Radiofrequency and Pulsed Radiofrequency Treatment of Chronic Pain Syndromes: The Available Evidence

Abstract

There are currently 6 reviews on (pulsed) radiofrequency (RF) for the management of spinal pain. Two reviews on interventional pain management techniques in general also discuss RF. The outcomes of those reviews depend on the type of studies included and the opinion of the reviewers, which may result in different evidence levels. Radiofrequency denervation at the cervical and lumbar level has produced the most solid evidence. The differences in treatment outcome registered in the 5 randomized controlled trials (RCTs) regarding lumbar facet denervation can be attributed to differences in patient selection and/or inappropriate technique. There is not sufficient evidence supporting the use of RF facet denervation for the management of cervicogenic headache. The studies examining the management of cervical radicular pain suggest a comparable efficacy for RF and pulsed RF (PRF). The PRF treatment is supposed to be safer and therefore should be preferred. The superiority of RF treatment adjacent to the lumbar dorsal root ganglion for the management of lumbar radicular pain has not been demonstrated in an RCT. Information regarding RF treatment of sacroiliac joint pain is accumulating. No randomized sham-controlled trials on the value of RF treatment of the Gasserian ganglion for the management of idiopathic trigeminal neuralgia have been published. One RCT indicates superiority of RF over PRF for the management of idiopathic trigeminal neuralgia. Future research to confirm or deny the efficacy of (P)RF should be conducted in carefully selected patient populations. The tests used for patient inclusion in such a trial could potentially help the clinician in selecting patients for this type of treatment. The value of PRF treatment of the peripheral nerves also needs to be confirmed in well-designed trials.

Radiofrequency therapy in back pain and complex regional pain syndrome

“…Due to its neurodestructive properties, side effects are more frequent. 84,115,116 However, compared to CRF, slightly better results with simultaneously less complications have been achieved with the use of PRF to the DRG. 113,115 In the treatment of CRPS, the use of CRF was found to be equally effective but safer than chemical sympatholysis.…”

“…110 PRF should be preferred, because it is safer and the heat-related side effects can be avoided. 116 While the results in the cervical region are promising, the evidence in the lumbosacral region is very sparse. Only two studies provide inconsistent outcomes.…”

Application of Radiofrequency in Low Back Pain Treatment

“…Three of them are positive, one is negative and one is equivocal (van Boxem et al, 2008). Among all the applications of RF and PRF, cervical facet and lumbar facet syndrome are most evidently effective.…”

Application of Radiofrequency in Pain Management

“…Efficacy of pulsed RF has been clinically documented and has been used for chronic pain conditions for the last 20 years, but its mechanism of action is not fully understood [10][11][12][13][14]. It has been suggested to alter gene expression in neurons, by means of neuromodulation [1,11,[17][18][19][20][21][22][23]. Stimulation of serotonergic and noradrenergic systems and induction of descending pathways have also been proposed [22].…”