open access

Vol 13, No 2 (2019)
Review paper
Published online: 2019-06-05
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Radiofrequency — an interventional method of chronic pain treatment: mechanisms of analgesic action, indications and application in selected pain syndromes

Hanna Justyna Kucia, Małgorzata Malec-Milewska, Agnieszka Sękowska
DOI: 10.5603/PMPI.2019.0011
·
Palliat Med Pract 2019;13(2):70-75.

open access

Vol 13, No 2 (2019)
Review articles
Published online: 2019-06-05

Abstract

Conventional radiofrequency (CRF) is an interventional chronic pain treatment method with the use of electromagnetic waves at the frequency of radio waves (or higher) consisting in a controlled use of high temperature in order to destroy sympathetic and/or sensory fibres. Application time equals 60s and the temperature achieved in the tissues, depending on the application site, 60–90ºC. Pulsed radiofrequency (PRF) constitutes another treatment method which also uses radio waves at high frequencies. It consists in implementing series of 20ms current injections at frequencies of 2 Hz with a specific voltage (2–45 V), which results in an increase of the temperature around the electrode up to 42–50ºC. According to the International Association for Study of Pain (IASP), an indication for the application of interventional methods is chronic pain resistant to pharmacological treatment, as well as non-invasive methods, with a positive response to a prognostic blockade. This article discusses both the mechanism of conventional and pulsed radiofrequency, its application in specific pain syndromes, the most common complications and its side effects. The efficacy and safety of CRF and PRF in the treatment of lumbosacral pain, pain in knee joints, occipital neuralgia, painful shoulder syndrome, neuralgia/trigeminal neuropathy, peripheral neuropathy, neuropathic pain of the sympathetic system and cancer pain was presented based on data from literature. It seems that the application of radiofrequency and its applicability in certain pain syndromes is well-documented (trigeminal neuralgia, Horton's headache, osteoarthritis of the interspinous joints), while further research is required to develop a methodology for the radiofrequency procedure of knee joints or occipital nerves, despite promising results. The possibility of using more and more precise imaging methods constitutes a significant factor in order to carry out the procedure in an effective and safe way (USG, computed tomography, laser techniques, 3D printing).

Abstract

Conventional radiofrequency (CRF) is an interventional chronic pain treatment method with the use of electromagnetic waves at the frequency of radio waves (or higher) consisting in a controlled use of high temperature in order to destroy sympathetic and/or sensory fibres. Application time equals 60s and the temperature achieved in the tissues, depending on the application site, 60–90ºC. Pulsed radiofrequency (PRF) constitutes another treatment method which also uses radio waves at high frequencies. It consists in implementing series of 20ms current injections at frequencies of 2 Hz with a specific voltage (2–45 V), which results in an increase of the temperature around the electrode up to 42–50ºC. According to the International Association for Study of Pain (IASP), an indication for the application of interventional methods is chronic pain resistant to pharmacological treatment, as well as non-invasive methods, with a positive response to a prognostic blockade. This article discusses both the mechanism of conventional and pulsed radiofrequency, its application in specific pain syndromes, the most common complications and its side effects. The efficacy and safety of CRF and PRF in the treatment of lumbosacral pain, pain in knee joints, occipital neuralgia, painful shoulder syndrome, neuralgia/trigeminal neuropathy, peripheral neuropathy, neuropathic pain of the sympathetic system and cancer pain was presented based on data from literature. It seems that the application of radiofrequency and its applicability in certain pain syndromes is well-documented (trigeminal neuralgia, Horton's headache, osteoarthritis of the interspinous joints), while further research is required to develop a methodology for the radiofrequency procedure of knee joints or occipital nerves, despite promising results. The possibility of using more and more precise imaging methods constitutes a significant factor in order to carry out the procedure in an effective and safe way (USG, computed tomography, laser techniques, 3D printing).
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Keywords

radiofrequency, pulsed radiofrequency, interventional pain management, chronic pain management, occipital neuralgia, trigeminal neuralgia , facet joint syndrome

About this article
Title

Radiofrequency — an interventional method of chronic pain treatment: mechanisms of analgesic action, indications and application in selected pain syndromes

Journal

Palliative Medicine in Practice

Issue

Vol 13, No 2 (2019)

Article type

Review paper

Pages

70-75

Published online

2019-06-05

DOI

10.5603/PMPI.2019.0011

Bibliographic record

Palliat Med Pract 2019;13(2):70-75.

Keywords

radiofrequency
pulsed radiofrequency
interventional pain management
chronic pain management
occipital neuralgia
trigeminal neuralgia
facet joint syndrome

Authors

Hanna Justyna Kucia
Małgorzata Malec-Milewska
Agnieszka Sękowska

References (25)
  1. Malec–Milewska M, Wordliczek J, Dobrogowski J. Interwencyjne metody leczenia bólu. In: Malec–Milewska M, Woroń J. ed. Kompendium leczenia bólu. Med Education, Warszawa 2017: 675–702.
  2. Dobrogowski J, Malec–Milewska M, Król A, Grzywna E, Moskala M. Blokady neurolityczne i inne zabiegi neurodestrukcyjne. In: Dobrogowski J. ed. Leczenie bólu. Wydawnictwo Lekarskie PZWL, Warszawa 2017: 178–197.
  3. Malec–Milewska M, Kolęda I, Sekowska A, et al. Zastosowanie termolezji w leczeniu bólu przewlekłego opornego na farmakoterapię. Radiofrequency ablation for the management of the pharmacotherapy resistent chronic pain. Post Nauk Med. 2014; 27(5): 317–322.
  4. Chua NHL, Vissers KC, Sluijter ME. Pulsed radiofrequency treatment in interventional pain management: mechanisms and potential indications-a review. Acta Neurochir (Wien). 2011; 153(4): 763–771.
  5. Sluijter ME, Imani F. Evolution and mode of action of pulsed radiofrequency. Anesth Pain Med. 2013; 2(4): 139–141.
  6. Cohen SP, Hurley RW, Christo PJ, et al. Clinical predictors of success and failure for lumbar facet radiofrequency denervation. Clin J Pain. 2007; 23(1): 45–52.
  7. Erdine S, Yucel A, Cimen A, et al. Effects of pulsed versus conventional radiofrequency current on rabbit dorsal root ganglion morphology. Eur J Pain. 2005; 9(3): 251–256.
  8. Cahana A, Vutskits L, Muller D. Acute differential modulation of synaptic transmission and cell survival during exposure to pulsed and continuous radiofrequency energy. J Pain. 2003; 4(4): 197–202.
  9. Higuchi Y, Nashold BS, Sluijter M, et al. Exposure of the dorsal root ganglion in rats to pulsed radiofrequency currents activates dorsal horn lamina I and II neurons. Neurosurgery. 2002; 50(4): 850–5; discussion 856.
  10. Hamann W, Abou-Sherif S, Thompson S, et al. Pulsed radiofrequency applied to dorsal root ganglia causes a selective increase in ATF3 in small neurons. Eur J Pain. 2006; 10(2): 171–176.
  11. Bogduk N. Pulsed radiofrequency. Pain Med. 2006; 7(5): 396–407.
  12. Hagiwara S, Iwasaka H, Takeshima N, et al. Mechanisms of analgesic action of pulsed radiofrequency on adjuvant-induced pain in the rat: roles of descending adrenergic and serotonergic systems. Eur J Pain. 2009; 13(3): 249–252.
  13. Çetin A, Yektaş A. Evaluation of the Short- and Long-Term Effectiveness of Pulsed Radiofrequency and Conventional Radiofrequency Performed for Medial Branch Block in Patients with Lumbar Facet Joint Pain. Pain Res Manag. 2018; 2018: 7492753.
  14. Cohen SP, Van Zundert J. Pulsed radiofrequency: rebel without cause. Reg Anesth Pain Med. 2010; 35(1): 8–10.
  15. Zheng B, Song Li, Liu H. Pulsed radiofrequency of brachial plexus under ultrasound guidance for refractory stump pain: a case report. J Pain Res. 2017; 10: 2601–2604.
  16. Jamison DE, Cohen SP. Radiofrequency techniques to treat chronic knee pain: a comprehensive review of anatomy, effectiveness, treatment parameters, and patient selection. J Pain Res. 2018; 11: 1879–1888.
  17. Louis ML, Magalon J, Jouve E, et al. Growth Factors Levels Determine Efficacy of Platelets Rich Plasma Injection in Knee Osteoarthritis: A Randomized Double Blind Noninferiority Trial Compared With Viscosupplementation. Arthroscopy. 2018; 34(5): 1530–1540.e2.
  18. Malec-Milewska M, Horosz B, Kosson D, et al. The effectiveness of neurolytic block of sphenopalatine ganglion using zygomatic approach for the management of trigeminal neuropathy. Neurol Neurochir Pol. 2015; 49(6): 389–394.
  19. Restrepo-Garces CE, Marinov A, McHardy P, et al. Pulsed radiofrequency under ultrasound guidance for persistent stump-neuroma pain. Pain Pract. 2011; 11(1): 98–102.
  20. Manolitsis N, Elahi F. Pulsed radiofrequency for occipital neuralgia. Pain Physician. 2014; 17(6): E709–E717.
  21. Naja ZM, El-Rajab M, Al-Tannir MA, et al. Repetitive occipital nerve blockade for cervicogenic headache: expanded case report of 47 adults. Pain Pract. 2006; 6(4): 278–284.
  22. Slavin KV, Nersesyan H, Wess C. Peripheral neurostimulation for treatment of intractable occipital neuralgia. Neurosurgery. 2006; 58(1): 112–9; discussion 112.
  23. Lavin PJ, Workman R. Cushing syndrome induced by serial occipital nerve blocks containing corticosteroids. Headache. 2001; 41(9): 902–904.
  24. Wu H, Zhou Ju, Chen J, et al. Therapeutic efficacy and safety of radiofrequency ablation for the treatment of trigeminal neuralgia: a systematic review and meta-analysis. J Pain Res. 2019; 12: 423–441.
  25. Chua NH, Halim W, Beems T, et al. Pulsed radiofrequency treatment for trigeminal neuralgia. Anesth Pain Med. 2012; 1(4): 257–261.

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