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Want to see PAZ get beaten to death by Algos for daring to mention "Pulsed RF" ?

Discussion in 'Pain Medicine' started by paz5559, Aug 4, 2006.

  1. paz5559

    10+ Year Member

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    Pulsed Radiofrequency of the Dorsal Root Ganglia is Superior to Pharmacotherapy or Pulsed Radiofrequency of the Intercostal Nerves in the Treatment of Chronic Postsurgical Thoracic Pain

    Steven P. Cohen, MD, Anthony Sireci, BA, Christopher L. Wu, MD, Thomas M. Larkin, MD,Kayode A. Williams, MD, and Robert W. Hurley, MD, PhD

    Pain Physician. 2006;9:227-236

    From: Department Of Anesthesiology & Critical Care Medicine, Pain Management Division, Johns Hopkins School Of Medicine, Baltimore, Md; and
    Department of Surgery, Walter Reed Army Medical Center, Washington, DC


    Background: Chronic postsurgical thoracic pain (CPTP) represents a major therapeutic challenge characterized by an absence of clinical studies to guide treatment. Recently, the implementation of pulsed radiofrequency (RF) has generated intense interest in the medical community as a safe and potentially effective treatment for neuropathic pain. To date, there are no studies comparing pulsed RF to more conventional therapeutic modalities for any pain condition.

    Objectives: To compare treatment outcomes between pharmacotherapy, pulsed RF of the intercostal nerves (ICN) and pulsed RF of the dorsal root ganglia (DRG) in CPTP.

    Methods: Retrospective data analysis involving 49 patients.

    Results: At 6-week follow-up, 61.5% of the pulsed RF DRG group reported ≥50% pain relief vs. 27.3% in the medical management (MM) group and 21.4% in the ICN group (P=0.12). At 3-month follow-up, 53.8% in the DRG group continued to report ≥ 50% pain relief vs. 19.9% in the MM and 6.7% in the ICN groups, respectively (P=0.02). Among the pulsed RF patients who did report a successful outcome, the mean duration of pain relief was 2.87 months in the ICN group and 4.74 months in the DRG group (P=0.01).

    Conclusions: Pulsed RF of the DRG was a superior treatment to pharmacotherapy and pulsed RF of the ICN in patients with CPTP. Prospective studies are needed to confirm these results and identify the best candidates for this treatment.
     
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  3. algosdoc

    algosdoc algosdoc
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    lol...no beatings here....I am including this paper in a didactic session on RF this weekend. It is a beginning in the acquisition of evidence needed for justification of the use of pulsed RF. The fact that it included a medical management group and an ICN group is enlightening. The study's main limitation is that it is not a randomized prospective study...it is a consecutive case series compared with a historical medical management group. Unfortunately, we cannot get paid for the procedure at this time given the paucity of studies. The only prospective randomized controlled study published thus far unfortunately demonstrated no effect of pulse RF:

    Eur J Pain. 2006 Jun 6; [Epub ahead of print] Comparison of pulsed radiofrequency with conventional radiofrequency in thetreatment of idiopathic trigeminal neuralgia.Erdine S, Ozyalcin NS, Cimen A, Celik M, Talu GK, Disci R.Istanbul University, Istanbul Faculty of Medicine, Department of Algology, CapaKlinikleri, Capa, Istanbul 34390, Turkey. The aim of this prospective, randomized, double-blinded study was to evaluate the effect of pulsed radiofrequency (PRF) in comparison with conventional radiofrequency (CRF) in the treatment of idiopathic trigeminal neuralgia. A total of 40 patients with idiopathic trigeminal neuralgia were included. The 20patients in each group were randomly assigned to one of the two treatment groups. Each patient in the Group 1 was treated with CRF, whereas each patient in the Group 2 was treated by PRF. Evaluation parameters were: pain intensity using a Visual Analogue Scale (VAS), patient satisfaction using a Patient Satisfaction Scale (PSS), additional pharmacological treatment, side effects,and complications related to the technique. The VAS scores decreased significantly (p<0.001) and PSS improved significantly after the procedure in Group 1. The VAS score decreased in only 2 of 20 patients from the PRF group (Group 2) and pain recurrence occurred 3 months after the procedure. At the end of 3 months, we decided to perform CRF in Group 2, because all patients in this group still had intractable pain. After the CRF treatment, the median VAS score decreased (p<0.001) and PSS improved (p<0.001) significantly. In conclusion, the results of our study demonstrate that unlike CRF, PRF is not an effective method of pain treatment for idiopathic trigeminal neuralgia.
     

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