Electrocatheter-mediated High-voltage Pulsed Radiofrequency of the Dorsal Root Ganglion in the Treatment of Chronic Lumbosacral Neuropathic Pain: A Randomized Controlled Study

Simone Vigneri, Gianfranco Sindaco, Marco La Grua, Matteo Zanella, Giuliano Lo Bianco, Valentina Paci, Francesca M Vinci, Chiara Sciacca, Laura Ravaioli, Gilberto Pari
Clinical Journal of Pain 2019 October 1

OBJECTIVES: Despite the interest in scientific community, there is still poor evidence about pulsed radiofrequency efficacy in the treatment of neuropathic pain. In order to determine if high-voltage pulsed radiofrequency plus adhesiolysis (PRF-EA) showed better results than epidural adhesiolysis alone (EA), a randomized, double-blind, comparative-effectiveness study was conducted in patients with chronic lumbosacral radiating pain and neuropathic features.

METHODS: 41 patients were randomly allocated to two groups. Twenty-one subjects were randomized to receive 2 cycles of 240 seconds high-voltage pulsed radiofrequency followed by the injection of local anaesthetics, hyaluronidase and betamethasone, whereas 20 subjects underwent sham stimulation followed by adhesiolysis. The treatment was delivered at the affected lumbosacral roots and patients, treating physicians and assessors were blinded to intervention.

RESULTS: A significant reduction of radiating pain was observed in mean numeric rating scale (NRS) score at follow-up. A change of -3.43 versus -1.75 (P=0.031) after 1 month and -3.34 versus -0.80 (P=0.005) after 6 months was reported in patients undergoing PRF-EA in comparison with EA, respectively. After one month, 57% of patients in the PRF-EA group experienced a pain reduction of 50% or greater versus only 25% of patients allocated to EA (P=0.037). Improvement decreased to 48% in the PRF-EA group whereas only 10% of EA reported significant pain relief after six months (P=0.008).

DISCUSSION: High-voltage pulsed radiofrequency of dorsal root ganglion delivered through multifunctional electrode provided significant pain relief and may be considered a valuable treatment in chronic lumbosacral radicular pain with neuropathic features.

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