Application of Radiofrequency in Pain Management

Abstract

The application of radiofrequency is a treatment for many clinical conditions such as trigeminal neuralgia, complex regional pain syndrome, chronic postsurgical pain, cancer pain, hyperhidrosis and facet joint pain requiring ablation of different nerve locations. In this procedure, a constant high-frequency, high-temperature electrical current is applied to target tissue. Sluijter has achieved significant pain relief using radiofrequency current at a temperature below 42°C that produced strong electromagnetic field with no thermal lesion and referred as pulsed radiofrequency. The use of pulsed radiofrequency is a nonneurodestructive and therefore less painful technique, and it serves as an alternative method to continuous radiofrequency. Many studies have demonstrated favorable outcomes with pulsed radiofrequency compared to continuous radiofrequency.This chapter suggests the use of continuous and pulsed radiofrequency with a minimally invasive procedure for patients with chronic pain as an alternative to surgical treatment and it might be an additional option among nonsurgical treatment methods.

Domain Heterogeneity in Radiofrequency Therapies for Pain Relief: A Computational Study with Coupled Models

“…There has been continuous development in RF delivery systems and protocols in the quest to increase the ablation volume, which will lead to enhanced efficacy of the RF procedure. Continuous RF is the conventional form of energy delivery, and it causes a decline in the transmission of pain signals by damaging both sensory and motor nerve fibers [1,19]. Three different types of electrodes are typically utilized for delivery of RF energy to the target neural tissue, viz., monopolar, bipolar and cooled RF electrodes (arranged in ascending order of ablation volume generation).…”

“…As mentioned earlier, contrary to the continuous RF that causes tissue destruction by heat, the pulsed RF is virtually painless and does not lead to any neural coagulation and irreversible tissue damage. Instead, it leads to an alteration in the pain signal transduction of the nerve fibers [1,19]. Although the efficacy of pulsed RF has been well-documented, the exact mechanism of action in the mitigation of pain is not fully understood yet [14,18,54,[56][57][58][59].…”

“…Radiofrequency ablation has been used for pain management since the mid-1970s [ 46 ] and has significantly evolved from a therapy that was mainly employed for mitigating neuropathic pain to one of the most promising and frequently applied techniques in clinical practices for alleviating axial spine and musculoskeletal pain [ 1 , 16 ]. Today, the application of RFA in treating pain has steadily expanded and accepted for the treatment of facet joint, sacroiliac joint dysfunction and osteoarthritis [ 8 , 9 , 10 , 11 , 12 , 13 , 15 , 16 , 17 , 18 , 19 , 20 ]. However, there are significant contradictions and inconsistencies in the reported clinical results on the efficacy of RF procedures.…”

“…In the conventional continuous power delivery mode, RF currents applied between the electrode (accurately placed on the target nerve) and the dispersive ground electrode (placed on the patient's skin) results in temperatures above 50 • C. The high temperature obtained during the continuous RF procedure results in coagulative necrosis of the neural tissue that further leads to protein denaturation and axon destruction, which ultimately stops the transmission of nociceptive signals from the periphery, thereby mitigating pain. In contrast to the continuous RF mode, which relies on the high temperature to cause neural ablation, the pulsed delivery mode utilizes the application of short pulses of RF current to the neural tissue from the RF generator that is followed by silent phases to allow time for heat dissemination [14,18,19]. The electric field generated due to these applied pulses disrupts the functioning of neuronal membrane, along with genetic changes that affect cytokine release [8].…”

Radiofrequency as Pain Interventional Therapy in Neurology

“…Kasus ini sebagian besar etiologinya adalah idiopatik tanpa adanya kelainan strukutral (22). Prosedur radiofrekuensi untuk terapi pada occipital neuralgia, migraine dan cervicogenic headchaches dengan target pada greater occipital nerve (C2), lesser occipital nerve (C3) (23). Studi klinis mengenai efikasi dari PRF sebagai terapi dari neuralgia occipitalis telah menunjukkan hasil yang menjanjikan, yakni perbakan dari nyeri, kualitas hidup dan penggunaan anti nyeri tambahan (22).…”