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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    • "Therefore, it is better to apply it if some damage to the nerve already existed, and the damage is difficult to repair or correct using current modalities. The current application of pulsed RFA in pain practices is to the dorsal root ganglia for the treatment of postherpetic neuralgia, which has scarred the dorsal horn of the spinal cord and dorsal root ganglion at 42 o C for 120 seconds, repeated 2 or 3 times (Fig. 4)[21]. It may be applied to the injured dorsal root ganglion in type 2 complex regional pain syndrome. "
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    ABSTRACT: A nerve block is an effective tool for diagnostic and therapeutic methods. If a diagnostic nerve block is successful for pain relief and the subsequent therapeutic nerve block is effective for only a limited duration, the next step that should be considered is a nerve ablation or modulation. The nerve ablation causes iatrogenic neural degeneration aiming only for sensory or sympathetic denervation without motor deficits. Nerve ablation produces the interruption of axonal continuity, degeneration of nerve fibers distal to the lesion (Wallerian degeneration), and the eventual death of axotomized neurons. The nerve ablation methods currently available for resection/removal of innervation are performed by either chemical or thermal ablation. Meanwhile, the nerve modulation method for interruption of innervation is performed using an electromagnetic field of pulsed radiofrequency. According to Sunderland's classification, it is first and foremost suggested that current neural ablations produce third degree peripheral nerve injury (PNI) to the myelin, axon, and endoneurium without any disruption of the fascicular arrangement, perineurium, and epineurium. The merit of Sunderland's third degree PNI is to produce a reversible injury. However, its shortcoming is the recurrence of pain and the necessity of repeated ablative procedures. The molecular mechanisms related to axonal regeneration after injury include cross-talk between axons and glial cells, neurotrophic factors, extracellular matrix molecules, and their receptors. It is essential to establish a safe, long-standing denervation method without any complications in future practices based on the mechanisms of nerve degeneration as well as following regeneration.
    Full-text · Article · Jan 2016 · The Korean journal of pain
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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.
    Full-text · Article · Dec 2014 · Micro & Nano Letters
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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.
    Full-text · Article · Feb 2014
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