Comparison of the Effects of Ultrasound-Guided Interfascial Pulsed Radiofrequency and Ultrasound-Guided Interfascial Injection on Myofascial Pain Syndrome of the Gastrocnemius

Abstract

ObjectiveTo investigate the comparative treatment effects of ultrasound-guided pulsed radiofrequency treatment (UG-PRF) in the gastrocnemius interfascial space and ultrasound-guided interfascial injection (UG-INJ) on myofascial pain syndrome.MethodsForty consecutive patients with myofascial pain syndrome of the gastrocnemius were enrolled and were allocated to one of the two groups. Twenty patients were treated by UG-PRF delivered to the gastrocnemius interfascial space (UG-PRF group) and the other 20 patients were treated by interfascial injection (UG-INJ group). The primary outcome measure was the numeric rating score (NRS) for pain on pressing the tender point in the gastrocnemius, and the secondary outcome measure was health-related quality of life as determined by the Short Form-36 questionnaire (SF-36). NRSs were obtained at the first visit, immediately after treatment, and at 2 and 4 weeks post-treatment, and physical component summary scores (PCS) and mental component summary scores (MCS) of the SF-36 questionnaire were measured at the first visit and at 4 weeks post-treatment.ResultsImmediately after treatments, mean NRS in the UG-PRF group was significantly higher than that in the UG-INJ group (p<0.0001). However, at 2 and 4 weeks post-treatment, the mean NRS was significantly lower in the UG-PRF group (both p<0.0001). Similarly, at 4 weeks post-treatment, mean PCS and MCS were significantly higher in the UG-PRF group (p<0.0001 and p=0.002, respectively).ConclusionBased on these results, the authors conclude that ultrasound-guided gastrocnemius interfascial PRF provides an attractive treatment for myofascial pain syndrome of the gastrocnemius.

Comparison between ultrasound-guided interfascial pulsed radiofrequency and ultrasound-guided interfascial block with local anesthetic in myofascial pain syndrome of trapezius muscle

“…This result is in agreement with previous studies, in which PRF has better and longer effects compared to local anesthesia when used on radiculopathy, neuropathy, joint arthritis, or complex regional pain syndrome. [ 17 , 38 – 40 ]…”

“…Eight (66%) out of 12 patients reported more than 50% pain relief at 6 months after the procedure. In 2016, Park et al [ 17 ] evaluated the effect of US-guided PRF stimulation on the interfascial area of the GCM in 20 patients. The NRS score was reduced from 5 to 2.4, and the effect of PRF was sustained for at least 4 weeks.…”

“…This study was approved by the Institutional Review Board of a university hospital. Based on our previous study, [ 17 ] we calculated a sample size. In that study, the difference of the NRS reduction after each treatment (PRF stimulation and lidocaine block) was 1.00 ± 0.97 (mean ± standard deviation).…”

“…Because steroid injection often causes adverse effects, such as muscle/fat atrophy and suppression of the pituitary-adrenal axis, [ 19 , 20 ] we used only local anesthetic for IFB. [ 17 , 21 – 23 ] Under US guidance, we injected 3 mL of 2% lidocaine mixed with 7 mL of normal saline solution (i.e., 10 mL of 0.6% lidocaine) into the interfascial area of the TM with a 25-gauge 1.5-inch needle.…”

Expert consensus on the diagnosis and treatment of myofascial pain syndrome

“…The mechanism of RF therapy is to produce a therapeutic effect by damaging the abnormal peripheral nerve of local hyperplasia, separating and releasing the contracture of soft tissue and improving microcirculation[ 55 ]. Several studies have shown that RF treatment of trapezius pain, psoas pain, heel pain and other MPS has a significant effect[ 56 - 58 ]. The complications of RF treatment of MPS include the injury caused by puncture operation.…”