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      Pulsed radiofrequency treatment in interventional pain management: mechanisms and potential indications—a review

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          Abstract

          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.

          Methods

          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.

          Findings

          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.

          Conclusion

          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.

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          Most cited references 64

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          Randomized, Controlled Trials, Observational Studies, and the Hierarchy of Research Designs

          New England Journal of Medicine, 342(25), 1887-1892
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            Electric and thermal field effects in tissue around radiofrequency electrodes.

             Eric Cosman (2015)
            A study is carried out of the spatial distribution and time dependence of electric and thermal fields in the tissue around a radiofrequency (RF) electrode used in pain therapy. Finite-element calculation of the fields is performed, and results are compared with ex vivo tissue data. Field predictions are made for continuous and for pulsed RF applications. A special RF cannula electrode is constructed with both macro and micro thermocouple sensors to measure both average and rapid, transitory temperature effects. Temperatures and impedances are recorded in liver and egg-white models using signal outputs from a commercially available RF lesion generator. These data are compared with the results of finite-element calculations using electric field equations and the bio-heat equation. Average and pulsatory temperatures at the RF electrode are measured. Rapid temperature spikes during pulsed RF bursts are observed. These data compared well with theoretical calculations using known electrical and thermal tissue parameters. Continuous RF lesioning causes heat destruction of neurons. Pulsed RF lesioning (PRFL) produces heat bursts with temperatures in the range associated with destructive heat lesions. PRFL also produces very high electric fields that may be capable of disrupting neuronal membranes and function. Finite-element calculations agree substantially with the measured data, giving confidence to their predictions of fields around the RF electrode.
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              Electroporation: a general phenomenon for manipulating cells and tissues.

               Donald Weaver (1993)
              Electroporation is a fascinating cell membrane phenomenon with several existing biological applications and others likely. Although DNA introduction is the most common use, electroporation of isolated cells has also been used for: (1) introduction of enzymes, antibodies, and other biochemical reagents for intracellular assays; (2) selective biochemical loading of one size cell in the presence of many smaller cells; (3) introduction of virus and other particles; (4) cell killing under nontoxic conditions; and (5) insertion of membrane macromolecules into the cell membrane. More recently, tissue electroporation has begun to be explored, with potential applications including: (1) enhanced cancer tumor chemotherapy, (2) gene therapy, (3) transdermal drug delivery, and (4) noninvasive sampling for biochemical measurement. As presently understood, electroporation is an essentially universal membrane phenomenon that occurs in cell and artificial planar bilayer membranes. For short pulses (microsecond to ms), electroporation occurs if the transmembrane voltage, U(t), reaches 0.5-1.5 V. In the case of isolated cells, the pulse magnitude is 10(3)-10(4) V/cm. These pulses cause reversible electrical breakdown (REB), accompanied by a tremendous increase molecular transport across the membrane. REB results in a rapid membrane discharge, with the elevated U(t) returning to low values within a few microseconds of the pulse. However, membrane recovery can be orders of magnitude slower. An associated cell stress commonly occurs, probably because of chemical influxes and effluxes leading to chemical imbalances, which also contribute to eventual survival or death. Basic phenomena, present understanding of mechanism, and the existing and potential applications are briefly reviewed.
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                Author and article information

                Contributors
                nicholaschua143@gmail.com
                Journal
                Acta Neurochir (Wien)
                Acta Neurochirurgica
                Springer Vienna (Vienna )
                0001-6268
                0942-0940
                30 November 2010
                30 November 2010
                April 2011
                : 153
                : 4
                : 763-771
                Affiliations
                [1 ]Department of Anaesthesiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, Singapore 308433
                [2 ]Department of Anesthesiology, Pain and Palliative Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
                [3 ]Institute for Anesthesiology and Pain, Swiss Paraplegic Center, Nottwil, Switzerland
                Article
                881
                10.1007/s00701-010-0881-5
                3059755
                21116663
                © The Author(s) 2010
                Categories
                Review Article
                Custom metadata
                © Springer-Verlag 2011

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