A Randomized Controlled Trial to Evaluate the Effect of Pulsed Radiofrequency as a Treatment for Anterior Cutaneous Nerve Entrapment Syndrome in Comparison to Anterior Neurectomy

Abstract

& AbstractBackground: Chronic abdominal pain can be due to entrapped intercostal nerves (anterior cutaneous nerve entrapment syndrome [ACNES]). If abdominal wall infiltration using an anesthetic agent is unsuccessful, a neurectomy may be considered. Pulsed radiofrequency (PRF) applies an electric field around the tip of the cannula near the affected nerve to induce pain relief. Only limited retrospective evidence suggests that PRF is effective in ACNES.Methods: A multicenter, randomized, nonblinded, controlled proof-of-concept trial was performed in 66 patients. All patients were scheduled for a neurectomy procedure. Thirty-three patients were randomized to first receive a 6minute cycle of PRF treatment, while the other 33 were allocated to an immediate neurectomy procedure. Pain was recorded using a numeric rating scale (NRS, 0 [no pain] to 10 [worst pain possible]). Successful treatment was defined as >50% pain reduction. Patients in the PRF group were allowed to cross over to a neurectomy after 8 weeks.Results: The neurectomy group showed greater pain reduction at 8-week follow-up (mean change from baseline À2.8 (95% confidence interval [CI] À3.9 to À1.7) vs. À1.5 (95% CI À2.3 to À0.6); P = 0.045) than the PRF group. Treatment success was reached in 12 of 32 (38%, 95% CI 23 to 55) of the PRF group and 17 of 28 (61%, 95% CI 42 to 72) of the neurectomy group (P = 0.073). Thirteen patients were withdrawn from their scheduled surgery. Adverse events were comparable between treatments.

Efficacy of Pulsed Radiofrequency or Short-Term Spinal Cord Stimulation for Acute/Subacute Zoster-Related Pain: A Randomized, Double- Blinded, Controlled Trial

“…There are numerous animal experiments and clinical research that demonstrated that PRF can achieve better pain relief on NP compared with other therapeutic methods (28,29). Although the detailed mechanics are unclear by far, studies mainly exhibit that the analgesia of PRF is through the pulse electric current and the biological effects, including the effects on neurons, glial cells, and nerve fibers (30).…”

Pulsed Radiofrequency Ablation for Anterior Cutaneous Nerve Entrapment Syndrome: A Case Report

“…14,15 In terms of efficacy, a clinical trial recently showed PRF to be a minimally invasive treatment alternative to neurectomy in patients with ACNES. 16 In the case presented, the patient had a notable allergy to corticosteroids, resulting in the search alternative treatment options. Before attempting PRF for long-lasting pain relief, a treatment of shorter duration was used to determine the location of nerve irritation and efficacy of nerve disruption.…”

Wanneer flankpijn op de zenuwen werkt: een nieuwe diagnose?

“…Wanneer de behandeling met lidocaïne niet voldoende (lang) effect heeft, kan als tweede stap pulsed radiofrequency (PRF) worden verricht via een pijnspecialist. Bij ACNES leidde behandeling met PRF tot een pijnreductie bij 38% van de patiënten tegenover 61% in de groep die werden behandeld met neurectomie [14]. Wanneer minimaal invasieve behandeling met injecties en PRF falen, kan neurectomie dus worden overwogen.…”