of 2 groups: the IA PRF group and the IA corticosteroid (ICI) group. There were 20 patients in each group. Pain intensity was evaluated using a numeric rating scale (NRS) at pre-treatment, and one, 3, and 6 months after treatment. Results: When compared to the pretreatment NRS scores, patients in both groups showed a significant decrease in NRS scores at one, 3, and 6 months after treatment (P = 0.000). Changes in the NRS scores over time were not significantly different between the groups (P = 0.227). Six months after treatment, 10 patients (50.0%) in the PRF group and 12 patients (60.0%) in the ICI group reported successful pain relief (pain relief of ≥ 50%). Limitations: A small number of participants. Conclusion: IA PRF stimulation is as effective as IA corticosteroid injection in attenuating CFJ pain. The use of PRF could decrease CFJ pain, while avoiding the adverse effects of steroids.

A comprehensive review of pulsed radiofrequency in the treatment of pain associated with different spinal conditions.

The objective of this review was to evaluate the efficacy of pulsed radiofrequency (PRF) treatment of pain associated with different spinal conditions. The mechanisms of action and biological effects are shortly discussed to provide the scientific basis for this radiofrequency modality. We systematically searched for clinical studies on spinal clinical conditions using PRF. We searched the MEDLINE (PubMed) database. We classified the information in one table focusing on randomized controlled trials (RCTs) and other types of studies. Date of last electronic search was October 2016. We found four RCTs that evaluated the efficacy of PRF on cervical radicular pain and five observational studies. Two trials and three observational studies were conducted in patients with facet pain. For disc-related pathology, we found one RCT with PRF applied intradiscally and three RCTs for dorsal root ganglia PRF modulation lumbosacral radicular pain. For sacroiliac joint pain, spondylolisthesis, malignancies and other minor spinal pathology, limited studies were conducted. From the available evidence, the use of PRF to the dorsal root ganglion in cervical radicular pain is compelling. With regard to its lumbosacral counterpart, the use of PRF cannot be similarly advocated in view of the absence of standardization of PRF parameters, enrolment criteria and different methods in reporting results; but, the evidence is interesting. The use of PRF in lumbar facet pain was found to be less effective than conventional RF techniques. For the other different spinal conditions, we need further studies to assess the effectiveness of PRF. Advances in knowledge: The use of PRF in lumbar facet pain was found to be less effective than conventional RF techniques. For the other different spinal conditions, we need further studies to assess the effectiveness of PRF.

Pulsed Compared to Thermal Radiofrequency to the Medial Calcaneal Nerve for Management of Chronic Refractory Plantar Fasciitis: A Prospective Comparative Study

Background: Radiofrequency (RF) treatment is a minimally invasive procedure that has been used for more than 3 decades in treating various chronic pain syndromes. Conventional (continuous) RF treatment occasionally results in worsening or even initiating a new type of pain. The use of pulsed radiofrequency (PRF), which has a non- or minimally neurodestructive neuromodulatory effect, serves as an alternative to conventional RF therapy in many medical situations. Objectives: To evaluate the effect of applying PRF for 6 minutes vs. thermal radiofrequency (TRF) for 90 seconds to the medial calcaneal nerve for treatment of chronic refractory plantar fasciitis pain. Study Design: Prospective comparative study. Setting: Pain, Orthopedic, and Rheumatology and Rehabilitation Clinics of Assiut University Hospital. Methods: Twenty patients with refractory chronic bilateral plantar fasciitis received PRF to the medial calcaneal nerve for 6 minutes for one heel and TRF to the same nerve on the other heel (as their own control) for 90 seconds. Numerical verbal rating scale (NVRS) at waking up from bed and after prolonged walking, and satisfaction score were used for assessment of studied patients at one, 3, 6, 12, and 24 weeks from the intervention. Results: All studied patients showed significant improvement in their pain scale after the intervention that lasted for 24 weeks; however, the PRF heels had significantly better pain scale and satisfaction scores at the first and third weeks assessments when compared to the TRF heels. Effective analgesia was achieved after one week or less after PRF compared to 3 weeks for the TRF (P &lt; 0.001). Limitations: No randomization. Conclusions: PRF to the medial calcaneal nerve is a safe and effective method for treatment of chronic plantar fasciitis pain. The onset of effective analgesia can be achieved more rapidly with PRF compared to TRF on the same nerve. Further randomized trials are needed to confirm the therapeutic effect and optimizing the dose of RF needed. Key words: Pulsed radiofrequency, thermal radiofrequency, medial calcaneal nerve, plantar fasciitis, plantar aponeurosis, visual analogue scale

Pulsed radiofrequency in clinical practice – A retrospective analysis of 238 patients with chronic non-cancer pain treated at an academic tertiary pain centre

Background and aimsPulsed radiofrequency is a non-neurodestructive invasive pain treatment which, in contrast to conventional continuous radiofrequency treatment, does not entail nerve tissue destruction. The aim of this study was to retrospectively analyse the short-term benefits of a broad use of pulsed radiofrequency in clinical practice. MethodsThe medical records of all patients treated with pulsed radiofrequency, or who received a diagnostic test block with a local anaesthetic in view of such a treatment, were retrospectively analysed. The patients had been referred to a tertiary pain centre in Sweden. The treatment effect one month after pulsed radiofrequency was retrospectively graded as follows, based on the wordings of the medical records: major improvement; minor improvement; no change; or worsened. ResultsA total of 238 patients received 587 interventions from 2009 to 2014. Chronic low back pain (CLBP) was by far the most common treatment indication (57% of patients), followed by CLBP with sciatica (9%). The age at first pulsed radiofrequency was 55 (15–94) years (mean, range), and 65% were female. Thirty-six patients (15%) underwent only a diagnostic test block using a local anaesthetic, i.e., the test block did not lead to treatment with pulsed radiofrequency. A total of 445 pulsed radiofrequency interventions were performed on 202 patients.Dichotomizing data into responders (i.e., minor or major improvement) and non-responders (i.e., worsened or no change), we found that, out of 63 responders to a median branch diagnostic test block (either at the cervical or lumbar level), 33 were responders to the first following median branch pulsed radiofrequency. Hence the positive predictive value of a median branch test block was 52%.In 127 patients, the lumbar level was targeted for median branch pulsed radiofrequency because of clinically suspected lumbar facetogenic pain. Looking at the first treatment, 30% experienced major improvement after 1 month, 16% minor improvement, 36% no change, 5% a worsened situation, and the effect was not assessable in 13% of patients. Lone dorsal root ganglion L2-treatment for suspected discogenic lumbar pain was done on 39 patients and, after one month, the effect was not assessable in 17% of patients, 14% had major improvement, 14% minor improvement, and 55% had no change.In 40 patients, a dorsal root ganglion or a peripheral nerve was targeted because of a non-axial chronic pain condition. There was a plethora of indications, but the most common was by far related to some form of neuropathic pain (52% of interventions, mainly because of neuralgia), followed by chronic nociceptive shoulder pain (8% of interventions). ConclusionsThis study shows that, after one month, the effect size of a broad and indiscriminate clinical use of pulsed radiofrequency is rather small. ImplicationsThe clinical effectiveness of pulsed radiofrequency has to be investigated further in carefully selected and more homogenous patient groups, in order to define effective treatment niches for this nondestructive invasive treatment method.

Pulsed Radiofrequency for Chronic Inguinal Neuralgia

Background: Chronic inguinal neuralgia has been reported after inguinal herniorrhaphy, caesarean section, appendectomy, and trauma to the lower quadrant of the abdomen or inguinal region. Objectives: This study was designed to evaluate the efficacy of pulsed radiofrequency in management of chronic inguinal neuralgia. Study Design: Randomized, double-blind controlled trial. Setting: Hospital outpatient setting. Methods: Twenty-one patients were allocated into 2 groups. Group 1 received 2 cycles of pulsed radiofrequency (PRF) for each nerve root. In Group 2, after stimulation, we spent the same time to mimic PRF. Both groups received bupivacaine 0.25% + 4 mg dexamethasone in 2 mL for each nerve root. Visual Analogue Scale (VAS) was assessed. Duration of the first block effective pain relief was reported. Repeated PRF blockade was allowed for any patient who reported a VAS &gt; 30 mm in both groups during the one year follow-up period. The number and duration of blocks were reported and adverse effects were also reported. Results: Significantly longer duration of pain relief was noticed in Group 1 (P = 0.005) after the first block, while the durations of pain relief of the second block were comparable (P = 0.59). In Group 1 the second PRF produced pain relief from the twenty-fourth week until the tenth month while in Group 2, pain relief was reported from the sixteenth week until the eighth month after the use of PRF. All patients in Group 2 received 3 blocks (the first was a sham PRF) during the one year follow-up period. Meanwhile, 2 PRF blocks were sufficient to achieve pain relief for patients in Group 1 except 4 patients who needed a third PRF block. No adverse events were reported. Limitations: Small sample size. Conclusion: For intractable chronic inguinal pain, PRF for the dorsal root ganglion represents a promising treatment modality. Key words: Radiofrequency, chronic, inguinal neuralgia

Pulsed Radiofrequency for Occipital Neuralgia

Background: The clinical application of pulsed radiofrequency (PRF) by interventional pain physicians for a variety of chronic pain syndromes, including occipital neuralgia, is growing. As a minimally invasive percutaneous technique with none to minimal neurodestruction and a favorable side effect profile, use of PRF as an interventional neuromodulatory chronic pain treatment is appealing. Occipital neuralgia, also known as Arnold’s neuralgia, is defined by the International Headache Society as a paroxysmal, shooting or stabbing pain in the greater, lesser, and/or third occipital nerve distributions. Pain intensity is often severe and debilitating, with an associated negative impact upon quality of life and function. Most cases of occipital neuralgia are idiopathic, with no clearly identifiable structural etiology. Treatment of occipital neuralgia poses inherent challenges as no criterion standard exists. Initially, conservative treatment options such as physical therapy and pharmacotherapy are routinely trialed. When occipital neuralgia is refractory to conservative measures, a number of interventional treatment options exist, including: local occipital nerve anesthetic and corticosteroid infiltration, botulinum toxin A injection, occipital nerve subcutaneous neurostimulation, and occipital nerve PRF. Of these, PRF has garnered significant interest as a potentially superior, safe, non-invasive treatment with long-term efficacy. Objective: The objective of this article is to provide a concise review of occipital neuralgia; and a concise, yet thorough, evidence-based review of the current literature concerning the use of PRF for occipital neuralgia. Study Design: Review of published medical literature up through April 2013. Setting: The Center for Pain Medicine and Regional Anesthesia, the University of Iowa Hospitals and Clinics. Results: A total of 3 clinical studies and one case report investigating the use of PRF for knee occipital neuralgia have been published worldwide. Statistically significant improvements in pain, quality of life, and adjuvant pain medication usage have been demonstrated. Limitations: Lack of randomized control trials, small study sample sizes, an absence of diagnostic block imaging guidance, and the use of outcome measures that are inherently subjective, limiting objectivity and introducing an unquantifiable degree of bias. Conclusion: Clinical studies to date examining the efficacy of PRF as a treatment for occipital neuralgia have yielded promising results, demonstrating sustained improvement in pain, quality of life, and adjuvant pain medication usage. Despite these encouraging clinical studies, conclusive evidence in support of PRF as an interventional treatment option for occipital neuralgia awaits to be seen. Key words: Occipital neuralgia, pulsed radiofrequency, PRF, greater occipital nerve, lesser occipital nerve, chronic pain, interventional pain management

A Patient With Loin Hematuria Syndrome and Chronic Flank Pain Treated With Pulsed Radiofrequency of the Splanchnic Nerves

Chronic abdominal and flank pain can be multifactorial and difficult to treat. Loin pain hematuria syndrome (LPHS) is a rare clinical cause of chronic abdominal and flank pain and is a diagnosis of exclusion with limited treatment options, ranging from medications to renal autotransplantation or even nephrectomy in resistant cases. A 50-year-old man with a history of recurrent nephrolithiasis secondary to hypercalcemia presented to the pain clinic with bilateral flank pain. After failed conservative medical management, the decision was made to proceed to interventional modalities. He responded for a short duration to a splanchnic nerve block and subsequently had a longer analgesic response to pulsed radiofrequency (PRF) ablation to the splanchnic nerves. LPHS is a difficult clinical scenario to diagnose and treat. Conservative options are often unsuccessful, but the more extreme interventions such as renal autotransplantation and nephrectomies are invasive and not always effective. In this case report, we describe the novel use of PRF to the splanchnic nerves as an alternative treatment modality for patients with LPHS.Although the exact mechanism of action of PRF on nerve tissue is unclear, its indication in pain management requires further research and discussion. Our patient experienced substantial and sustained relief of his flank pain. PRF may be a viable option for patients with LPHS.

Radiofrequency Therapy for Severe Idiopathic Vulvodynia

The study aimed to provide a description of a new and a hopeful possibility in the treatment of severe vulvodynia, which does not respond to treatments used so far. The use of radiofrequency therapy in vulvodynia treatment is described for the first time. This method was suggested by a neurosurgeon after applying all available possibilities. In this article, we are reporting on the successful use of the pulsed radiofrequency treatment in a patient with intractable chronic vulvodynia. To our knowledge, this is the first report of a successful use of pulsed radiofrequency in the treatment of chronic vulvodynia. If efficacy of pulsed radiofrequency is confirmed by more studies, it would be a welcome addition to the treatment modalities used to treat this sometimes truly intractable condition.

Pulsed radiofrequency treatment within brachial plexus for the management of intractable neoplastic plexopathic pain

We report on the use of pulsed radiofrequency (RF) within the plexus for the management of intractable pain in three patients with metastatic or invasive plexopathy. The patients were a 38-year-old woman with a history of breast cancer 6years earlier whose computed tomography (CT) scans revealed a mass lesion at the infraclavicular part of the right brachial plexus, a 68-year-old man diagnosed with advanced lung cancer whose CT scans revealed a bone metastasis in the right humerus invading the axillary region of the right brachial plexus, and a 67-year-old woman diagnosed with advanced lung cancer whose CT scans revealed a bone metastasis in the left humerus invading the axillary region of the left brachial plexus. Ultrasound-guided pulsed RF was performed within the interscalene brachial plexus. During the follow-up period, their intractable pain was moderately controlled.

O uso da radiofrequência pulsátil no tratamento da dor lombar

BACKGROUND AND OBJECTIVES: Low back pain treatment may be either conservative or surgical. Current guidelines recommend conservative treatment for most cases, with drugs and rehabilitation, including physical medicine and psychological assistance. Invasive procedures may be justified if there are evidences of short and long term benefits, and minimally invasive techniques, such as radiofrequency, are modern and effective to relieve this pain. This study aimed at searching Brazilian literature about the use of pulsed radiofrequency to treat low back pain. CONTENTS: A literature survey was carried out with articles published from 2004 to 2010 in Portuguese and Spanish in LILACS, Scielo and Cochrane, Cinahl and Medline databases. CONCLUSION: Pulsed radiofrequency is an effective method to treat chronic low back pain, with low incidence of complications.