PULSED RADIOFREQUENCY TREATMENT IN PAIN SYNDROMES

Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

WHAT IS THE EVIDENCE?

?Problem

Is there any evidence that proves the efficacy of this treatment?

What are the cases that its use is well stabilised and with efficacies proved?

Abstract

Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Background• Pulsed radiofrequency is a development of heat

based radiofrequency denervation

• Is used in medicine to treat especially chronic pain

• This type of treatment does not provoke lesions of the nervous structures, but changes in the conduction of the pain stimulus by creating an electromagnetic field

• Unlike heat based radiofrequency treatment, pulsed radiofrequency does no direct damage to the nerve.

Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Abstract

Aims

1. Investigate if pulsed radiofrequency has any evidence in treatment of chronic syndromes

2. Study the patients’ life quality improvement

3. Compare this therapy to others more commonly applied procedures, focusing on the advantages of pulsed radiofrequency therapy.

Abstract

Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Methods

Type of studySystematic Review and Meta-Analysis

  Units of analysis

Articles found in databases  Data Search

PubMedISI Web of Knowledge

Abstract

Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Methods

Key-wordsPainChronicSyndromePulsedRadiofrequency

  Query

pulsed[All Fields] AND radiofrequency[All Fields] AND ("pain"[MeSH Terms] OR "pain"[All Fields])) AND (("syndrome"[MeSH Terms] OR "syndrome"[All Fields]) OR chronic[All Fields]

Abstract

Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Methods Research Limits

Exclusion CriteriaOther types of articles, such as reviews, letter to editor or commentsArticles contemplating pulsed radiofrequency used not as a treatment for pain syndromesArticles which don’t mention the methods used or the results

Inclusion CriteriaLanguage: EnglishNo date of publication limits

 

Abstract

Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Methods

Work Fases

1. Formulation of a clear question: “Pulsed radiofrequency treatment in pain syndromes - What is the evidence?”

2. Definition of selection’s criteria3. Databases’ research4. Abstracts’ reading5. Articles selection, by application of inclusion an exclusion criteria (each article

should be read by two people. Divergences will be solved by consensus)6. Analysis of the selected articles 7. Discussion of the results8. Review article’s writing9. Website’s building

Abstract

Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Expected results To reassure the knowledge previously acquired mainly in subjects

regarding scientific research tools and information selection. Verify the article’s credibility and if the method is applicable in clinic

procedures. To improve the quality of our research both in terms of knowledge and

information, and also time. To have a solid review about this subject. Manage to present it correctly to the public Verify the credibility and the success of the method by the analysis of

various articles.

Abstract

Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Basic concepts

Pulsed Radiofrequenc

yPain

syndromes

Introduction

Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Pulsed Radiofrequency (PRF): A development of heat based radiofrequency denervation To treat especially chronic pain Minimally invasive target selective technique Uses brief pulses of high voltage (Rf range – 300kHz) to produce

controlled tissue destruction Heat dissipates between pulses, avoiding thermocoagulation Reduces pain by modullating pain transmission Produces transient inibition of evoked synaptic activity

Introduction

Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Main location of neuropathic pain:

Dorsal root ganglia (DRG) Peripheral nerves Trigeminal ganglions Sphenopalatine ganglion Intervertebral disc Sacroiliac joint Glossopharyngeal nerve

Introduction

Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Clinical Procedure:

1- Insulated neddle placed in the vicinity of the nerve to be lesioned2- Multiple fluoroscopic X-ray views to check needle position3- Motor and sensory nerve stimulation testing4- Grounded electrode passed through the insulated needle to the tip5- Electric current through the electrode heats up the surrounding tissue

Introduction

Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Main side effects:- The pain is greater the days after the treatment- Pain during the procedure- Global anesthetic- Damage blood vessels or other nerves close to the area

Clinical Experience on Radiofrequency: in clinical use for 30 years demonstrated success at reducing pain in several chronic pain

condition useful tool in the overall management of refractory neuropathic

pain.

Introduction

Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Introduction

Success in chronic pain has not been adequately reproduced in randomized

controlled trials (RCTs), its use in the management of neuropathic pain is under some debate:

conventional radiofrequency occasionally leads to worsening and even new onset of neuropathic pain.(Kornik et al., 2004)

pulsed radiofrequency may offer new opportunities and a broader perspective for therapy with radiofrequency. (Racz et al, 2006)

Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Justification of the study

Pulsed radiofrequency is a minimally invasive

treatment that has been used in many

pain syndromes

Need to check if there is any conclusion on

the evidence published.

Curiosity about the subject

Research on the topic (Sum up the published studies and articles)

Pulsed radiofrequency treatment in pain

syndromes – What is the evidence?

Introduction

Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Class 14 ANA LUIS FARIA INES PINTO JORGE PINTO JORGE SOARES JOSE BARRETO JOSE VICENTE FORMOSO LUÍS OLIVEIRA MAFALDA PINTO MAFALDA PAIS CARRINGTON MARIA TERESA SILVERIO MARIA LEONOR GODINHO MIGUEL VALENTE PAULA TEIXEIRA PEDRO MONTEIRO

References1. Kornick, C., Meng, F.C., Xu, S.J., Liu, Y.G., Wang, H.W. Selective percutaneous radiofrequency thermocoagulation in the treatment of trigeminal neuralgia:report on 1860 cases. Chinese Medical Journal 2004; 117:467-4702. RACZ, G.B, RUIZ-LOPEZ, R. Radiofrequency Procedures: Review Article, Pain Practice, 2006; p.46-503. Van Zundert J, Huntoon M, Patijn J, Lataster A, Mekhail N, van Kleef M. Cervical Radicular Pain, 05/05/2009.4. KESKINBORA K, AYDINLI I. Long-term results of suprascapular pulsed radiofrequency in chronic shoulder pain, Jan. 2009; p.16-215. Misra S, Ward S, Coker C.Pain. Pulsed radiofrequency for chronic testicular pain-a preliminary report, 19/03/2009, p.673-8 6. Byrd D, Mackey S. Curr Pain Headache Rep. Pulsed radiofrequency for chronic pain. 2008 Jan, p.37-41.