Pulsed radiofrequency for chronic pain

Stanford University, 780 Welch Road #208, Palo Alto, CA 94304, USA.
Current Pain and Headache Reports (Impact Factor: 2.26). 02/2008; 12(1):37-41. DOI: 10.1007/s11916-008-0008-3
Source: PubMed


Pulsed radiofrequency (PRF), a technology related to continuous radiofrequency, is unique in that it provides pain relief without causing significant damage to nervous tissue. The mechanism by which PRF controls pain is unclear, but it may involve a temperature-independent pathway mediated by a rapidly changing electrical field. Although much anecdotal evidence exists in favor of PRF, there are few quality studies substantiating its utility.

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Available from: Sean Mackey, Aug 11, 2015
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    • "From 1999 to 2004, clinical cases showed that the therapeutic effect lasts about 4–6 months on average [2]. To make treatments more permanent, implantable neural electrical stimulation systems have been developed to make the system more viable to treat various disorders, such as for Parkinson's disease [3] and sciatica [4] [5]. To address the invasiveness of implanting surgeries, minimally invasive surgery (MIS) procedures have been developed, which aim to reduce the size of incisions as well as a patient's discomfort after an operation [6]. "
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    ABSTRACT: A bipolar electrode probe used for implantable nerve stimulation treatments in minimally invasive surgeries is presented. The probe is composed of a flexible printed circuit substrate and a patterned SU-8 film. This probe features a three-dimensional (3D) tweezer-like mechanism opened by residual stress from the SU-8 film, designed to fix the probe in the tissue surrounding a target nerve. Stripes on the SU-8 film direct the net residual stress in a single direction to form a curve. The holding strengths of the probes with different deformations are defined and measured by a tensile test. Results show that the fixing ability of a 3D probe is better than a plane probe. The probes with curvature heights between 13 and 14 mm have a maximum average breaking force of 0.258 N, which is 16.3 and 13.1% higher than the probes with curvature heights between 9 and 10 mm and between 10 and 11 mm, respectively. In addition, a film of gelatin fibrous membrane, produced by electrospinning, covers the fixed ends of the probe's anchors and acts as cell scaffolds to induce cell growth, which help to ensure long-term fixation in the body. 3T3 fibroblast cells are grown to verify the scaffold effect of the fibrous membrane.
    Micro & Nano Letters 12/2014; 9(12):901-905. DOI:10.1049/mnl.2014.0447 · 0.85 Impact Factor
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    • "This is advantageous because it avoids lesioning of the wrong nerves. Generally, focal tissue destruction occurs between 60 and 80°C [9]. Unfortunately, this procedure has risks such as deafferentation pain syndrome [9], neuritis, and parenthesis [10, 11]. "
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    ABSTRACT: This report describes a case of bilateral greater occipital neuralgia treated with cooled radiofrequency ablation. The case is considered in relation to a review of greater occipital neuralgia, continuous thermal and pulsed radiofrequency ablation, and current medical literature on cooled radiofrequency ablation. In this case, a 35-year-old female with a 2.5-year history of chronic suboccipital bilateral headaches, described as constant, burning, and pulsating pain that started at the suboccipital region and radiated into her vertex. She was diagnosed with bilateral greater occipital neuralgia. She underwent cooled radiofrequency ablation of bilateral greater occipital nerves with minimal side effects and 75% pain reduction. Cooled radiofrequency ablation of the greater occipital nerve in challenging cases is an alternative to pulsed and continuous RFA to alleviate pain with less side effects and potential for long-term efficacy.
    02/2014; 2014:257373. DOI:10.1155/2014/257373
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    • "The evidence was supposedly similar for both RF and PRF in cervical radicular pain but they opined that PRF should be preferred as it is associated with lesser side effects. Bryd and Mackey [49] performed an excellent review of PRF including its history and its applications in various pain conditions. Apart from recognizing that evidence in the form of RCTs are lacking, they stated that the emergence of PRF technology represents a promising step toward treating complicated pain conditions. "
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    ABSTRACT: Background Chronic lumbar radicular pain can be described as neuropathic pain along the distribution of a particular nerve root. The dorsal root ganglion has been implicated in its pathogenesis by giving rise to abnormal impulse generation as a result of irritation, direct compression and sensitization. Chronic lumbar radicular pain is commonly treated with medications, physiotherapy and epidural steroid injections. Epidural steroid injections are associated with several common and rarer side effects such as spinal cord infarction and death. It is essential and advantageous to look for alternate interventions which could be effective with fewer side effects. Pulse radio frequency is a relatively new technique and is less destructive then conventional radiofrequency. Safety and effectiveness of pulse radio frequency in neuropathic pain has been demonstrated in animal and humans studies. Although its effects on dorsal root ganglion have been studied in animals there is only one randomized control trial in literature demonstrating its effectiveness in cervical radicular pain and none in lumbar radicular pain. Our primary objective is to study the feasibility of a larger trial in terms of recruitment and methodology. Secondary objectives are to compare the treatment effects and side effects. Methods/designs This is a single-center, parallel, placebo-controlled, triple-blinded (patients, care-givers, and outcome assessors), randomized control trial. Participants will have a history of chronic lumbar radicular pain for at least 4 months in duration. Once randomized, all patients will have an intervention involving fluoroscopy guided needle placement to appropriate dorsal root ganglion. After test stimulation in both groups; the study group will have a pulse radio frequency treatment at 42°C for 120 s to the dorsal root ganglion, with the control group having only low intensity test stimulation for the same duration. Primary outcome is to recruit at least four patients every month with 80% of eligible patients being recruited. Secondary outcomes would be to assess success of intervention through change in the visual analogue scale measured at 4 weeks post intervention and side effects. Allocation to each group will be a 1:1 ratio with allocation block sizes of 2, 4, and 6. Trial registration ClinicalTrials.gov NCT01117870
    Trials 04/2012; 13(1):52. DOI:10.1186/1745-6215-13-52 · 1.73 Impact Factor
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