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Pulsed Radiofrequency Current in the Treatment of Pain

DOI: 10.1615/CritRevPhysRehabilMed.v23.i1-4.150
pages 213-240

Justin Hata
Department of Anesthesiology & Perioperative Care, Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, University of California, Irvine, Orange, California 92697; Loma Linda Pain Management, 11406 Loma Linda Drive, Loma Linda, CA 92354

Danielle Perret-Karimi
Department of Anesthesiology & Perioperative Care, Department of Physical Medicine and Rehabilitation, University of California, Irvine, Irvine, CA 92697

Cecil DeSilva
Department of Physical Medicine and Rehabilitation, University of California, Irvine, Orange, California

Daniel Leung
Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI

Naomi Betesh
Department of Physical Medicine & Rehabilitation, The Mount Sinai Medical Center, New York, NY

Z. David Luo
Department of Physical Medicine and Rehabilitation, University of California, Irvine, Orange, California

Segun Dawodu
Albany Medical College, Albany, New York

Karin Sinavsky
Department of Physical Medicine and Rehabilitation, University of California, Irvine, Orange, California

O. Jameson Stokes
Department of Physical Medicine and Rehabilitation, University of California, Irvine, Orange, California

Steve English
Department of Physical Medicine and Rehabilitation, University of California, Irvine, Orange, California


KEY WORDS: pain, chronic pain, pulsed radiofrequency, dorsal root ganglion, facet joint, cervical, lumbar, radiculopathy, trigeminal neuralgia, intra-articular, joint neuralgia, neuropathic pain, neuromodulation

Abstract

The objective of this article is to explore the validity of the concept behind the application of pulsed radiofrequency (PRF) current in the treatment of pain. Included are the potential mechanisms of action, a review of animal and clinical studies, and a comparison of PRF clinically, when available, to traditional radiofrequency.
The antinociceptive effects of PRF are independent of temperature; PRF current reversibly and selectively disrupts impulse transmission in small unmyelinated pain fibers, and several mechanisms of action may play a role. There are few animal studies available but they confirm improvement of both thermal hyperalgesia and mechanical allodynia and show that the analgesic effect of PRF involves enhancement of descending noradrenergic and serotonergic inhibitory pathways.
In the clinical treatment of facet-mediated pain, the magnitude and duration of the PRF effect seems to be less than that of conventional radiofrequency. For radicular pain, 50% to 70% response rates are noted for 2−4 months after PRF; an efficacy similar to that of radiofrequency. Overall, despite the accumulation of a large amount of observational data supporting PRF, there are still few randomized, controlled, double-blind trials. A review of reported applications of PRF, however, is provided here to enumerate the potential indications of PRF.
To eliminate nonspecific treatment, control groups are critical in study design; sham and standard of care controls should be considered. Future studies should include in particular both short-term (<6 months) and long-term (6−12 months) follow-up intervals to establish the true efficacy of PRF. A greater body of basic science, animal, and clinical study data is imperative to establish further validation of this concept.