scholarly journals Efficacy of Pulsed Radiofrequency in the Treatment of Thoracic Postherpetic Neuralgia from the Angulus Costae: A Randomized, Double-Blinded, Controlled Trial

2013 ◽  
Vol 1;16 (1;1) ◽  
pp. 15-25
Author(s):  
Wang Yingwei

Background: Postherpetic neuralgia (PHN) is often refractory to existing treatments. Pulsed radiofrequency (PRF) is known to be effective for treating neuropathic pain. In common, the targets of PRF treatment were the segmental dorsal root ganglion (DRG) neurons responsible for the pain. A potential complication that can occasionally occur with PRF treatment is damage to the adjacent tissue and organ. The effectiveness of the angulus costae as a puncture site for PRF has not been tested in thoracic PHN treatment. Objective: The goal of this study was to investigate the therapeutic efficacy and safety of PRF for treating thoracic PHN through the puncture of the angulus costae. Study Design: Prospective, randomized, double-blinded study. Setting: Department of Anesthesiology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine. Methods: Ninety-six patients with thoracic (T2-11) PHN were equally randomized assigned into 2 groups. The electrode needle punctured through the angulus costae of each patient guided by x-ray; PRF at 42°C for 120 seconds was applied after inducing paresthesia involving the affected dermatome area. PRF was applied in the PRF group (n = 48) twice. It was also applied in the sham group (n = 48) twice without radiofrequency energy output. The treatment was done once a week for 3 weeks. Tramadol was used for flare pain when the visual analog scale (VAS) ≥ 3. Outcomes Assessment: The therapeutic effect was evaluated by VAS, SF-36 health survey questionnaire, side effects (type, frequency, and onset time) before treatment, at days 3, 7, and 14, and at months one, 2, 3 and 6 after PRF. The average of tramadol (mg/d) administrated within the first month after treatment was also recorded. Results: The postprocedure VAS scores in the PRF group were significantly lower than those in the sham group and lasted for 6 months after treatment (P < 0.05). The SF-36 score, such as physical functioning, physical role, bodily pain, general health perceptions, social function, emotional role, and mental health index were significantly improved until 6 months after treatment in the PRF group compared to the sham group (P < 0.01-0.05). The average dosage of tramadol administered (mg/d) within the first month after treatment was also significantly reduced in the PRF group compared to the sham group (P < 0.05). There were no obvious signs of pneumothorax, bleeding, infection, or other severe side effects in either group (P > 0.05). Limitations: Single center study, relatively small number of patients. Conclusions: The strategy that the angulus costae be used as the PRF puncture point of an electrode needle and the final localization of the needle tip as determined by sensory testing is an effective and safe therapeutic alternative for thoracic PHN treatment. Benefits include that the procedure is minimally invasive, provides short-term pain relief, and improves quality of life. Clinical Trial Registration: NO ISRCTN25588650. Key words: Thoracic, postherpetic neuralgia, pulsed radiofrequency, angulus costae

2019 ◽  
Vol 4 (22;4) ◽  
pp. 361-368
Author(s):  
Tao Song

Background: Trigeminal postherpetic neuralgia is a severe neuropathic pain and often refractory to existing treatment, it develops secondary to herpes zoster-infected Gasserian ganglion. Therefore, it is important to prevent the transition of acute/subacute zoster-related pain to trigeminal postherpetic neuralgia. Despite numerous studies, the optimal intervention that reduces trigeminal postherpetic neuralgia incidence is still unknown. Objectives: This study aimed to evaluate the efficacy and safety of high-voltage, long-duration pulsed radiofrequency (PRF) on the Gasserian ganglion in patients with acute/subacute zosterrelated trigeminal neuralgia. Study Design: Prospective, randomized, double-blinded study. Setting: Department of Pain Medicine, the First Affiliated Hospital of China Medical University. Methods: Ninety-six patients with acute/subacute zoster-related trigeminal neuralgia were equally randomly assigned into 2 groups. The electrode needle punctured the Gasserian ganglion guided by computed tomography in every patient. High-voltage, long-duration PRF at 42°C for 900 seconds was applied in the PRF group (n = 48). It was also applied in the sham group (n = 48) without radiofrequency energy output. The therapeutic effects were evaluated using a visual analog scale (VAS) and the 36-Item Short Form Health Survey (SF-36) at different time points. The average dosage of pregabalin (mg/d) administrated within the first month after treatment was also recorded. Results: The postprocedure VAS scores in the PRF group were significantly lower than those in the sham group at different time points after treatment (P < 0.01). The SF-36 scores, which included physical functioning, physical role, bodily pain, general health perceptions, vitality, social function, emotional role, and the mental health index, were significantly improved at the sixth month after treatment in the PRF group compared with the sham group (P < 0.01). The average dosage of pregabalin administered (mg/d) within the first month after treatment was also significantly reduced in the PRF group compared with the sham group (P < 0.01). There were no bleeding, infection, or other severe side effects in both groups. Limitations: Single center study, relatively small number of patients. Conclusions: High-voltage, long-duration PRF on the Gasserian ganglion is an effective and safe therapeutic alternative for patients with acute/subacute zoster-related trigeminal neuralgia. Key words: Pulsed radiofrequency, zoster-related trigeminal neuralgia, visual analog scale, 36- Item Short Form Health Survey


2016 ◽  
Vol 5;19 (5;19) ◽  
pp. E721-E728
Author(s):  
Tao Song

Background: Postherpetic neuralgia (PHN) is often refractory to existing treatments. Treatment of the dorsal root ganglion (DRG) using monopolar pulsed radiofrequency (PRF), which is a nonor minimally neurodestructive technique, is not efficacious in all patients. Objectives: This study aimed to determine the safety and clinical efficacy of bipolar highvoltage, long-duration PRF on the DRG in PHN patients. Study Design: Self before-after controlled clinical trial. Setting: Department of Pain Medicine, the First Affiliated Hospital of China Medical University. Methods: Ninety patients diagnosed with PHN for > 3months were included. Bipolar highvoltage, long-duration PRF at 42°C for 900 seconds was applied after the induction of paresthesias covered the regions of hyperalgesic skin. The therapeutic effects were evaluated using a visual analog scale (VAS) and the 36-item Short Form health survey (SF-36) before treatment and one, 4, 8, and 12 weeks after PRF. Results: The VAS scores at one, 4, 8, and 12 weeks after PRF treatment were significantly lower than before treatment (P < 0.001). The SF-36 scores, which included physical functioning, physical role, bodily pain, general health perceptions, vitality, social function, emotional role, and the mental health index, were significantly improved up to 12 weeks after PRF treatment (P < 0.001). No serious adverse effects were identified following treatment. The main adverse reactions included pain, tachycardia, and high blood pressure (especially when the field strength was enhanced). Limitations: Single center study, relatively small number of patients, lack of a control group. Conclusion: Bipolar high-voltage, long-duration PRF on the DRG is an effective and safe therapeutic alternative for PHN patients. This treatment could improve the quality of life of PHN patients. Clinical Trial Registration: NO ChiCTR-OCS-14005461 Key words: Pulsed radiofrequency, postherpetic neuralgia, VAS, SF-36


2000 ◽  
Vol 6 (5) ◽  
pp. 338-342
Author(s):  
J HA Arnoldus ◽  
J Killestein ◽  
L EMA Pfennings ◽  
B Jelles ◽  
B MJ Uitdehaag ◽  
...  

Objectives: To determine the quality of life (QoL) of MS patients during the initial 6 months of treatment with interferon-b (IFN-b). Furthermore, to determine whether changes in QoL relate to disability, emotional state, therapeutic expectations or side effect profile. Background: IFN-b has been shown to have beneficial effects on the course of MS. Since the aim of IFN-b treatment is not to cure but to slow down the disease it is important to know how this treatment affects QoL. Surprisingly, the impact of treatment with IFN-b on QoL measures has not been extensively studied so far. Methods: Case report documentation, including EDSS, SF-36 and MADRAS scores, of 51 relapsing-remitting MS patients treated with IFN-b was obtained at baseline and at months 1, 3 and 6. Patients also filled in a form about their expectations of therapy and a questionnaire on side effects. Results: During treatment there was a significant linear trend indicating improvement in the role-physical functioning (RPF) scale of the SF-36 (F1,50=4.9, P=0.032). A transient decrease at month 1 was found in the scale for bodily pain, indicating more experienced pain (F1,50=19.8, P50.001). Subgroup analysis showed that patients with most depressive symptoms on the MADRAS at baseline contributed most to the increase in RPF scores over time (F1,24=5,6 P=0.026). Furthermore, we found associations between adverse event scores and several domains of QoL. Conclusions: Our findings suggest that IFN-b therapy has an impact on QoL of MS patients in that it improves role-physical functioning and transiently worsens experienced bodily pain. QoL during treatment with IFN-b is influenced by depressive symptoms at baseline as well as by treatment-associated side-effects.


Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1533-1533
Author(s):  
Amy Sobota ◽  
Robert Yamashita ◽  
Yan Xu ◽  
Felicia Trachtenberg ◽  
Pamela Kohlbry ◽  
...  

Abstract Abstract 1533 Background: Advances in treatment of thalassemia have led to increased life expectancy for patients, making outcomes such as health related quality of life (HRQOL) an important consideration of therapy. However little has been published about the HRQOL of patients living with thalassemia, especially as it may change over time. Our study reports changes in patient-reported HRQOL from baseline to year 1 in the Thalassemia Clinical Research Networks (TCRN) Thalassemia Longitudinal Cohort (TLC) study. Methods: The TCRN is an NIH sponsored network of 16 major thalassemia centers in the US, Canada and London. We report here on the results from 220 patients (approximately 80% of the total cohort) over the age of 14 who completed baseline and year 1 assessments. HRQOL was measured by self-report with the Medical Outcomes Study 36-Item Short Form Health Survey version 2 (SF36v2). We defined a clinically significant change as a difference of at least 2 points on any SF-36 subscale. Results: Overall the patients were 46% male with a mean age of 29 years at baseline (range 14–58). Across the TLC population, mean self-reported HRQOL showed little change over the 1 year study period, with only social functioning showing a significant increase (p=0.04). However in each SF-36 domain over 50% of patients reported a signficant change in scores (an increase or decrease of more than 2 points) (Figure 1). All patients had a significant change on at least one domain, with a mean of 7 domains affected. Overall a small majority of patients (56%) reported that their health in general was “about the same” at year 1 as at baseline; 14% reported it was somewhat worse, 19% somewhat better, and 11% much better. Forty-nine % of patients reported requiring fewer transfusions in year 1, while 34% needed more, and 17% had no change. Most patients (82%) made no change in their chelator, although 8% changed from deferoxamine (DFO) to an oral chelator, fewer than 1% changed from oral to DFO, and 3% each stopped and started chelation. Most patients (61%) reported the same general adherence rate, although taken together there was slightly better reported adherence in year 1. Almost half of patients (47%) reported no change in chelator side effects, although again there was a slight overall decrease in reported side effects across the group. Most patients (92%) reported no new secondary complications in year 1. As expected, increasing age was associated with decreased HRQOL in the following domains: physical function, bodily pain, vitality, social function, mental health, and physical summary scales, although only bodily pain showed a clinically significant change (+2.1 points). Gender, race, change in number of transfusions, and change in chelator were not associated with change in HRQOL, although there was a trend towards improved general health in patients who made any change in chelation. A decrease in reported side effects from chelation was associated with an improvement in physical functioning (+2.8) and the mental summary score (+3.48), while development of a new complication during the one year study period was associated with a decrease in role-emotional (-8.2). Surprisingly an increase in reported adherence was associated with a decrease in social functioning (-5.1), role emotional (-7.7) and the mental summary score (-5.4). Conclusions: As a population, the TLC showed overall stability in clinical status and SF-36 scores over the 1 year study period. However individual patients reported significant changes, both positive and negative, in an average of 7 SF-36 domains. HRQOL appears to be most affected by age, with some association with changes in chelator, secondary complications, side effects and adherance. Further analysis is needed in order to fully understand these associations. Disclosures: Neufeld: Novartis, Inc: Research Funding; Ferrokin, Inc: Research Funding.


2021 ◽  
pp. 215-222
Author(s):  
Tao Song

Background: Postherpetic neuralgia (PHN) is the final stage of varicella zoster infection and a severe refractory neuropathic pain. Hence preventing transition of herpes zoster-related pain to PHN is a very important therapeutic principle for patients at an early stage, especially for older patients.Both pulsed radiofrequency (PRF) and short-term spinal cord stimulation (stSCS) have been proven to be effective to relieve acute/subacute zoster-related pain. However, which treatment could achieve better analgesic effects remains unclear. Objectives: This study aimed to investigate the therapeutic efficacy and safety of PRF and stSCS in patients with acute/subacute zoster-related pain. Study Design: Prospective, randomized, double-blinded study. Setting: Department of Pain Medicine, the First Affiliated Hospital of China Medical University. Methods: Ninety-six patients with acute/subacute zoster-related pain were equally randomized into 2 groups: PRF group and stSCS group. Patients in the different groups were treated with high-voltage, long-duration PRF or stSCS. The therapeutic effects were evaluated using a Numeric Rating Scale (NRS-11) and the 36-Item Short Form Health Survey (SF-36) at different time points. The average dose of pregabalin (mg/d) administrated at different time points was also recorded. Results: The posttreatment NRS-11 scores in the 2 groups were significantly lower compared with baseline (P < 0.001). The NRS-11 scores in the stSCS group were significantly lower than those in the PRF group at 30 and 180 days after treatments (P < 0.05). The SF-36 scores of general health, social function, role-emotional, mental health, bodily pain, physical function, physical role, and vitality could be significantly improved at each time point after treatments in the 2 groups. Some SF-36 scores could be significantly improved at some time points in the stSCS group compared with the PRF group. The rescue drug (pregabalin) dosages were lower in the stSCS group than those in the PRF group at days 90 and 180 after treatments. There was no bleeding at the puncture site, infection, postoperative paresthesia, nerve injury, or any other serious adverse effects in either group. Limitations: Single-center study, relatively small number of patients. Conclusions: PRF and stSCS are both effective and safe therapeutic alternatives for patients with acute/subacute zoster-related pain, however, stSCS could achieve more pain relief and improvement of life quality compared with PRF. Key words: Pulsed radiofrequency, short-term spinal cord stimulation, zoster-related pain, Numeric Rating Scale, 36-Item Short Form Health Survey


2020 ◽  
Vol 14 ◽  
Author(s):  
Zhenkai Han ◽  
Tao Hong ◽  
Yuanyuan Ding ◽  
Shimeng Wang ◽  
Peng Yao

BackgroundPostherpetic neuralgia (PHN) is a form of long-lasting neuropathic pain that can severely affect patients’ quality of life. Pulsed radiofrequency (PRF) has been proven to be effective in treating PHN, but the optimal radiofrequency parameters are still not well defined. This retrospective study aimed to compare the efficacy and safety of CT-guided PRF at three different voltages for the treatment of PHN patients.MethodsThis study included 109 patients with PHN involving the thoracic dermatome who were treated in the Department of Pain Management of Shengjing Hospital, China Medical University, from January 2017 to May 2019. They were divided into three groups based on the PRF voltage used: group A (45 V), group B (55 V), and group C (65 V). The PRF therapy (voltage 45, 55, and 65 V) was performed in all patients by targeting the thoracic dorsal root ganglion. After surgery, patients were followed at 3 days, 1 month, 3 months, 6 months, and 12 months. Observation at each follow-up included basic patient characteristics, visual analog scale (VAS), 36-Item Short Form Health Survey (SF-36) scores, patient satisfaction, complications, and side effects.ResultsVisual analog scale scores decreased and SF-36 scores increased for all patients in the three groups at each post-operative time point (1, 3, 6, and 12 months; all P &lt; 0.01). Pain relief, improvement in quality of life, and overall satisfaction were more significant for patients in group C than for those in groups A and B at the 3-, 6-, and 12-month follow-ups (all P &lt; 0.05). Patients in group B had lower VAS scores and higher overall satisfaction levels than those in group A (both P &lt; 0.01). A small number of patients from each group (n ≤ 3) experienced mild intraoperative and post-operative complications, which bore no relationship with group assignment (all P &gt; 0.05). At post-operative day 3, patients in group C had skin numbness affecting a larger area than patients in the other two groups (both P &lt; 0.05), but the differences were no longer statistically significant at day 30 after the operation. All patients experienced a drop in numbness area of more than 30% after surgery.ConclusionCompared with PFR at 45 and 55 V, PFR at 65 V had superior efficacy in treating PNH, with a favorable safety profile.


2008 ◽  
Vol 2;11 (3;2) ◽  
pp. 137-144
Author(s):  
Thomas T. Simopoulos

Objectives: We aimed to prospectively evaluate the response and safety of pulsed and continuous radiofrequecy lesioning of the dorsal root ganglion/segmental nerves in patients with chronic lumbosacral radicular pain. Methods: Seventy-six patients with chronic lumbosacral radicular pain refractory to conventional therapy met the inclusion criteria and were randomly assigned to one of 2 types of treatment, pulsed radiofrequency lesioning of the dorsal root ganglion/segmental nerve or pulsed radiofrequency followed immediately by continuous radiofrequency. Patients were carefully evaluated for neurologic deficits and side effects. The response was evaluated at 2 months and was then tracked monthly. A Kaplan-Meier analysis was used to illustrate the probability of success over time and a Box-Whisker analysis was applied to determine the mean duration of a successful analgesic effect. Results: Two months after undergoing radiofrequency treatment, 70% of the patients treated with pulsed radiofrequency and 82% treated with pulsed and continuous radiofrequency had a successful reduction in pain intensity. The average duration of successful analgesic response was 3.18 months (± 2.81) in the group treated with pulsed radiofrequency and 4.39 months (±3.50) in those patients treated with pulsed and continuous radiofrequency lesioning. A Kaplan-Meier analysis illustrated that in both treatment groups the chance of success approached 50% in each group at 3 months. The vast majority of patients had lost any beneficial effects by 8 months. There was no statistical difference between the 2 treatment groups. No side effects or neurological deficits were found in either group. Conclusion: Pulsed mode radiofrequency of the dorsal root ganglion of segmental nerves appears to be a safe treatment for chronic lumbosacral radicular pain. A significant number of patients can derive at least a short-term benefit. The addition of heat via continuous radiofrequency does not offer a significant advantage. A randomized controlled trial is now required to determine the effectiveness of pulsed radiofrequency. Key words: Pulsed radiofrequency lesioning, dorsal root ganglion, segmental nerve, continuous radiofrequency lesioning, chronic lumbosacral radicular pain


2020 ◽  
Vol 3;23 (6;3) ◽  
pp. 263-270
Author(s):  
Lei Sima

Background: Postherpetic neuralgia (PHN) occurs in 9% to 34% of herpes zoster (HZ) patients, and the incidence of PHN is positively correlated with age. A number of patients suffer from poor therapeutic effects or intolerable side effects and need to accept minimally invasive analgesia. Objectives: This study aimed to investigate the effects of spinal cord stimulation (SCS) and pulsed radiofrequency (PRF) on the treatment of elderly patients with HZ-related pain persisting beyond the acute phase. Study Design: A prospective, randomized-controlled trial. Setting: Research was conducted at the National Pain Management and Research Center, ChinaJapan Friendship Hospital (Beijing, China). Methods: We selected 63 patients aged over 50 years with zoster-related pain of 1 to 6 months onset. They were randomly divided into an SCS group and a PRF group. In the SCS group, the stimulus electrodes were placed in the affected spinal ganglion segment of the epidural space for 2 weeks. In the PRF group, the radiofrequency needle was percutaneously punctured in the affected dorsal root ganglion. The main outcome measures were the Numeric Rating Scale (NRS-11) score, response rate, and complete remission rate. The secondary endpoint was defined as the use of analgesics and calcium channel antagonists. Results: The NRS-11 score in the SCS group decreased to 2.90 ± 1.83 (1 week post operation) and 4.37 ± 2.43 (24 weeks post operation), while that in the PRF group decreased to 3.13 ± 1.78 and 4.23 ± 2.64, respectively (compared with baseline, P < .001); there was no significant difference between the 2 groups (P > .05) . The effective rate of pain management was in the range of 56.67% to 81.25%, and the complete pain relief rate ranged from 37% to 71%. The number of patients still using analgesics and calcium channel antagonists after operation were significantly less than those pre-operation (P < .001). Univariate and multivariate logistic regression analyses showed that the operation method, age, gender, and course of disease did not affect surgical efficacy. Limitations: The main limitation of this study is that all the cases were from the same center. Conclusion: It therefore can be concluded that SCS and PRF can effectively relieve PHN. Key words: Spinal cord stimulation, pulsed radiofrequency, postherpetic neuralgia


2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Xiumei Ren ◽  
Chang Yao ◽  
Fan Wu ◽  
Zhao Li ◽  
Jinyun Xing ◽  
...  

Objective.To observe the effects of traditional Chinese moxibustion, compared with sham moxibustion, on the quality of life (QOL) in patients with chronic knee osteoarthritis (KOA).Methods.This is a randomized double-blinded, placebo-controlled trial. 150 patients with KOA were randomly allocated to either a true moxibustion treatment (n= 77) or a sham moxibustion treatment (n= 73) three times a week for six weeks. The QOL of patients was evaluated with SF-36 at baseline and 3, 6, and 12 weeks after baseline.Results.136 patients were available for analysis. Participants in the true moxibustion group experienced statistically significantly greater improvement in GH (general health) scores than the sham group at week 6 (P= 0.015) and week 12 (P= 0.029). Participants in the true moxibustion group experienced statistically significantly greater improvement in VT (vitality) scores than the sham group at week 12 (P= 0.042). No significant adverse effects were found during the trial.Conclusion.A 6-week moxibustion treatment seems to improve general health and vitality, which are associated with physical and mental quality of life, in patients with KOA up to 12 weeks, relative to credible sham moxibustion. This trial is registered with Clinicaltrials.govISRCTN68475405.


2019 ◽  
Vol 46 (5) ◽  
pp. E14
Author(s):  
Michael Kern ◽  
Matthias Setzer ◽  
Lutz Weise ◽  
Ali Mroe ◽  
Holger Frey ◽  
...  

OBJECTIVEThe treatment of patients with spinal stenosis and concurrent degenerative spondylolisthesis is controversial. Two large randomized controlled clinical trials reported contradictory results. The authors hypothesized that a substantial number of patients will show evidence of micro-instability after a sole decompression procedure.METHODSThis study was a retrospective analysis of all cases of lumbar spinal stenosis treated at the Frankfurt University Clinic (Universitätsklinik Frankfurt) from 2010 through 2013. Patients who had associated spondylolisthesis underwent upright MRI studies in flexion and extension for identification of subtle signs of micro-instability. Clinical outcome was assessed by means of SF-36 bodily pain (BP) and physical functioning (PF) scales.RESULTSA total of 21 patients were recruited to undergo upright MRI studies. The mean duration of follow-up was 65 months (SD 16 months). Of these 21 patients, 10 (47%) showed signs of micro-instability as defined by movement of > 4 mm on flexion/extension MRI. Comparison of mean SF-36 BP and PF scores in the group of patients who showed micro-instability versus those who did not showed no statistically significant difference on either scale.CONCLUSIONSThere seems to be a substantial subset of patients who develop morphological micro-instability after sole decompression procedures but do not experience any clinically significant effect of the instability.


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