Clinical efficacy of ultrasound-guided pulsed radiofrequency combined with ganglion impar block for treatment of perineal pain

BACKGROUND Ganglion impar block alone or pulsed radiofrequency alone are effective options for treating perineal pain.However,ganglion impar block combined with pulsed radiofrequency(GIB-PRF)for treating perineal pain is rare and the puncture is usually performed with X-ray or computed tomography guidance.AIM To evaluate the safety and clinical efficacy of real-time ultrasound-guided GIBPRF in treating perineal pain.METHODS Thirty patients with perineal pain were included and were treated by GIB-PRF guided by real-time ultrasound imaging between January 2015 and December 2016.Complications were recorded to observe the safety of the ultrasound-guided GIB-PRF procedure,and visual analogue scale(VAS)scores at 24 h before and after treatment and 1,3,and 6 mo later were analyzed to evaluate clinical efficacy.RESULTS Ultrasound-guided GIB-PRF was performed successfully in all patients,and no complications occurred.Compared with pretreatment scores,the VAS scores were significantly lower(P<0.05)at the four time points after treatment.The VAS scores at 1 and 3 mo were slightly lower than those at 24 h(P>0.05)and were significantly lower at 6 mo after treatment(P<0.05).There was a tendency toward lower VAS scores at 6 mo after treatment compared with those at 1 and 3 mo(P>0.05).CONCLUSION Ultrasound-guided GIB-PRF was a safe and effective way to treat perineal pain.The 6-mo short-term clinical efficacy was favorable,but the long-term outcomes need future study.

Efficacy and safety of pulsed radiofrequency for knee osteoarthritis:A Meta-analysis

Objective:Systematic evaluation of the effect and safety of pulsed radiofrequency on knee osteoarthritis.Methods:The computer searched the database and searched for randomized controlled trials(RCT)of pulsed radiofrequency treatment of knee osteoarthritis.The search time limit was all established until April 5,2020.Two researchers conducted literature review review and data extraction,and evaluated the risk of bias in the included studies,using RevMan5.3 software for data analysis.Results:A total of 13 RCTs were included,a total of 853 patients with knee osteoarthritis.The overall efficiency,VAS score,WOMAC score,and Lysholm score of the experimental group in the treatment of knee osteoarthritis were better than the control group,which was statistically significant.Conclusion:Pulse radiofrequency has a clinical effect on knee osteoarthritis,and it is better than some conventional treatments.

Effectiveness of pulsed radiofrequency on the medial cervical branches for cervical facet joint pain

BACKGROUND Cervical facet joint pain(CFP)is one of the most common causes of neck pain and headache.Persistent CFP deteriorates the quality of life of patients and reduces their productivity at work.AIM To investigate the effectiveness of pulsed radiofrequency(PRF)stimulation of cervical medial branches in patients with chronic CFP.METHODS We retrospectively included 21 consecutive patients(age=50.9±15.3 years,range 26-79 years;male:female=8:13;pain duration=7.7±5.0 mo)with chronic CFP,defined as≥4 on the numeric rating scale(NRS).We performed PRF stimulation on the cervical medial branches.The outcomes of the PRF procedure were evaluated by comparing the NRS scores for CFP before treatment and 1 and 3 mo after treatment.Successful pain relief was defined as a≥50%reduction in the NRS score at 3 mo when compared with the pretreatment NRS score.RESULTS No patient had immediate or late adverse effects following PRF.The average NRS score for CFP decreased from 5.3±1.1 at pre-treatment to 2.4±0.6 at the 1 mo follow-up,and 3.1±1.1 at the 3 mo follow-up.Compared to the NRS scores before PRF stimulation,those at 1 and 3 mo after PRF stimulation had significantly decreased.Eleven of the 21 patients(52.4%)reported successful pain relief 3 mo after the PRF procedure.PRF stimulation on cervical medial branches may be a useful therapeutic option to control chronic CFP.CONCLUSION PRF stimulation of the cervical medial branches may be used as an alternative treatment method in patients with CFP.PRF can effectively alleviate CFP,and is safe to perform.

Effects of pulsed radiofrequency on spasticity in patients with spinal cord injury:a report of two cases

Spasticity following spinal cord injury（SCI） results in functional deterioration and reduced quality of life. Herein, we report two SCI patients who presented with good response to pulsed radiofrequency（PRF） for the management of spasticity in the lower extremities. Patient 1（a 47-year-old man） had complete thoracic cord injury and showed a phasic spasticity on the extensor of both knees（3–4 beats clonus per every 30 seconds） and tonic spasticity（Modified Ashworth Scale： 3） on both hip adductors. Patient 2（a 64-yearold man） had incomplete cervical cord injury and showed a right ankle clonus（approximately 20 beats） when he walked. After the application of PRF to both L2 and L3 dorsal root ganglion（DRG）（patient 1） and right S1 DRG（patient 2） with 5 Hz and 5 ms pulsed width for 360 seconds at 45 V under the C-arm guide, all spasticity disappeared or was reduced. Moreover, the effects of PRF were sustained for approximately 6 months with no side effects. We believe that PRF treatment can be useful for patients with spasticity after SCI.

Effect of Pulsed Radiofrequency on Rat Sciatic Nerve Chronic Constriction Injury： A Preliminary Study

Background：Pulsed radiofrequency （PRF） application to the dorsal root ganglia can reduce neuropathic pain （NP） in animal models,but the effect of PRF on damaged peripheral nerves has not been examined.We investigated the effect of PRF to the rat sciatic nerve （SN） on pain-related behavior and SN ultrastructure following chronic constriction injury （CCI）.Methods：The analgesic effect was measured by hindpaw mechanical withdrawal threshold （MWT） and thermal withdrawal latency （TWL）.Twenty rats with NP induced by ligating the common SN were then randomly divided into a PRF treatment group and a sham group.The contralateral SN served as a control.The MWT and TWL were determined again 2,4,6,8,10,12,and 14 days after the PRF or sham treatment.On day 14,ipsilateral and contralateral common SNs were excised and examined by electron microscopy.Results：Ipsilateral MWT was significantly reduced and TWL significantly shorter compared to the contralateral side 14 days after CCI （both P =0.000）.In the PRF group,MWT was significantly higher and TWL significantly longer 14 days after the PRF treatment compared to before PRF treatment （both P =0.000）,while no such difference was observed in the sham group （P ＞ 0.05）.Electron microscopy revealed extensive demyelination and collagen fiber formation in the ipsilateral SN of sham-treated rats but sparse demyelination and some nerve fiber regrowth in the PRF treatment group.Conclusions：Hyperalgesia is relieved,and ultrastructural damage ameliorated after direct PRF treatment to the SN in the CCI rat model of NP.

Expert consensus of Chinese Association for the Study of Pain on the radiofrequency therapy technology in the Department of Pain

On the basis of continuous improvement in recent years,radiofrequency therapy technology has been widely developed,and has become an effective method for the treatment of various intractable pain.Radiofrequency therapy is a technique that uses special equipment and puncture needles to output ultra-high frequency radio waves and accurately act on local tissues.In order to standardize the application of radiofrequency technology in the treatment of painful diseases,Chinese Association for the Study of Pain(CASP)has developed a consensus proposed by many domestic experts and scholars.