scholarly journals CT-Guided Percutaneous Infiltration for the Treatment of Alcock’s Neuralgia

2011 ◽  
Vol 3;14 (2;3) ◽  
pp. 211-215
Author(s):  
Dimitrios K. Filippiadis
Keyword(s):  
Computed Tomography ◽  
Pain Relief ◽  
Local Anesthetic ◽  
Efficient Method ◽  
Pudendal Nerve ◽  
Mobility Impairment ◽  
Painful Condition ◽  
Ct Guided ◽  
Alcock’S Canal ◽  
Long Acting

The pudendal nerve may be strained either between the sacrospinous and sacrotuberous ligaments at the ischial spine level or within Alcock’s canal. Alcock’s neuralgia is a rare, painful condition caused by compression of the pudendal nerve within Alcock’s canal (pudendal canal) which is an aponeurotic tunnel that cannot be stretched. Patients usually present with intense, unilateral pain involving anatomic areas along the pudendal nerve’s root, genital, anal, and pelvic regions causing mobility impairment. A computed tomography (CT) - guided percutaneous infiltration of the pudendal nerve with a mixture of a local anesthetic and a long-acting corticosteroid is a safe and efficient method that reduces the pain caused by the neuralgia. Corticosteroids and local anesthetics interfere with the neurons, the encoding, and the processing of noxious stimuli; interrupt the pain-spasm cycle; and reduce inflammation. The injected glucocorticosteroid may take 3-5 days to reach its anti-inflammatory effect; therefore, the initial pain relief from the local anesthetic is followed by a baseline pain return and then secondary pain relief at 3-5 days. The procedure is performed under minimal or no anesthesia. In general, at discharge, a responsible person must accompany the patient and ensure a safe return home. Clinical evaluation is performed after 7-10 days. There are 2 types of potential complications that are associated with percutaneous steroid infiltrations: intra-operative (associated with needle placement) and post-operative (infection, bleeding and those associated with the injectate administration). In all cases that steroids were administered within therapeutic doses, no complications were noted. In conclusion, CT-guided percutaneous infiltration with a mixture of long-acting corticosteroid and local anesthetic seems to be a safe and efficient method for the treatment of Alcock’s neuralgia. Key words: Alcock’s canal, neuralgia, corticosteroid, pudendal; nerve, local anesthetic, computed tomography, infiltration, percutaneous, image guided.

scholarly journals Measuring the Quality of Pudendal Nerve Perineural Injections

2016 ◽  
Vol 4;19 (4;5) ◽  
pp. 299-306 ◽  
Author(s):  
Stanley Antolak, Jr
Keyword(s):  
Pain Relief ◽  
Pelvic Pain ◽  
Local Anesthetic ◽  
Private Practice ◽  
Pain Control ◽  
Pudendal Nerve ◽  
P Value ◽  
Pudendal Neuropathy ◽  
Nerve Branch

Background: Pudendal neuropathy is a tunnel syndrome characterized by pelvic pain and may include bowel, bladder, or sexual dysfunction or a combination of these. One treatment method, pudendal nerve perineural injections (PNPIs), uses infiltration of bupivacaine and corticosteroid around the nerve to provide symptom relief. Bupivacaine also anesthetizes the skin in the receptive field of the nerve that is injected. Bupivacaine offers rapid pain relief for several hours while corticosteroid provides delayed pain control often lasting 3 to 5 weeks. Not all pudendal nerve blocks may provide complete pain relief but long-term pain control from the steroid appears to be associated with immediate response to bupivacaine. We offer a method of evaluating the quality of a pudendal block on the day it is performed using pinprick sensation evaluation. Objective: To demonstrate that pinprick sensory changes provide a simple and rapid method of measuring response to local anesthetic and pain reduction provided by a PNPI on the day it is performed. This response defines the quality of each PNPI. Study Design: This is a case series based on retrospective review of a private practice database that is maintained by HealthEast hospitals in Minnesota. Database information includes standard physical examination, recording techniques, and treatment processes that had been in place for several years. Setting: Private practice in United States. Methods: Patients with a diagnosis of pudendal neuropathy are treated with PNPIs. Two hours after each block, 2 endpoints are measured: response to a sensory pinprick examination of the pudendal territory and difference in patient-reported pain level before and after nerve block. Fifty-three men from a private practice treating only pelvic pain received the treatment in 2005. Reported pain level was not recorded for 2 patients. Results: Bupivacaine in perineural injections produces varying degrees of analgesia or hypalgesia to pinprick. Normal pinprick response suggests pudendal nerves were not penetrated by bupivacaine. Patient responses varied from complete, i.e. all 6 branches anesthetized to none. Most men had 2 – 5 nerve branches anesthetized. One man had a single nerve branch that responded to bupivacaine. Three men failed to respond to local anesthetic. Changes in pre-PNPI to post-PNPI pain scores were significantly decreased (n = 51, P-value < 0.0001), indicating that bupivacaine in the PNPI reduced pain. Forty-one patients (80.4%) indicated less pain after the procedure and only 2 patients (4.0%) indicated more pain. The number of nerve branches successfully anesthetized was also significantly correlated with change in score. On average, an additional successful nerve branch anesthetized corresponded to a drop of about 0.66 in the change score (n = 51, P - value = 0.0005). Conclusion: PNPIs relieve pain. Anesthesia affected all 6 pudendal nerve branches in only 13.2% of patients. Complete pain relief occurred in 39.2%. This argues against use of perineural pudendal blockade as a diagnostic test. Pain relief after PNPI is associated with number of nerve branches that are anesthetized. At 2 hours after a PNPI its quality (the number of the 6 nerve branches with reduced response to pinprick from the perineural local anesthetic) is associated with subjective reduction of pain. Key words: Pudendal neuralgia, chronic perineal pain, pudendal nerve block, sensory examination, neurologic examination, pain management, chronic pelvic pain syndrome

Computed Tomography-Guided Radiofrequency Thermocoagulation of the Gasserian Ganglion Using an Alternative to Hartel Anterior Approach: A Bicentral Study

2020 ◽  
Vol 3;23 (6;3) ◽  
pp. 293-298 ◽  
Author(s):  
Dimitrios K. Filippiadis
Keyword(s):  
Computed Tomography ◽  
Pain Relief ◽  
Anterior Approach ◽  
Anatomic Variation ◽  
Control Group ◽  
Complication Rates ◽  
Gasserian Ganglion ◽  
Ct Guided ◽  
Radiofrequency Thermocoagulation ◽  
Number Of Patients

Background: Trigeminal neuralgia (TN) is associated with multiple mechanisms involving peripheral and central nervous system pathologies. Among percutaneous treatments offered, radiofrequency thermocoagulation (RFT) is associated with longer duration of pain relief. Mostly due to anatomic variation, cannulation of the foramen ovale using the Hartel approach has a failure rate of 5.17%. Objectives: To report safety and efficacy of continuous RFT with an alternative to Hartel anterior approach under computed tomography (CT) guidance in patients with classic TN. Study Design: Retrospective institutional database review; bicentral study. Setting: Although this was a retrospective database research, institutional review board approval was obtained. Methods: Institutional database review identified 10 patients (men 8, women 2) who underwent CT-guided RFT of the Gasserian ganglion. Preoperational evaluation included physical examination and magnetic resonance imaging. Under anesthesiology control and local sterility measures, a radiofrequency needle was advanced, and its approach was evaluated with sequential CT scans. Motor and sensory electrostimulation tests evaluated correct electrode location. Pain prior, 1 week, 1, 3, and 6 months after were compared by means of a numeric visual scale (NVS) questionnaire. Results: Mean self-reported pain NVS score prior to RFT was 9.2 ± 0.919 units. One week after the RFT mean NVS score was 1.10 ± 1.287 units (pain reduction mean value of 8.1 units). At 3 and 6 months after thermocoagulation the mean NVS score was 2.80 ± 1.549 units and 2.90 ± 1.370 units, respectively. There were no postoperative complications. Three patients experienced facial numbness, which gradually resolved over a period of 1 month. Limitations: Retrospective nature; small number of patients; lack of a control group undergoing a different treatment of TN. Conclusions: Percutaneous CT-guided RFT of the Gasserian ganglion constitutes a safe and efficacious technique for the treatment of TN, with significant pain relief and minimal complication rates improving life quality in this group of patients. Key words: Trigeminal nerve, neuralgia, pain, radiofrequency, ablation, percutaneous, computed tomography, imaging

Percutaneous CT-Guided Cryoablation of the Bilateral Pudendal Nerves for Palliation of Intractable Pain Related to Pelvic Neoplasms

2020 ◽  
Vol 37 (8) ◽  
pp. 619-623 ◽  
Author(s):  
John David Prologo ◽  
Sivasai Manyapu ◽  
Zachary L. Bercu ◽  
Ashmit Mittal ◽  
Jason W. Mitchell
Keyword(s):  
Computed Tomography ◽  
Pelvic Pain ◽  
Pudendal Nerve ◽  
Intractable Pain ◽  
Pelvic Neoplasms ◽  
Ct Guided ◽  
Patient Demographics ◽  
Pain Scores ◽  
The Mean ◽  
Mean Time

Objectives: The purpose of this report is to describe the effect of computed tomography–guided bilateral pudendal nerve cryoablations on pain and time to discharge in the setting of acute hospitalizations secondary to refractory pelvic pain from cancer. Methods: Investigators queried the medical record for patients who underwent pudendal nerve cryoablation using the Category III Current Procedural Technology code assignment 0442T or Category I code 64640 for cases prior to 2015. The resulting list was reviewed, and procedures performed on inpatients for intractable pelvic pain related to neoplasm were selected. The final cohort was then analyzed with regard to patient demographics, procedure details, technical success, safety, pain scores, and time to discharge. Results: Ten patients underwent cryoablation by 3 operators for palliation of painful pelvic neoplasms between June 2014 and January 2019. All probes were satisfactorily positioned and freeze cycles undertaken without difficulty. There were no procedure-related complications or adverse events. The mean difference in pre- and posttreatment worst pain scores was significant (n = 5.20, P = .003). The mean time to discharge following the procedure was 2.3 days. Conclusion: Computed tomography–guided percutaneous cryoablation of the bilateral pudendal nerves may represent a viable option in the setting of acute hospitalization secondary to intractable pain in patients with pelvic neoplasms.

scholarly journals Radiofrequency Neurolysis Versus Local Nerve Infiltration in 42 Patients with Refractory Chronic Inguinal Neuralgia

2012 ◽  
Vol 3;15 (3;5) ◽  
pp. 237-244 ◽  
Author(s):  
Adrian Kastler
Keyword(s):  
Computed Tomography ◽  
Pain Relief ◽  
Hernia Repair ◽  
Local Injection ◽  
Abdominal Incision ◽  
Painful Condition ◽  
Inguinal Pain ◽  
Before And After ◽  
Vas Scores ◽  
Inguinal Neuralgia

Background: Chronic inguinal neuralgia involving ilioinguinal and iliohypogastric nerves is a frequent complication of surgical procedures involving a lower abdominal incision such as hernia repair, appendicitis surgery, or cesarean sections. Chronic inguinal neuralgia is a very painful condition and diagnosis can be challenging as it is an overlooked impairment. Existing specific treatments are inefficient and often fail. Objective: The purposes of this study are to describe, evaluate, and compare ilioinguinal and iliohypogastric radiofrequency neurolysis (RFN) and local injection. Study Design: Retrospective comparison cohort study from 2005 to 2011. Setting: A single center, Academic Interventional Pain Management Unit Methods: Forty-two patients suffering from chronic inguinal pain refractory to specific medication were included. A total of 18 RFN procedures (14 patients) and 28 injections (28 patients) were performed. Pain was assessed in both groups using Visual Analog Scale (VAS) scores (0-10) measured immediately before and after the procedure and at one, 3, 6, 9, and 12 months after the procedure. Mean duration of pain prior to the procedure and mean duration of pain relief were noted. Moreover, mean maximum early pain relief was assessed. All procedures were ambulatory under computed tomography (CT) guidance. Injections contained 1.5 mL of cortivazol and 3 mL of lidocaine-ropivacaine (30%-70%). Radiofrequency neurolysis was performed using a Neurotherm RF Generator. In both cases, 22-gauge needles were used. After needle retrieval, control slices were taken and the patient was supervised for 30 minutes at the CT unit. Results: The mean age in both groups was 48.7 years. Forty-two patients (97.6%) presented postsurgical inguinal pain, 62% of which occurred after hernia repair. All included patients had undergone previously unsuccessful pain therapies. Mean VAS scores were 7.72 in the RF group and 7.46 in the infiltration group. Maximum early pain relief did not statistically differ (77% in the RFN group and 81.5% in the injection group). Mean duration of pain relief was statistically significant (P = .005) in the RF group (12.5 months) compared to the infilitration group (1.6 months). Mean VAS scores during the year following the procedure were all significantly in favor of radiofrequency neurolysis management. Limitations: Those inherent to small study samples and retrospective studies. Conclusion: Radiofrequency neurolysis appears to be significantly more effective than local nerve infiltrations. It is a safe and effective treatment for chronic inguinal pain. Local steroid injection along with local injection of anesthetics should be used as a confirmation of ilioinguinal neuropathy before performing radiofrequency neurolysis. Key words: Radiofrequency, Ilioinguinal, Iliohypogastric, neuropathy, infiltration, computed tomography guidance.

Percutaneous Computed Tomography-Guided Radiofrequency Ablation of Spinal Trigeminal Tract and Nucleus Caudalis for Refractory Trigeminal Neuropathic Pain: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (5) ◽  
pp. E530-E531
Author(s):  
M Benjamin Larkin ◽  
Robert Y North ◽  
Ashwin Viswanathan
Keyword(s):  
Computed Tomography ◽  
Neuropathic Pain ◽  
Radiofrequency Ablation ◽  
Pain Relief ◽  
Afferent Neurons ◽  
Spinal Trigeminal Nucleus ◽  
Percutaneous Radiofrequency Ablation ◽  
Trigeminal Nucleus ◽  
Ct Guided ◽  
Trigeminal Neuropathic Pain

Abstract This is a surgical video of a computed tomography (CT)-guided percutaneous radiofrequency ablation of the spinal trigeminal tract and nucleus caudalis for refractory trigeminal neuropathic pain.1,2 Many have contributed historically, among them, Sjoqvist3 in 1938 first described destruction of the descending medullary trigeminal tractus via open craniotomy.3-6 In 1967 and 1968, Crue7 and Hitchcock8 independently developed a percutaneous tractotomy technique. Although Kanpolat9,10 first described the use of CT imaging for percutaneous creation of a single tractotomy/nucleotomy lesion resulting in satisfactory pain relief for 85% of patients. The spinal trigeminal tract is a descending fiber pathway containing central processes of first-order afferent neurons from cranial nerves V, VII, IX, and X. The spinal trigeminal nucleus is the terminal projection of the spinal trigeminal tract comprised of 3 subnuclei: oralis, interpolaris, and caudalis. The nucleus caudalis is the most caudal of the 3 subdivisions of the spinal trigeminal nucleus and houses the cell bodies of second-order afferent neurons critical in nociception of the face. Lesioning of the spinal trigeminal tract and nucleus caudalis can provide pain relief without affecting facial sensation or trigeminal motor function.9,11-13 Percutaneous radiofrequency ablation is performed using anatomical landmarks, serial CT scans, impedance monitoring, and functional confirmation to ensure appropriate insertion of the probe to the target of interest prior to lesioning. This procedure remains uncommon in current practices even among functional neurosurgery pain specialists but offers a low-risk, minimally invasive treatment option for refractory facial pain.14 This procedure was done under Institutional Review Board guidance (H-41228: retrospective chart review of patients undergoing spine surgery for pain). The risks and benefits were explained, and the patient consented to videography/procedure. Images in the video used with permission from the following: Carter HV. Anatomy of the Human Body. Wikimedia Commons [Public Domain]. https://commons.wikimedia.org/wiki/File:Gray698.png. Published 1918. Accessed June 30, 2019; Carter HV. Anatomy of the Human Body. Wikimedia Commons [Public Domain]. https://commons.wikimedia.org/wiki/File:Gray784.png. Published 1918. Accessed June 30, 2019; Reprinted from Kanpolat Y, Kahilogullari G, Ugur HC, Elhan AH, CT-guided percutaneous trigeminal tractotomy-nucleotomy, Neurosurgery, 2008, 63(1 Suppl 1), ONS147-53; discussion ONS153-5, by permission of the Congress of Neurological Surgeons; Madhero88. Onion Distribution of Pain and Temperature Sense by Trigeminal Nerve. Wikimedia Commons [Creative Commons BY 3.0 license]. https://en.wikipedia.org/wiki/File:Onionskinddistribution.svg#/media/File:Onionskinddistribution.svg. Accessed June 30, 2019.

scholarly journals Computed Tomography-Guided SCREW Fixation PLUS Cementoplasty in Myeloma Patients

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5971-5971
Author(s):  
Daniele Derudas ◽  
Claudio Pusceddu ◽  
Federica Pilo ◽  
Nicola Ballicu ◽  
Luca Melis ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pain Relief ◽  
Conflicts Of Interest ◽  
Screw Fixation ◽  
Functional Mobility ◽  
Walking Ability ◽  
Thoracic Vertebrae ◽  
Pathological Fractures ◽  
Ct Guided ◽  
Mobility Score

Abstract INTRODUCTION:The aim of this report is to evaluate feasibility, safety and activity of a new procedure of computed tomography (CT) - guided percutaneous screw fixation (PSF) plus cementoplasty for treatment of mielomatous osteolytic lesions with refractory pain and fracture or to prevent impending pathological fractures. The association of scew fixation with cementoplasty allows, compared to cementoplasty alone, a better augmentation of the bone and reduces the risk of cement leakage through a selective injection of the of polymethylmethacrylate (especially in case of lytic lesion of vertebral pedicle). METHODS: From September 2014 to May 2016 thirteen (13) consecutive patients (eight men and five women, median age 67 years, range 48-78 years) with Multiple Myeloma who had developed painful and symptomatic bone lytic lesions in the pelvis and vertebrae were submitted to the procedure (three patients underwent multiple interventions). This consisted of PSF followed by percutaneous bone-cement injection with an solution of polymethylmethacrylate (PMMA) in eighteen sessions. The procedures were performed into the thoracic vertebrae (three interventions), lumbar vertebrae (nine interventions), pelvis (five interventions, bilateral in one instance) and into a paravertebral mass which involved the fifth and sixth thoracic vertebrae. For the osteosynthesis we used cannulated screws with lateral holes, that allow to selectively inject the cement through the screw avoiding undesired leakage. After the screw insertion, to obtain a better augmentation of the bone, from 8 to 22 ml of PMMA in all the lesions. In two cases, before the PSF and PMMA injection, in order to reduce the volume of the tumor a radiofrequency ablation was performed. All the procedures were performed using local anesthesia, conscious sedation in all patients and antibiotic prophylaxis with ceftriaxone 2 gr i.v. Pain was measured by visual analogue scale (range 0-10), mobility by functional mobility score system with a range from 1 (normal mobility) to 4 (bedridden). Statistical analysis was performed using the test of Wilcoxon. RESULTS:Technical success was achivied in all patients. The CT scan acquired immediately after the procedure didn't demonstrate any complications such as leakage of cement or incorrect positioning of the screws or undesired burning during thermal ablation. No additional bone fractures occurred during a median follow-up of 19 months (range 3-23 months). Pain relief occurred in all the patients within one month. Median VAS score was 7 (range 4-9), 3 (range1-4) and 1 (range 1-2) before, at one and six months after procedure respectively (p<0.05). Median functional mobility score was 3 (range 2-4), 2 (range 2-3) and 1 (range 1-2) before, at one and six months after the procedure respectively (p<0.05). All patients required analgesic therapy with opiods and no-steroidal anti-inflammatory agents/analgesics (NSAIAs). Only three patients needed opioid therapy after the procedure. CONCLUSION:The PSF plus cemetoplasty of the pelvis and vertebrae is safe and effective in patients affected by myelomatous localizzations. The procedure is minimally invasive and allows to stabilize the fracture and prevent pathological fractures with significant pain relief and good recovery of walking ability. Further controlled studies with large series of patients are warranted to confirm these preliminary results. Disclosures No relevant conflicts of interest to declare.

scholarly journals CT-Guided Transforaminal Epidural Injections with Local Anesthetic, Steroid, and Tramadol for the Treatment of Persistent Lumbar Radicular Pain

2012 ◽  
Vol 2;15 (2;3) ◽  
pp. 153-159 ◽  
Author(s):  
Mathias Wewalka
Keyword(s):  
Pain Relief ◽  
Local Anesthetic ◽  
Nerve Root ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Pain Reduction ◽  
Radicular Pain ◽  
Ct Guided ◽  
Numerical Rating ◽  
Serial Ct

Background: A substantial number of patients with persistent lumbar radicular pain are treated with a multimodal spectrum of conservative therapies without lasting effect. The duration of pain is certainly a risk factor for chronification. There is evidence that guided periradicular infiltrations are a valid option in the treatment of radiculopathies. Usually a combination of local anesthetic and/or corticosteroid is injected. Tramadol is being used for perioperative analgesia and has been shown to provide effective, long-lasting pain relief after epidural administration. Objective: The aim of this pilot study was to evaluate the efficacy of serial CT-guided transforaminal nerve root infiltrations with a supplement of tramadol for patients with persistent, radicular pain. Study Design: Interventional cohort study. Setting: Outpatient department for interdisciplinary pain medicine. Methods: 37 patients who had radicular leg pain for over 9 weeks received up to 3 CTguided transforaminal nerve root infiltrations at intervals of 2 weeks as long as their level of pain was over 3 on a numerical rating scale from 0 to 10. 50 mg of Tramadol were added to a combination of local anesthetic (Ropivacain, 2 mg) and corticosteroid (Triamcinolon, 40 mg). Evaluations were carried out 24 hours after the Infiltration as well as 2 weeks, 3 and 6 months after the treatment series. The intensity of their radicular pain was measured by a numerical rating scale (NRS). Pain reduction of at least 50% was defined as successful outcome. Results: In total, 65 infiltrations were carried out with pain relief in more than 90% of the patients within 24 hours and an average pain reduction of 64%. Six months post-injection 23 of 34 patients available for follow-up (67.6%) had a successful pain reduction of 84% on average. No adverse effects ascribable to the use of tramadol were noted. Limitations: Due to the lack of a control group we cannot make any statement if tramadol improves short-term pain reduction. Conclusion: Fast and lasting pain relief is the key to optimize rehabilitation for patients with radicular pain. There is a physiological rationale that the opioid receptors at the spinal level could be used to optimize the analgetic effect of guided periradicular injections. In our case series, serial CT-guided selective nerve root infiltrations with the supplement of tramadol were found to be highly effective in the treatment of persistant radiculopathies. Randomized controlled trials will be necessary to clarify the possible benefit of the supplement of an opioid. Key words: Serial, nerve root infiltration, tramadol, chronic pain, outcome.

scholarly journals Comparison of Pulsed Radiofrequency, Oxygen-Ozone Therapy and Epidural Steroid Injections for the Treatment of Chronic Unilateral Radicular Syndrome

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 136
Author(s):  
Pavel Ryska ◽  
Jiri Jandura ◽  
Petr Hoffmann ◽  
Petr Dvorak ◽  
Blanka Klimova ◽  
...  
Keyword(s):  
Pain Relief ◽  
Analogue Scale ◽  
Pulsed Radiofrequency ◽  
Ozone Therapy ◽  
Ct Guided ◽  
The Third ◽  
Vas Score ◽  
Radicular Syndrome ◽  
Epidural Steroid

Background and objectives: For the treatment of chronic unilateral radicular syndrome, there are various methods including three minimally invasive computed tomography (CT)-guided methods, namely, pulsed radiofrequency (PRF), transforaminal oxygen ozone therapy (TFOOT), and transforaminal epidural steroid injection (TFESI). Despite this, it is still unclear which of these methods is the best in terms of pain reduction and disability improvement. Therefore, the purpose of this study was to evaluate the short and long-term effectiveness of these methods by measuring pain relief using the visual analogue scale (VAS) and improvement in disability (per the Oswestry disability index (ODI)) in patients with chronic unilateral radicular syndrome at L5 or S1 that do not respond to conservative treatment. Materials and Methods: After screening 692 patients, we enrolled 178 subjects, each of whom underwent one of the above CT-guided procedures. The PRF settings were as follows: pulse width = 20 ms, f = 2 Hz, U = 45 V, Z ˂ 500 Ω, and interval = 2 × 120 s. For TFOOT, an injection of 4–5 mL of an O2-O3 mixture (24 μg/mL) was administered. For the TFESI, 1 mL of a corticosteroid (betamethasone dipropionate), 3 mL of an anaesthetic (bupivacaine hydrochloride), and a 0.5 mL mixture of a non-ionic contrast agent (Iomeron 300) were administered. Pain intensity was assessed with a questionnaire. Results: The data from 178 patients (PRF, n = 57; TFOOT, n = 69; TFESI, n = 52) who submitted correctly completed questionnaires in the third month of the follow-up period were used for statistical analysis. The median pre-treatment visual analogue scale (VAS) score in all groups was six points. Immediately after treatment, the largest decrease in the median VAS score was observed in the TFESI group, with a score of 3.5 points (a decrease of 41.7%). In the PRF and TFOOT groups, the median VAS score decreased to 4 and 5 points (decreases of 33% and 16.7%, respectively). The difference in the early (immediately after) post-treatment VAS score between the TFESI and TFOOT groups was statistically significant (p = 0.0152). At the third and sixth months after treatment, the median VAS score was five points in all groups, without a statistically significant difference (p > 0.05). Additionally, there were no significant differences in the Oswestry disability index (ODI) values among the groups at any of the follow-up visits. Finally, there were no significant effects of age or body mass index (BMI) on both treatment outcomes (maximum absolute value of Spearman’s rank correlation coefficient = 0.193). Conclusions: Although the three methods are equally efficient in reducing pain over the entire follow-up, we observed that TFESI (a corticosteroid with a local anaesthetic) proved to be the most effective method for early post-treatment pain relief.

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