Pulsed radiofrequency lesioning of the lumbosacral dorsal root ganglion in a patient with lumbosacral plexopathy due to locally advanced pelvic liposarcoma

Background: The modified technique, pulsed radiofrequency (PRF) procedure, applied to nervous tissue has been providing anecdotal benefits for the management of chronic and intractable pain conditions. Although PRF has a neuromodulatory effect instead of thermally lesioning nervous tissue, the mechanism underlying the analgesic effect of PRF has not been fully clarified yet. Objectives: To see the changes of electricallyevoked responses of peripheral A-δ and A-β nerve fibers and the analgesic effect induced by PRF. Study Design: Case series. Setting: Inpatient. Methods: This study investigated how dorsal root ganglion (DRG) PRF influenced electricallyevoked responses of peripheral A-δ and A-β nerve fibers at the treated root ganglion dominating areas in five patients with intractable vertebral metastatic pain. Results: DRG PRF provided sound pain relief for patients with intractable vertebral metastatic pain. PRF application at DRGs had a different effect on electrically-evoked responses of peripheral A-δ and A-β nerve fibers at not only the treated root ganglion dominating areas but also the nontreated root ganglion dominating areas far from the treated root ganglion dominating areas in each patient. Limitation: This report is a case series. Conclusions: PRF application at some peripheral nerves could cause drastic neuromodulation throughout the whole body. Key words: Pulsed radiofrequency, dorsal root ganglion block, neuromodulation

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F716 MANAGEMENT OF LOW BACK PAIN BY APPLYING THE COMBINATION OF FACET RADIOFREQUENCY AND TRANSFORAMINAL DORSAL ROOT GANGLION PULSED RADIOFREQUENCY (PRF)

European Journal of Pain Supplements ◽

10.1016/s1754-3207(11)70662-9 ◽

2011 ◽

Vol 5 (1) ◽

pp. 192

Author(s):

Z. Elchami ◽

O. Asali ◽

J. Akiki ◽

E. Umlas

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Dorsal Root Ganglion ◽

Dorsal Root ◽

Low Back ◽

Pulsed Radiofrequency

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Selective dorsal root ganglion pulsed radiofrequency lesioning combined with gabapentin in the treatment of postherpetic neuralgia: The unanswered questions

Neurology India ◽

10.4103/0028-3886.246228 ◽

2018 ◽

Vol 66 (6) ◽

pp. 1711

Author(s):

ManishSingh Sharma ◽

JasonP Dauffenbach

Keyword(s):

Dorsal Root Ganglion ◽

Postherpetic Neuralgia ◽

Dorsal Root ◽

Pulsed Radiofrequency

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Transforaminal Epidural Injection of Local Anesthetic and Dorsal Root Ganglion Pulsed Radiofrequency Treatment in Lumbar Radicular Pain: A Randomized, Triple‐Blind, Active‐Control Trial

Pain Practice ◽

10.1111/papr.12840 ◽

2019 ◽

Vol 20 (2) ◽

pp. 154-167 ◽

Cited By ~ 2

Author(s):

Manish De ◽

Virender K. Mohan ◽

Debesh Bhoi ◽

Praveen Talawar ◽

Ajeet Kumar ◽

...

Keyword(s):

Dorsal Root Ganglion ◽

Active Control ◽

Local Anesthetic ◽

Dorsal Root ◽

Epidural Injection ◽

Radicular Pain ◽

Pulsed Radiofrequency ◽

Pulsed Radiofrequency Treatment ◽

Transforaminal Epidural Injection ◽

Lumbar Radicular Pain

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Microglial BDNF, PI3K, and p-ERK in the Spinal Cord Are Suppressed by Pulsed Radiofrequency on Dorsal Root Ganglion to Ease SNI-Induced Neuropathic Pain in Rats

Pain Research and Management ◽

10.1155/2019/5948686 ◽

2019 ◽

Vol 2019 ◽

pp. 1-15 ◽

Cited By ~ 3

Author(s):

Xueru Xu ◽

Shaoxiong Fu ◽

Xiaomei Shi ◽

Rongguo Liu

Keyword(s):

Spinal Cord ◽

Neuropathic Pain ◽

Dorsal Root Ganglion ◽

Nerve Injury ◽

Calcium Binding ◽

Dorsal Root ◽

Intrathecal Injection ◽

Pulsed Radiofrequency ◽

Erk Phosphorylation ◽

Extracellular Signal

Background. Pulsed radiofrequency (PRF) on the dorsal root ganglion (DRG) has been applied to alleviate neuropathic pain effectively, yet the mechanisms underlying pain reduction owing to this treatment are not clarified completely. The activated microglia, brain-derived neurotrophic factor (BDNF), phosphatidylinositol 3-kinase (PI3K), and phosphorylated extracellular signal-regulated kinase (p-ERK) in the spinal cord were demonstrated to be involved in developing neuropathic pain. Also, it has been just known that PRF on DRG inhibits the microglial activation in nerve injury rats. Here, we aim to investigate whether PRF treatment could regulate the levels of BDNF, PI3K, and p-ERK in the spinal cord of rats with spared nerve injury (SNI) via suppressing the spinal microglia activation to ease neuropathic pain. Methods. The rats with SNI were intrathecally treated with minocycline (specific microglia inhibitor) or same volume of dimethyl sulfoxide once daily, beginning from 1 h before nerve transection to 7 days. PRF was applied adjacent to the L4-L5 DRG of rats with SNI at 45 V for 6 min on the seventh postoperative day, whereas the free-PRF rats were treated without PRF. The withdrawal thresholds were studied, and the spinal levels of ionized calcium-binding adapter molecule 1 (Iba1), BDNF, PI3K, and p-ERK were calculated by western blot analysis, reverse transcription-polymerase chain reaction, and immunofluorescence. Results. The paw withdrawal mechanical threshold and paw withdrawal thermal latency decreased in the ipsilateral hind paws after SNI, and the spinal levels of Iba1, BDNF, PI3K, and p-ERK increased on day 21 after SNI compared with baseline (P<0.01). An intrathecal injection of minocycline led to the reversal of SNI-induced allodynia and increase in levels of Iba1, BDNF, PI3K, and p-ERK. Withdrawal thresholds recovered partially after a single PRF treatment for 14 days, and SNI-induced microglia hyperactivity, BDNF upregulation, and PI3K and ERK phosphorylation in the spinal cord reduced on D14 due to the PRF procedure. Conclusion. Microglial BDNF, PI3K, and p-ERK in the spinal cord are suppressed by the therapy of PRF on DRG to ease SNI-induced neuropathic pain in rats.

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Randomized controlled trials between dorsal root ganglion thermal radiofrequency, pulsed radiofrequency and steroids for the management of intractable metastatic back pain in thoracic vertebral body

British Journal of Pain ◽

10.1177/2049463720942538 ◽

2020 ◽

pp. 204946372094253

Author(s):

Sherry Nabil Fanous ◽

Emad Gerges Saleh ◽

Ekramy Mansour Abd Elghafar ◽

Hossam Zarif Ghobrial

Keyword(s):

Dorsal Root Ganglion ◽

Dorsal Root ◽

Oral Morphine ◽

Good Alternative ◽

Drop Out ◽

Pulsed Radiofrequency ◽

Vertebral Metastasis ◽

Randomized Controlled ◽

Augmentation Techniques ◽

Axial Pain

Background: Bone metastasis is a complication of various cancers causing severe pain. The current modalities for the treatment of metastatic axial pain include pharmacological, surgical and vertebral augmentation techniques, each of which has its own challenges. Objectives: To evaluate the effectiveness of pulsed radiofrequency (PRF), thermal radiofrequency (RF) and steroids on dorsal root ganglion (DRG) in patients with thoracic axial pain due to vertebral metastasis. Methods: In this randomized controlled prospective study, 140 patients were assessed for eligibility, of which only 69 fulfilled the criteria. Patients were randomly divided into three equal groups, PRF, RF and steroid. Results: During the assessment of pain using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Opioid consumption using oral Morphine Equivalence (OME) and Analgesic Quantification Algorithm (AQA) – at baseline, 1 week, 1 month and 3 months – 81 patients were assessed for final eligibility, of which 12 were excluded before intervention due to drop-out. The remaining 69 were randomized (mean age: 53.87 ± 10.55, 55.78 ± 7.34 and 59.39 ± 13.72) for PRF, RF and steroid, respectively with no statistical difference. VAS% and ODI% decreased significantly at 3 months in RF group ( p <0.001, 0.014, respectively), as did the AQA ( p <0.027). Steroid group was the worst. Discussion: RF on DRG is the main stay for controlling intractable metastatic pain. PRF is a good alternative.

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