Why carry out this study?
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Radiofrequency treatment is an interventional pain management technique that has shown enhanced control over lesion size and an enhanced ability to confirm accurate positioning compared to other interventional methods. |
In this review article, we characterize the currently available evidence supporting the use and efficacy of radiofrequency treatments in sympathetically mediated pain conditions. |
What was learned from the study?
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Radiofrequency treatment shows promise in alleviating complex regional pain syndrome, pain in the perineal region, headache and facial pain, abdominal pain, and other types of pain with minimal complications. |
Patients should be carefully selected for radiofrequency treatment, and further randomized controlled studies are needed prior to implementing it into common practice. |
DIGITAL FEATURES
Introduction
RF Technique
Methods
Results
References | Study type | Population | Treatment method | Outcomes | Complications |
---|---|---|---|---|---|
Park et al. [36] | RA | n = 15, Upper extremity CRPS I, age: 48.2 ± 13.16 (TSG PRF), 47.6 ± 10.04 (CSG PRF) | PRF applied to T2 and T3 TSG (n = 5) or SG (n = 10) | TSG PRF showed > 1.5 °C temperature difference in patient hands in 100% and SG PRF in 40% of patients. TSG PRF had lower 1-week NRS scores (p = .015), and longer effect duration (TSG PRF: 85.71 ± 40.35 days vs. SG PRF: 34.90 ± 27.18 days, p = .007) | None reported |
Kim et al. [35] | RA | n = 12, Upper extremity CRPS I, age: 45.16 ± 10.71 | PRF applied to C6 and C7 CSG | 91.7% obtained at least moderate benefit (≥ 30% self-described degree of benefit), which was maintained for a mean of 31.41 ± 26.07 days. Mean temperature difference between patient hands of 1.39 ± 0.96 °C following procedure | None reported |
Kastler et al. [33] | RA | n = 67, Upper extremity CRPS I, age: 49.5 (25-81) | Anesthetic block (n = 33) or CRF (n = 34) applied to SG | Significantly (p < 0.0001) higher success (> 50% reduction in VAS at 2 years) rate in the CRF group (67.6%) compared with the block group (21.2%). Technical success rate was higher in block group (100%) compared with CRF group (92%) due to needle placement difficulties in the CRF group | 2 minor complications in CRF group: Horner’s syndrome (3 weeks) and one case of prevertebral hematoma |
Manjunath et al. [29] | RCT | n = 20, Lower limb CRPS I, age: 38.9 ± 13.22 (CRF) and 51.6 ± 10.03 (CN) | CRF (n = 10) or CN via phenol injection (n = 10) applied to L2, L3, L4 LSG | Both methods showed significant and similar pain relief (~ 50% reduction in VAS and reduction in various types of pain quality assessments such as intensity of pain, dull pain, hot pain, etc.) over a 4-month follow-up | Post-sympathectomy neuralgia (1 CN patient), paresthesia during needle positioning (2 CRF patients and 1 CN patient), all patients complained of temporary soreness at the site of injection (5–7 days) |
Geurts et al. [34] | RA | n = 27, Upper extremity CRPS I, mean age: 47 | CRF applied to the SG | After 6–8 weeks, 21 were pain-free and 4 had an improvement in pain. 16 remained pain-free after a mean follow-up period of 13.2 months | Vasovagal collapse and hematoma at puncture site in 2 patients |
Haynsworth Jr. et al. [28] | PA | n = 17, Lower extremity CRPS, age: (24–78) | CRF (n = 8) or CN via phenol injection (n = 9) applied to the L2, L3, L4 LSG | 89% of patients in the phenol group showed signs of sympathetic blockade after 8 weeks, compared to 12% in the CRF group | Post-sympathectomy neuralgia (11% of CRF and 33% of CN patients) and mild to moderate pain post-procedure in 6/9 CN patients |
References | Study type | Population | Treatment method | Outcomes | Complications |
---|---|---|---|---|---|
Sir et al. [44] | RA | n = 39, Coccydynia, age: 42.64 ± 13.60 (block) and 45.52 ± 14.68 (PRF) | PRF (n = 14) or anesthetic block (n = 25) applied to the ganglion impar | PRF and blockade showed similar significant drops in mean NPRS score up to the 3rd month, but blockade returned to baseline by 6th month. Patient satisfaction was 71.4% vs. 48% in favor of PRF | Hypotension and bradycardia (1 anesthetic block patient) |
Kırcelli et al. [39] | RA | n = 20, Coccydynia, age: 48.7 ± 14.3 | CRF applied to the ganglion impar | > 50% VNS reduction in 20, 18, 15 patients at 1, 6, 12 months of follow-up, respectively. Successful outcomes in 67.4% and 61.1% of patients at 6 and 12 months utilizing EQ-5D | None reported |
Usmani et al. [40] | RCT | n = 65, Chronic non-oncologic perineal pain (coccydynia, anal pain, perineal pain, sacrococcygeal pain), age: 39.32 ± 14.29 (CRF) and 42.32 ± 15.64 (PRF) | CRF (n = 34) or PRF (n = 31) applied to the ganglion impar | PRF showed insignificant pain relief (similar to baseline VAS during follow-up) except at 1 day, whereas CRF showed significant pain relief (VAS reduction from baseline) throughout follow-up (6 weeks). 82% of CRF and 13% of PRF patients had excellent results at the end of follow-up as measured by a subjective patient satisfaction questionnaire | Short-lived infection at the site of skin puncture in 5 patients |
Gopal et al. [42] | RA | n = 20, Coccydynia, age: 51.3 years (range 36–78 years) | PRF applied to the ganglion impar | Treatment was successful in 15 (75%) patients (significantly lowered VAS scores (6.53–0.93), little or no analgesics needed for pain control) after 6 and 12 months. Many patients who were unable to work before the procedure were able to return to work afterwards (11/14). 5 (25%) received no relief | None reported |
Karaman et al. [43] | RA | n = 8, Coccygeal region pain, age: 39.4 ± 14.3 | PRF applied to the ganglion impar (n = 8) and other non-sympathetic locations (n = 16) | 75% of patients had ≥ 50% decrease in their VAS scores over a 8.9 ± 6.4-month follow-up period | None reported |
Atim [41] | RA | n = 21, Coccydynia, age: median 36 (range 5–144) | PRF applied to the ganglion impar | 90% and 81% success (> 50% VAS reduction) was seen at 3 weeks and 6 months, respectively. A subjective patient satisfaction showed 57%, 24%, and 19% of patients with excellent, good, and poor results | None reported |
Demircay et al. [38] | RA | n = 10, Coccydynia, age: 49.2 ± 14.4 | CRF applied to the ganglion impar | 90% of patients had a successful outcome (> 50% VNS reduction) and 10% experienced failure (33% VNS score improvement) after 6 months. EQ-5D scores were correlated with VNS scores | None reported |
Reig et al. [37] | PA | n = 13, Perineal region pain (sacroiliitis, sacrococcygeal pain, coccydynia, postherpetic neuralgia, post-traumatic perianal pain, vulvovaginitis, post-episiotomy pain, anal pain, pain of the glans), age: 54 (35–76) | CRF applied to the ganglion impar | Average of 50% reduction in VAS with a 95% CI (22.8% to 77.1%) over a mean duration of 2.2 months (1–6 months) | None reported |
References | Study type | Population | Treatment method | Outcomes | Complications |
---|---|---|---|---|---|
Salgado-López et al. [52] | PA | n = 37, Chronic cluster headache, age: 40 (26–59) | PRF (n = 24) or CRF (n = 13) applied to the SPG | 13.5% experienced complete clinical relief, 56.8% had partial (reduced symptoms and pharmacologic need) and transient relief (5.21 months for CRF and 4.69 months for PRF), and 29.7% did not improve over a mean 68.1 (15–148) month follow-up. No major difference between PRF and CRF groups | None reported |
Fang et al. [53] | RA | n = 16, Episodic (n = 13) and chronic (n = 3) cluster headache, age: 44.6 ± 13.9 | PRF applied to the SPG | 11/13 episodic and 1/3 chronic cluster headaches patient experienced complete relief within 6.3 ± 6.0 days post-procedure. Duration of clusters was significantly shorter and periods of remission were longer (not significant) following treatment | None reported |
Akbas et al. [57] | RA | n = 27, Chronic face and head pain (atypical facial pain, SPG neuralgia due to zona zoster, atypical TN, and unilateral migraine headaches), age: 56 (27–78) | PRF applied to the SPG | 23% had no pain relief (VNRS 7–10), 35% had complete relief (VNRS 0–2), and 42% had mild to moderate pain relief (VNRS 3–6) after 3 months | None reported |
Oomen et al. [58] | RA | n = 15, Headache and facial pain (atypical facial pain, neuropathy, postherpetic and SN, SNPT, cluster headache, SUNCT), age: 33–78 | CRF applied to the SPG | 9 out of 15 patients had considerable pain relief (≥ 90% reduction) at 3 months post-procedure. Most positive results were seen in Sluder's neuropathy, atypical facial pain, and cluster headache | None reported |
Narouze et al. [50] | RA | n = 15, Chronic cluster headache, age: not disclosed | CRF applied to the SPG | Overall, significantly reduced attack frequency and intensity after 18 months and significantly reduced PDI after 12 months. 20% experienced no change or increase initially before seeing a positive change. 46.7% alteration from chronic to episodic form and reduced need for medications, and 20% were headache-free in the absence of medication after 18 months. 13% had complete resolution on one side, which switched to episodic cluster headache on the other side | 46.7% reported temporary paresthesias in the upper gums and cheek lasting for 3–6 weeks. and 1 patient reported a coin-like area of permanent anesthesia over his cheek |
Bayer et al. [56] | RA | n = 30, Headache and facial pain (atypical facial pain, SPG neuralgia, atypical TN nonresponsive to prior treatments, and unilateral migraine headaches), age: 45 (22–82) | PRF applied to the SPG | 14%, 21%, and 65% of patients had no pain relief, complete pain relief, and mild to moderate pain relief, respectively, and 65% reported mild to moderate reduction in oral opioids over a range of 4 to 52 months | None reported |
Filippini-De Moor et al. [49] | RA | n = 19, Episodic (n = 17) and chronic (n = 2) cluster headache, age: 47.2 (19–76) | CRF applied to the SPG | 50%, 22%, and 28% had complete, marked/partial, and no improvement, respectively. through 12 months of follow-up, which reduced to 28%, 37%, 37% over long-term follow-up (9–64 months with a mean of 33). Duration of improvement was variable (up to 12 months) and repeat procedures were need in 11/19 | None reported |
Sanders et al. [51] | RA | n = 66, Episodic (n = 56) and chronic (n = 10) cluster headache, age: 33.4 ± 8.2 (episodic) and 33.6 ± 5.5 (chronic) | CRF applied to the SPG | 61%, 25%, and 14% of patients had complete, partial, and no pain relief, respectively, when treated for episodic cluster headache after 29.1 ± 10.6 months compared to 30%, 30%, and 40% patients when treated for chronic cluster headache after 24.0 ± 9.7 months | Epistaxis (n = 8), cheek hematoma (n = 11), partial RF lesion of the maxillary nerve (n = 4), and hypesthesia of the palate (n = 9). All resolved after 3 months |
References | Study type | Population | Treatment method | Outcomes | Complications |
---|---|---|---|---|---|
Bang et al. [71] | RCT | n = 26, Pancreatic cancer pain, age: 65.7 ± 12.1 (CN) and 62.8 ± 13.7 (CRF) | EUS-CN via alcohol injection (n = 14) and EUS-CRF (n = 12) applied to the celiac ganglion | Compared with EUS-CN, EUS-CRF provided significantly more pain relief (VAS, PAN26, C30, and BPI) and improved the QoL for patients with pancreatic cancer (PAN26 and C30) through 4 weeks of follow-up. Opioid use was the same between groups. 3 patients crossed over to CRF because CN was insufficient | No difference in complications between groups. Included diarrhea (n = 1), fever (n = 1), nausea/vomiting (n = 5), and transient increase in abdominal pain (n = 3) at 48 h, which resolved with conservative management by 2 weeks |
Amr et al. [65] | RCT | n = 60, Abdominal pain due to various cancers (adrenal gland, duodenal, gall bladder, HCC, HFL, esophagus, pancreas, peritoneal mass, retroperitoneal mass, right colon, stomach, suprarenal mass), age: 57.30 ± 14.02 (CRF) and 60.03 ± 13.32 (CN) | CRF (n = 30) applied to splanchnic nerves at the T10 and T11 level or CN via alcohol injection (n = 30) applied to splanchnic nerves at the T11 level | VAS, GPES, and MST consumption reductions remained significant in the CRF group but returned to baseline in the CN group by week 12. MEAD levels and QoL scores were significantly better in the CRF group for the majority of follow-up. CRF was the recommended treatment option | Transient paresthesia (n = 21 in CN group) and abdominal colic (n = 22 in CRF group and n = 9 in CN group) as well as diarrhea (n = 22), hypotension (n = 19), injection pain (n = 22), and backache (n = 6) present similarly in both groups |
Zhang et al. [66] | RA | n = 7, Cancer pain of various causes (pancreatic, cervical carcinoma, cholangiocarcinoma, esophageal cancer), age range: 30–75 | Endovascular denervation of the abdominal aorta around the origin of the celiac artery using CRF | Significant reduction in VAS (≥ 3 in all cases) and narcotic use was seen throughout 12 weeks of follow-up. QoL was also significantly improved through 8 weeks of follow-up | 2 patients had minor abdominal distension and constipation, which resolved within 3 days |
Papadopoulos et al. [70] | RA | n = 35, Pancreatic cancer pain, age: 67.8 (56–82) | PRF applied to splanchnic nerves at the T11 and T12 levels | Mean NRS (≥ 50% reduction in all cases), QoL, and opioid consumption were significantly improved for the majority of the 5-month follow-up. Worsening of metrics was noticed, especially at 5 months, which may be due in part to disease progression (no patients survived past 6 months) | None reported |
Verhaegh et al. [73] | RA | n = 11, Chronic pancreatitis, age: 50 (39–59) | CRF applied to splanchnic nerves at the T11 and T12 levels | Effective in 15/18 cases (5 repeat procedures and 2 third procedures). 33% had > 75% VAS reduction and 78% had > 50% VAS reduction. Mean NRS decreased significantly, median pain-free period of 45 weeks (132 max), repeated interventions were comparable to the initial procedure, and 4 patients reduced analgesic usage and 4 completely stopped | 1 patient experienced temporal hypoesthesia of the flank |
Garcea et al. [72] | RA | n = 10, Chronic pancreatitis pain (n = 8) and chronic abdominal pain unknown cause (n = 2), age: 39.5 (31–68) | CRF applied to the splanchnic nerves at the T12 level | Significant decrease in average VAS, opiate use, acute admissions for pain, anxiety levels, daily activity, overall mood, and general perception of health post-procedure. Follow-up was 18 (12–24) months | 1 patient experienced self-resolving diarrhea |
Raj et al. [64] | CE | n = 69, Epigastric, RUQ, or LUQ pain (e.g. chronic pancreatitis, postabdominal surgery pain, pancreatic, or liver cancer) | CRF applied to the splanchnic nerves at the T12 or T11 level | 55–70% of patients had > 50% VAS reduction, 40% were excellent results (> 75% VAS reduction), and 15% had < 10% VAS reduction after at least 6 months | None reported |
References | Study type | Population | Treatment method | Outcomes | Complications |
---|---|---|---|---|---|
Ding et al. [79] | RCT | n = 90, LE PDPN, age: 58.67 ± 6.56 (CN), 59.73 ± 6.44 (CRF), 58.83 ± 6.63 (CRF+CN) | CN via anhydrous ethanol (n = 30), CRF (n = 30), or CN and CRF (n = 30) applied to L2 and L3 LSG | All groups showed a significant reduction in VAS through 1 year of follow-up. Reductions in VAS were greatest in the CN+CRF group followed by the CRF group starting at 6 months (results were significant between groups). 93.3%, 73.3%, and 66.7% of patients showed at least mild remission in CN+CRF, CRF, and CN groups, respectively. Patient satisfaction was highest in in the CN+CRF group | Temporary decrease in blood pressure after CN (n = 4) and CRF+CN (n = 2) as well as genitofemoral neuritis after CN (n = 3) |
Abbas et al. [77] | RCT | n = 80, Post-mastectomy neuropathic pain syndrome, age: 50.7 ± 11.0 (similar between groups) | PRF (n = 40) or CRF (n = 40) applied to the SG | CRF was significantly better than PRF throughout 24-week follow-up, showing significant reduction from baseline metrics in VAS score, functional improvement, and less rescue analgesia, whereas PRF primarily showed improvement at 1 month of follow-up. No differences were shown between groups in terms of QoL metrics and ECOG measurements | Transient ptosis (for weeks) was reported in 2 CRF patients |
Shaaban et al. [78] | RCT | n = 40, Post-mastectomy neuropathic pain (n = 23), CRPS (n = 14), phantom Pain (n = 3), age: 44.3 ± 8.3 (F), 46.1 ± 11.4 (US) | PRF (n = 20 (F) and n = 20 (US)) applied to the SG | Significant reduction in VAS, morphine consumption, and pregabalin consumption compared to baseline over 3 months. There was no significant difference between the guidance techniques of PRF treatment in pain relief. However, the procedure time was significantly lower using US | Pain at puncture site (n = 19), temporary Horner syndrome (n = 33), hematoma n = 2, and hoarseness of voice (n = 1). No significant difference between groups |
Forouzanfar et al. [76] | RA | n = 86, Various chronic pain syndromes, age: 46.25 ± 0.87 | CRF applied to the SG | 40.7% of patients reported > 50%, 54.7% reported no change, and 4.7% showed worsening of VAS score after the procedure. Pain relief occurred for an average of 52.4 (SE = 7.78) weeks but was determined by data from only 27 patients | Did not disclose |