The Mechanism of Action between Pulsed Radiofrequency and Orthobiologics: Is There a Synergistic Effect?

Abstract

Radiofrequency energy is a common treatment modality for chronic pain. While there are different forms of radiofrequency-based therapeutics, the common concept is the generation of an electromagnetic field in the applied area, that can result in neuromodulation (pulsed radiofrequency—PRF) or ablation. Our specific focus relates to PRF due to the possibility of modulation that is in accordance with the mechanisms of action of orthobiologics. The proposed mechanism of action of PRF pertaining to pain relief relies on a decrease in pro-inflammatory cytokines, an increase in cytosolic calcium concentration, a general effect on the immune system, and a reduction in the formation of free radical molecules. The primary known properties of orthobiologics constitute the release of growth factors, a stimulus for endogenous repair, analgesia, and improvement of the function of the injured area. In this review, we described the mechanism of action of both treatments and pertinent scientific references to the use of the combination of PRF and orthobiologics. Our hypothesis is a synergic effect with the combination of both techniques which could benefit patients and improve the life quality.

Pulsed Radiofrequency for Auriculotemporal Neuralgia: A Case Report

“…The treatments involving local anesthetic blocks of the auriculotemporal nerve and botulinum toxin injections yielded results for our patient that were not entirely satisfactory. Consequently, we decided to apply pulsed radiofrequency as a last resort since this approach successfully treats neuropathic pain conditions, and the short-term and long-term adverse events are very low [ 11 , 15 , 16 , 17 , 18 , 19 ].…”

“…The treatment of refractory cases is challenging, and the literature needs to be more conclusive. Pulsed radiofrequency (PRF) is a common treatment modality for chronic pain [ 11 ]. Pulsed radiofrequency (PRF) is a technique that applies radiofrequency electrical current to a target nerve; the electrical current is of short duration (20 ms) and is followed by a resting phase (480 ms) that repeats for a specific time [ 12 , 13 , 14 ].…”

“…Currently, PRF is used in the treatment of conditions such as radicular pain, occipital and trigeminal neuralgia, as well as shoulder and knee pain. Still, it is also effective in migraine, tension-type headaches, and cluster headaches [ 11 , 15 , 16 , 17 , 18 , 19 ]. Radiofrequency energy used in this technique is not continuous but pulsed, allowing for sufficient cooling to maintain a target temperature below 42 °C and prevent nerve axonotmesis or neurotmesis [ 20 , 21 ].…”

Pulsed Radiofrequency Ablation for Refractory Cancer-Related Leg Pain: A Case Report

“…It is reported to decrease levels of interleukin 1. Metalloproteinase -3 and tumor necrosis factor-alpha in the tissues after treatment [ 2 ]. It can also enhance the noradrenergic and serotonergic pain inhibitory pathway and damage nociceptive C and A delta fibers affecting their functioning [ 3 , 4 ].…”

Ultrasound-guided pulsed radiofrequency versus dry needling for pain management in chronic neck and shoulder myofascial pain syndrome patients at a tertiary hospital in China: a randomised controlled trial protocol

“…PRF is an important and effective interventional treatment for chronic neuropathic pain disorders. It generates an electromagnetic field in the pain region that acts on several biological pathways, including ion channels, neurotransmitters, postsynaptic receptors and immune activities,16 thus eliciting a neuromodulation effect 17. Recent studies have reported that ultrasound-guided PRF might also be a promising treatment for chronic MPS 18–21.…”