Efficacy of Radiofrequency as Therapy and Diagnostic Support in the Management of Musculoskeletal Pain: A Systematic Review and Meta-Analysis

Abstract

Radiofrequency (RF) is a minimally invasive procedure used to interrupt or alter nociceptive pathways for treating musculoskeletal pain. It seems a useful tool to relieve chronic pain syndromes, even if, to date, solid evidence is still needed about the effectiveness of this therapy. By this systematic review and meta-analysis, we aimed to evaluate the efficacy of RF in treating musculoskeletal pain. PubMed, Medline, Cochrane, and PEDro databases were searched to identify randomized controlled trials (RCTs) presenting the following: patients with chronic musculoskeletal pain as participants; RF as intervention; placebo, anesthetic injection, corticosteroid injection, prolotherapy, conservative treatment, physiotherapy, and transcutaneous electrical nerve stimulation as comparisons; and pain and functioning as outcomes. Continuous random-effect models with standardized mean difference (SMD) were used to compare the clinical outcomes. Overall, 26 RCTs were eligible and included in the systematic review. All of them analyzed the efficacy of RF in four different regions: cervical and lumbar spine, knee, sacroiliac (SI) joint, shoulder. The outcomes measures were pain, disability, and quality of life. A medium and large effect in favor of the RF treatment group (SMD < 0) was found for the shoulder according to the Visual Analogical Scale and for the SI joint according to the Oswestry Disability Index. A small effect in favor of the RF treatment group (SMD > 0) was found for the spine according to the 36-item Short Form Survey. Non-significant SMD was found for the other outcomes. RF represents a promising therapy for the treatment of chronic musculoskeletal pain, especially when other approaches are ineffective or not practicable. Further studies are warranted to better deepen the effectiveness of RF for pain and joint function for each anatomical region of common application.

Is Electrocatheter-Mediated High-Voltage Pulsed Radiofrequency of the Dorsal Root Ganglion an Effective Adjuvant to Epidural Adhesiolysis in the Treatment of Chronic Lumbosacral Radicular Pain? A Retrospective Analysis

“…Many RCT studies, as displayed by Farì et al [17] in their meta-analysis, demonstrated that both pulsed or continuous or water-cooled RF (WCRF), could represent a promising therapy for treating chronic musculoskeletal pain, especially when other approaches are ineffective or not practicable. Their group also showed that continuous RF combined with therapeutic exercise in rehabilitating severe hip osteoarthritis is an attractive option for significant pain relief as it allows patients to carry out kinesitherapy more easily [18].…”

Physiatry for Treating Hip, Knee, and Back Pain

“…Another minimally invasive technique used in the treatment of chronic musculoskeletal pain includes RFA also known as radiofrequency neurotomy (RFN). This nonsurgical procedure is used to treat chronic pain from an innervated structure typically of facet origin that ablates (disconnects) nociceptive pathways causing the pain (Farì et al, 2022; Huang et al, 2020; Wray et al, 2022). Ablation is typically done using high temperatures, cold temperatures, or chemicals.…”

“…Both epidural steroid injections and RFAs give physiatrists additional means to treat back pain when more conservative options have failed. A systematic review and meta-analysis by Farì et al (2022) indicated RFA as a therapy favorable in treating chronic musculoskeletal pain when other methods are not feasible. Evidence-based guidance for the use of RFN identified by The American Society of Pain and Neuroscience examined a variety of anatomic uses of RFA resulting in practice guidelines (Lee et al, 2021).…”

Joint pathology in musculoskeletal lumbar pain: a dialogue between a neurologist and a rheumatologist

“…Широко используются диагностические блокады с местными анестетиками у тех пациентов, у которых Терапия боли нет эффекта от консервативной терапии. В таких случаях если введение анестетиков в область ФС или КПС приводит к исчезновению или существенному снижению боли (на 50% и более), выполняется введение анестетиков и кортикостероидов в область ФС и КПС [13,14], а также микрохирургические методы денервации, преимущественно радиочастотная денервация [22]. Эти методы терапии обычно уменьшают боль и улучшают функциональное состояние пациента, однако нет убедительных доказательств, что они имеют преимущество перед рекомендуемой экспертами тактикой, включаю щей применение нестероидных противовоспалительных средств (НПВС), кинезитерапию, психологические и другие консервативные методы лечения [19,21].…”