Pulsed Radiofrequency of Dorsal Root Ganglia for the Treatment of Complex Regional Pain Syndrome in an Adolescent with Poliomyelitis Sequel: A Case Report

Apilioğulları, Seza; Aydın, Bahattin Kerem; Önal, Özkan; Kirac, Yunus; Çelik, Jale Bengi

doi:10.1111/pme.12710

Cited by 6 publications

(9 citation statements)

References 16 publications

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“…Traditionally, the DRG neuron is considered to be a structure that merely ‘supports’ physiological communication between the peripheral and central nervous systems to convey peripherally encoded information to the spinal cord or trigeminal nuclei of the brain stem. 15 However, new clinical data have shown that a pulsed radiofrequency current applied to the DRG may reduce pain intensity in patients with complex regional pain syndrome 16 or lumbosacral radicular syndrome. 17 Thus, the DRG is an active participant in the processing of pain information and therefore a robust target for neuromodulation therapies.…”

Section: Introductionmentioning

confidence: 99%

Effect of Electroacupuncture on Thermal Pain Threshold and Expression of Calcitonin-Gene Related Peptide, Substance P and γ-Aminobutyric Acid in the Cervical Dorsal Root Ganglion of Rats with Incisional Neck Pain

et al. 2017

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ObjectiveAcupuncture therapy effectively reduces post-surgical pain, but its mechanism of action remains unclear. The aim of this study was to investigate whether expression of γ-aminobutyric acid (GABA) and the neuropeptides substance P (SP) and calcitonin gene-related peptide (CGRP) in the primary sensory neurons of cervical dorsal root ganglia (DRG) are involved in electroacupuncture (EA)-induced analgesia in a rat model of incisional neck pain.MethodsThe pain model was established by making a longitudinal midline neck incision in 60 rats. Another 15 rats underwent sham surgery (normal group). Post-incision, 15 rats remained untreated (model group) and 45 rats underwent EA (frequency 2/100 Hz, intensity 1 mA) at bilateral LI18, LI4-PC6 or ST36-GB34 (n=15 each) for 30 min at 4 hours, 24 hours, and 48 hours post-surgery, followed by thermal pain threshold (PT) measurement. 30 min later, the rats were euthanased and cervical (C3-6) DRGs removed for measurement of immunoreactivity and mRNA expression of SP/CGRP and the GABAergic neuronal marker glutamic acid decarboxylase 67 (GAD67).ResultsThermal PT was significantly lower in the model group versus the normal group and increased in the LI18 and LI4-PC6 groups but not the ST36-GB34 group compared with the model group. Additionally, EA at LI18 and LI4-PC6 markedly suppressed neck incision-induced upregulation of mRNA/protein expression of SP/CGRP, and upregulated mRNA/protein expression of GAD67 in the DRGs of C3-6 segments.ConclusionsEA at LI18/LI4-PC6 increases PT in rats with incisional neck pain, which is likely related to downregulation of pronociceptive mediators SP/CGRP and upregulation of the inhibitory transmitter GABA in the primary sensory neurons of cervical DRGs.

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Section: Introductionmentioning

confidence: 99%

Effect of Electroacupuncture on Thermal Pain Threshold and Expression of Calcitonin-Gene Related Peptide, Substance P and γ-Aminobutyric Acid in the Cervical Dorsal Root Ganglion of Rats with Incisional Neck Pain

et al. 2017

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“…Both RCTs included participants with low back pain (LBP) [14,15]. Non-randomized studies included patients with the following indications: LBP [16][17][18], postsurgical pain [19][20][21], pain associated with herpes zoster [6], cervicogenic headache [22,23], complex regional pain syndrome type 1 [24,25], intractable vertebral metastatic pain [26], chronic scrotal and inguinal pain [27], occipital radiating pain in rheumatoid arthritis [28] and chronic migraine [29] (Table 1). These studies had highly heterogeneous parameters of stimulation (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…This group included only two case reports [24,25] with three participants included. Albayrak et al [24] reported cases of two women with post-stroke complex regional pain syndrome (CRPS).…”

Section: Complex Regional Pain Syndromementioning

confidence: 99%

“…Apiliogullari et al [25] reported a case of a 16-year-old girl suffering from CRPS due to sequelae of poliomyelitis, who did not respond to non-steroidal antiinflammatory drugs. However, after two PRF treatments (first applied at L5 and repeated after 2 weeks at L4 DRG) she reported immediate pain relief, with VAS scores going from 100 points down to 10, this effect remained for over 6 months of follow-up [25]. Both studies reported that no complications occurred (Table 1).…”

Section: Complex Regional Pain Syndromementioning

confidence: 99%

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Efficacy and safety of pulsed radiofrequency as a method of dorsal root ganglia stimulation for treatment of non-neuropathic pain: a systematic review

et al. 2020

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Background: We systematically reviewed the evidence on the efficacy and safety of dorsal root ganglion (DRG) targeted pulsed radiofrequency (PRF) versus any comparator for treatment of non-neuropathic pain. Methods: We searched MEDLINE, CINAHL, Embase, PsycINFO, clinicaltrials.gov and WHO clinical trial register until January 8, 2019. All study designs were eligible. Two authors independently conducted literature screening. Primary outcomes were pain intensity and serious adverse events (SAEs). Secondary outcomes were any other pain-related outcome and any other safety outcome that was reported. We assessed the risk of bias using the Cochrane tool and Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I). We conducted narrative evidence synthesis and assessed the conclusiveness of included studies regarding efficacy and safety. Results: We included 17 studies with 599 participants, which analyzed various pain syndromes. Two studies were randomized controlled trials; both included participants with low back pain (LBP). Non-randomized studies included patients with the following indications: LBP, postsurgical pain, pain associated with herpes zoster, cervicogenic headache, complex regional pain syndrome type 1, intractable vertebral metastatic pain, chronic scrotal and inguinal pain, occipital radiating pain in rheumatoid arthritis and chronic migraine. In these studies, the PRF was usually initiated after other treatments have failed. Eleven studies had positive conclusive statements (11/17) about efficacy; the remaining had positive inconclusive statements. Only three studies provided conclusiveness of evidence statements regarding safetytwo indicated that the evidence was positive conclusive, and one positive inconclusive. The risk of bias was predominantly unclear in randomized and serious in non-randomized studies.

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“…35 Dermatomes responsible for generating pain are also inhibited by the application of PRF to the DRG in disorders associated with neuropathic pain, such as cervical or lumbar radicular pain, postherpetic neuralgia, and complex regional pain syndrome. 36,37 The primary nerve innervation of the knee arises from the femoral nerve (originates from branches of L2-L4 dorsal rood) and from the sciatic nerve (originates from branches of L4, L5, sacral [S] 1, S2, S3 nerves). 38,39 In previous case reports, RF application was effective in reducing PPSP after TKA when applied to the peripheral branch of the sciatic 18,19 or femoral nerve.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Pulsed Radiofrequency Therapy to Dorsal Root Ganglion Adding to TENS and Exercise for Persistent Pain after Total Knee Arthroplasty

et al. 2016

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The majority of patients achieve substantial pain relief and improved function after total knee arthroplasty (TKA), but a proportion continues to experience life-disturbing persistent postsurgical pain (PPSP) in the months and years after surgery. This study aimed to assess the efficacy of transcutaneous electrical nerve stimulation (TENS), exercise, and pulsed radiofrequency (PRF) treatment on pain severity, neuropathic pain, knee flexion range of motion (ROM), functional status, and patient satisfaction in patients with PPSP after TKA. This is a retrospective study of prospectively collected data. Patients who were identified retrospectively from hospital charts were divided into two groups: group 1 ( = 17) received TENS and exercise treatment and group 2 ( = 22) received TENS, exercise, and PRF application to the dorsal root ganglion (DRG). The following procedure-related parameters were collected from the special registry form: visual analog scale (VAS), Douleur Neuropathique 4 (DN4) questionnaire, knee flexion ROM, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and patient satisfaction scale scores. The mean follow-up was 253.8 ± 109 days. When the two groups were compared, a significant difference of at least 50% improvement in the VAS (activity) and a significant reduction in the DN4 scores following the last control examination were found in group 2. There was a significant reduction in total WOMAC scores in group 1 compared with group 2 for the four study periods. Higher scores for the patient satisfaction scale were found in group 1 compared with group 2 following the last control examination. Adding PRF to TENS and exercise therapy is useful in reducing the degree of pain and the neuropathic component of PPSP in patients with PPSP.

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Pulsed Radiofrequency of Dorsal Root Ganglia for the Treatment of Complex Regional Pain Syndrome in an Adolescent with Poliomyelitis Sequel: A Case Report

Abstract: This case illustrates that PRF applied to lumbar 4 and lumbar 5 DRG may play a significant role in CRPS type 1 management after the surgical treatment of poliomyelitis sequelae in adolescent patients. Further randomized, controlled studies are needed to support this argument.

Cited by 6 publications

References 16 publications

Effect of Electroacupuncture on Thermal Pain Threshold and Expression of Calcitonin-Gene Related Peptide, Substance P and γ-Aminobutyric Acid in the Cervical Dorsal Root Ganglion of Rats with Incisional Neck Pain

Effect of Electroacupuncture on Thermal Pain Threshold and Expression of Calcitonin-Gene Related Peptide, Substance P and γ-Aminobutyric Acid in the Cervical Dorsal Root Ganglion of Rats with Incisional Neck Pain

Efficacy and safety of pulsed radiofrequency as a method of dorsal root ganglia stimulation for treatment of non-neuropathic pain: a systematic review

Efficacy of Pulsed Radiofrequency Therapy to Dorsal Root Ganglion Adding to TENS and Exercise for Persistent Pain after Total Knee Arthroplasty

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