Efficacy and safety of high-voltage versus standard-voltage pulsed radiofrequency ablation for patients with neuropathic pain: protocol for a systematic review and meta-analysis

Jia, Yitong; Wang, Zheng; Ma, Yanhui; Wang, Tengteng; Feng, Kunpeng; Feng, Guang; Wang, Tianlong

doi:10.1136/bmjopen-2022-063385

Cited by 6 publications

(4 citation statements)

References 29 publications

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“…Radiofrequency probes ranged from 5 to 10 cm, active tip ranging from 4 to 10 mm, needle gauge ranging from 20 to 22 G, and the duration of treatment from 120 s to 20 min. Output voltage, although seldom reported in the reviewed studies, was at the standard output of 45 V. As such, these results may not reflect more recent studies employing high‐voltage PRF at 60 V at other anatomical targets, for which the upcoming results of a meta‐analysis will be of high clinical interest 27 . That being said, most studies (except for two 7,8 ), appeared to have some consistency in a few of the PRF technical parameters (duration of 2 min, 42°C, 5 cm active tip, 22 Gauge needle) and all studies except one 12 utilized ultrasound guidance.…”

Section: Discussionmentioning

confidence: 82%

“…Output voltage, although seldom reported in the reviewed studies, was at the standard output of 45 V. As such, these results may not reflect more recent studies employing high-voltage PRF at 60 V at other anatomical targets, for which the upcoming results of a meta-analysis will be of high clinical interest. 27 That being said, most studies (except for two 7,8 ), appeared to have some consistency in a few of the PRF technical parameters (duration of 2 min, 42°C, 5 cm active tip, 22 Gauge needle) and all studies except one 12 utilized ultrasound guidance. Overall, the lack of standardization for PRF parameters makes it challenging to compare results across studies.…”

Section: Limitations Of Reviewmentioning

confidence: 91%

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A narrative review of pulsed radiofrequency for the treatment of carpal tunnel syndrome

Gupta,

Vance,

Bansal

et al. 2023

Pain Practice

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ObjectiveCarpal tunnel syndrome (CTS), which is the most common peripheral nerve entrapment syndrome, can commonly persist despite conservative treatment modalities such as wrist splinting or medications. Pulsed radiofrequency represents a minimally invasive pain intervention technique to alleviate pain. The literature was reviewed to establish the effectiveness of PRF therapy for CTS.Study DesignThis is a narrative review of relevant articles on the effectiveness of PRF for CTS.MethodFour databases, MEDLINE, Cochrane Central Register of Controlled Trials, Embase, OVID Emcare, and Web of Science, were systematically searched. 804 records were screened, and the reference lists of eligible articles were examined. For this review, eight extracted studies were narratively explored.ResultsOne case report, three retrospective cohorts, one observational prospective study, and three randomized‐controlled trials were included. PRF likely provides both an analgesic and functional benefit in patients with mild to severe CTS, and it also shows benefit as an adjunct to carpal tunnel release surgery. Long‐term data is limited. It also appears likely that steroid injection may represent a comparable treatment modality to PRF, and there have been positive results when these modalities are used together. Notably, all studies differed in their methodology, making direct comparisons between studies challenging.ConclusionsThe evidence for PRF in the treatment of CTS, across the range of spectrum of severity or peri‐operative to CTS surgery, appears favorable and avoids known side effects of steroid injections. Potential mechanisms for PRF and future directions for research are explored.

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Section: Discussionmentioning

confidence: 82%

Section: Limitations Of Reviewmentioning

confidence: 91%

A narrative review of pulsed radiofrequency for the treatment of carpal tunnel syndrome

Gupta,

Vance,

Bansal

et al. 2023

Pain Practice

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“…The protocol of the systematic review was registered in the PROSPERO database (registration number: CRD 42022297804) and published on BMJ open. 24…”

Section: Methodsmentioning

confidence: 99%

Efficacy and Safety of High-Voltage Pulsed Radiofrequency versus Standard-Voltage Pulsed Radiofrequency for Patients with Neuropathic Pain: A Literature Review and Meta-Analysis

Wang,

Jia,

Wang

et al. 2024

JPR

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Background: Neuropathic pain (NP) is recognized as one of the most difficult pain syndromes which lacks a safe, well-tolerated and effective treatment. Pulsed radiofrequency (PRF), a novel and minimally invasive interventions, has been introduced to alleviate various types of NP. Previous studies reported PRF with higher voltage could further improve the treatment efficacy. Therefore, we conducted this systematic review and meta-analysis to determine whether high-voltage PRF is superior to standard-voltage PRF for the treatment of NP patients. Methods: Databases published from the date of inception until 15 March 2022 on PubMed/MEDLINE, EMBASE, Web of Science and the Cochrane Library were searched for RCTs comparing high-voltage PRF and standard-voltage PRF in NP patients. The primary outcome measures were the efficiency rates of NP patients with high-voltage PRF or standard-voltage PRF treatment. Data analysis was conducted using the Review Manager software (RevMan V.5.3). Results: Six RCTs involving 423 patients were included in our meta-analysis. Compared with standard-voltage PRF group, the highvoltage PRF group attained a higher efficiency rate at 1 month (P = 0.04; I 2 = 0%), 3 months (P = 0.04; I 2 = 0%), 6 months (P = 0.002; I 2 = 0%) post-procedure respectively. There was no significant difference in the complications between the two groups. Conclusion: Our study supported that high-voltage PRF attained more satisfactory efficacy than standard-voltage PRF without increased side effects. High-voltage PRF could be a promising, effective, minimally invasive technology for NP patients.

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“…Common formulations for epidural injections include methylprednisolone, triamcinolone, betamethasone, or dexamethasone [32]. Non particulate (such as dexamethasone) formulations are considered first line as severe complications have been observed only with particulate formulations [3,33]. The effectiveness of epidural corticosteroid injection in treating painful radiculopathy remains a topic of debate, with differing recommendations and evidence of moderate quality.…”

Section: Epidural Injectionmentioning

confidence: 99%

Interventional procedures for refractory neuropathic pain

Matejowsky,

Kataria,

Spillers

et al. 2023

Explor Neurosci

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Neuropathic pain is an increasingly common disease affecting millions of individuals worldwide. Refractory pain poses a significant impact on patients’ quality of life, financial and economic stability, and social interaction. Numerous effective modalities for treatment of refractory neuropathic pain are presently available. Currently, many options provide symptomatic treatment but are associated with an unfavorable side effect profile and increased risk of addiction. The present investigation reviews current medical management for refractory neuropathic pain including the use of antidepressants, anticonvulsants, gabapentinoids and opioid therapy, as well as interventional pain procedures such as spinal cord stimulation (SCS) and intrathecal targeted drug delivery. While multidisciplinary management with lifestyle modification and pharmacologic regimens remains at the forefront of treating many of these patients, interventional modalities are growing in popularity and have been demonstrated to be highly efficacious. In this regard, continued understanding of the pathophysiology surrounding refractory neuropathic pain has led to the development of interventional procedures and better outcomes for patients suffering from refractory neuropathic pain. When and if patients fail conservative therapy, interventional techniques are desirable alternatives for pain management. SCS and intrathecal targeted drug delivery are important tools for the treatment of refractory neuropathic pain. In summary, treatment modalities for refractory neuropathic pain are evolving with demonstrated efficacy. This review aims to outline the efficacy of various interventional procedures for refractory neuropathic pain in comparison to traditional drug therapies.

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Efficacy and safety of high-voltage versus standard-voltage pulsed radiofrequency ablation for patients with neuropathic pain: protocol for a systematic review and meta-analysis

Cited by 6 publications

References 29 publications

A narrative review of pulsed radiofrequency for the treatment of carpal tunnel syndrome

A narrative review of pulsed radiofrequency for the treatment of carpal tunnel syndrome

Efficacy and Safety of High-Voltage Pulsed Radiofrequency versus Standard-Voltage Pulsed Radiofrequency for Patients with Neuropathic Pain: A Literature Review and Meta-Analysis

Interventional procedures for refractory neuropathic pain

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