11 Oct Pulsed Radiofrequency Treatment
Pulsed radiofrequency (PRF) treatment is a novel therapeutic modality with many uses in pain management. There are several conventional continuous radiofrequency methods used to control pain, but PRF offers the advantage of pain control with no tissue destruction or painful consequences.
What is the benefit of pulsed radiofrequency treatment?
The theoretical benefit of PRF is pain relief without negative consequences. The technique uses carefully controlled electrical current around an electrode, which is strategically placed on the body. The electrode is built into the shape and size of an injection needle. This technique applies energy to the electrode intermittently, thus the term ‘pulsed.’
Why is pulsed radiofrequency used to treat pain?
Scientific reports and clinical studies have shown that pulsed radiofrequency applied to certain nerves will block the nerve’s ability to transmit pain signals. When a pulsed radiofrequency electrical fields is applied to the nerve, it affects only a portion of the nerve. PRF is most effective for treating pain that originates from irritated nerves or nerve damage. PRF can offer additional pain relief after other therapies have failed, such as epidural injections.
What happens during the pulsed radiofrequency treatment procedure?
When you arrive at the outpatient center, you will be given light IV sedation to relax. The nurses will closely monitor your blood pressure, heart rhythm, heart rate, and oxygen level. After a local anesthetic is used, the electrode on the end of a needle is inserted through the skin, with x-ray guidance to be used to position the electrode close to the affected nerves. Once the needle is in position, a mild amount of PRF energy is applied. Once the PRF procedure is performed, a small amount of corticosteroid and local anesthetic is injected. After the electrode is removed, a small bandage is used to cover the injection site.
Is the procedure painful?
You will usually be in the medical facility for 2 hours for pulsed radiofrequency treatment. This time includes check-in, preparation, and recovery room monitoring. The actual procedure takes 30 minutes. Because a needle is inserted into the body, you will have some mild soreness of the back. Many patients report relief of usual pain or numbness for 6-12 hours after the procedure, which is due to the local anesthetic. The steroid’s beneficial effects occur 2-4 days after the injection. The effects of PRF can take up to 2-3 weeks to occur, and onset of effects is subtle.
How does PRF treat pain?
Controlled pulsed radiofrequency treatment uses high-frequency alternating current to induce coagulative necrosis to body tissue. Tissue destruction occurs due to heating with the electrode tip. The magnitude of tissue destruction is related to the size of the electrode and duration of the procedure. The electrical fields generated by PRF alter nerve membranes, which eliminates the transmission of pain signals.
Does pulsed radiofrequency work?
Pulsed radiofrequency is a treatment used in chronic pain management. Researchers evaluated the results of numerous clinical studies and found that six randomized trials studied the efficacy of PRF. They concluded that PRF for cervical radicular pain had compelling positive results, and PRP to the application of the supracapular nerve (shoulder) was proven to work well for people with chronic shoulder pain.Background
The objective of this review is to evaluate the efficacy of Pulsed Radiofrequency (PRF) treatment in chronic pain management in randomized clinical trials (RCTs) and well-designed observational studies. The physics, mechanisms of action, and biological effects are discussed to provide the scientific basis for this promising modality.
We systematically searched for clinical studies on PRF. We searched the MEDLINE (PubMed) and EMBASE database, using the free text terms: pulsed radiofrequency, radio frequency, radiation, isothermal radiofrequency, and combination of these. We classified the information in two tables, one focusing only on RCTs, and another, containing prospective studies. Date of last electronic search was 30 May 2010. The methodological quality of the presented reports was scored using the original criteria proposed by Jadad et al.
We found six RCTs that evaluated the efficacy of PRF, one against corticosteroid injection, one against sham intervention, and the rest against conventional RF thermocoagulation. Two trials were conducted in patients with lower back pain due to lumbar zygapophyseal joint pain, one in cervical radicular pain, one in lumbosacral radicular pain, one in trigeminal neuralgia, and another in chronic shoulder pain.
From the available evidence, the use of PRF to the dorsal root ganglion in cervical radicular pain is compelling. With regards to its lumbosacral counterpart, the use of PRF cannot be similarly advocated in view of the methodological quality of the included study. PRF application to the supracapular nerve was found to be as efficacious as intra-articular corticosteroid in patients with chronic shoulder pain. The use of PRF in lumbar facet arthropathy and trigeminal neuralgia was found to be less effective than conventional RF thermocoagulation techniques.
Byrd D & Mackey S (2010). Pulsed Radiofrequency for Chronic Pain. Curr Pain Headache Rep, 12(1), 37-41.
Chua NHL, Vissers KC, & Slutijter ME (2011). Pulsed radiofrequency treatment in interventional pain management: mechanisms and potential indications—a review. Acta Neurochir, 153(4), 363-771.