Cooled Radiofrequency Ablation for Intercostal Neuralgia

Abstract

Background: Intercostal neuralgia is pain associated with the intercostal nerves along the rib, chest, and upper abdominal wall. Intercostal neuralgia has various etiologies, and current conventional treatment options include intercostal nerve blocks, nonsteroidal anti-inflammatory drugs, transcutaneous electrical nerve stimulation, topical medications, opioids, tricyclic antidepressants, and anticonvulsants. For a subset of patients, these conventional treatment options provide little relief. Radiofrequency ablation (RFA) is an emerging procedure for the treatment of chronic pain and neuralgias. Cooled RFA (CRFA) is a specific type of RFA that has been trialed as a treatment for intercostal neuralgia in patients refractory to conventional treatment modalities. This case series assesses the efficacy of CRFA for the treatment of intercostal neuralgia in 6 patients. Case Series: Three female and 3 male patients underwent CRFA of the intercostal nerves to treat intercostal neuralgia. The patients had an average age of 50.7 years and demonstrated an average pain reduction of 81.3%. Conclusion: This case series suggests that CRFA may be an effective treatment option for patients with intercostal neuralgia that is not responsive to conservative treatment options. To determine the duration of pain improvement, large research studies need to be conducted.

Bony Decompression of a Chronically Painful Intercostal Nerve Yields Immediate and Long-Lasting Pain Relief

“…Despite a potentially promising and precise technique, cryoablation has limited long-term efficacy with variable success in patients' 1year postablation 16,19,20 . Other nonsurgical treatments of intercostal neuralgia have been attempted but likewise with variable success 2,15,[21][22][23] .…”

Pathophysiology and Management of Chest Wall Pain after Surgical and Non-Surgical Local Therapies for Lung Cancer

“…In a case series of two patients with post-surgical intercostal neuralgias, RFA led to a significant improvement in patients’ pain with no procedural complications. 74 In a retrospective series of 18 patients who underwent cryoablation for post-thoracotomy pain syndrome, the authors reported a mean improvement in pain scores of 3.4 points on a 10-point scale following the procedure. 75 No procedural complications were reported.…”