This work was presented at the World Institute of Pain U.K. Section, Symposium on “Evidence in Interventional Pain Procedures” in London on June 21, 2007 and has subsequently undergone peer-review.
Radiofrequency and Pulsed Radiofrequency Treatment of Chronic Pain Syndromes: The Available Evidence
Article first published online: 19 AUG 2008
© 2008 World Institute of Pain
Volume 8, Issue 5, pages 385–393, September/October 2008
How to Cite
Van Boxem, K., Van Eerd, M., Brinkhuize, T., Patijn, J., Van Kleef, M. and Van Zundert, J. (2008), Radiofrequency and Pulsed Radiofrequency Treatment of Chronic Pain Syndromes: The Available Evidence. Pain Practice, 8: 385–393. doi: 10.1111/j.1533-2500.2008.00227.x
Section Editor: Jan Van Zundert, MD, PhD, FIPP
- Issue published online: 20 SEP 2008
- Article first published online: 19 AUG 2008
Vol. 10, Issue 2, 164, Article first published online: 23 FEB 2010
- pulsed radiofrequency;
- facet joint;
- dorsal root ganglion;
- trigeminal neuralgia;
- Gasserian ganglion
There are currently 6 reviews on (pulsed) radiofrequency (RF) for the management of spinal pain. Two reviews on interventional pain management techniques in general also discuss RF. The outcomes of those reviews depend on the type of studies included and the opinion of the reviewers, which may result in different evidence levels.
Radiofrequency denervation at the cervical and lumbar level has produced the most solid evidence. The differences in treatment outcome registered in the 5 randomized controlled trials (RCTs) regarding lumbar facet denervation can be attributed to differences in patient selection and/or inappropriate technique. There is not sufficient evidence supporting the use of RF facet denervation for the management of cervicogenic headache. The studies examining the management of cervical radicular pain suggest a comparable efficacy for RF and pulsed RF (PRF). The PRF treatment is supposed to be safer and therefore should be preferred. The superiority of RF treatment adjacent to the lumbar dorsal root ganglion for the management of lumbar radicular pain has not been demonstrated in an RCT.
Information regarding RF treatment of sacroiliac joint pain is accumulating. No randomized sham-controlled trials on the value of RF treatment of the Gasserian ganglion for the management of idiopathic trigeminal neuralgia have been published. One RCT indicates superiority of RF over PRF for the management of idiopathic trigeminal neuralgia. Future research to confirm or deny the efficacy of (P)RF should be conducted in carefully selected patient populations. The tests used for patient inclusion in such a trial could potentially help the clinician in selecting patients for this type of treatment. The value of PRF treatment of the peripheral nerves also needs to be confirmed in well-designed trials.