EFFICACY AND SAFETY OF PULSED RADIOFREQUENCY TREATMENT IN

CHRONIC PAIN SYNDROMES

Introdução à Medicina II | Teacher Luís Filipe Azevedo | Class 14

Summary

Introdução à Medicina II | Teacher Luís Azevedo | Class 14

1. Introduction

2. Methods

3. Results

4. Planning and development of future tasks

5. References

1.Introduction Research question and aims

What is the efficacy and safety of Pulsed Radiofrequency treatment in chronic pain

syndromes?

Aim:

To systematically review the evidence about efficacy and safety of pulsed radiofrequency in patients with chronic pain syndromes.

Introdução à Medicina II | Teacher Luís Azevedo | Class 14

1.Introduction

What is pain?

PAIN

Acute Chronic

The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage."

“Chronic pain has been increasing in prevalence. It is considered the most underestimated health care problem impacting quality of life. A number of epidemiological studies conducted in different parts of the world, reported prevalence rates of chronic pain ranging from 12-80%. Chronic pain has detrimental effects on physical and mental health, daily activities, family relationships, employment and economic well-being of the sufferers and family caregivers. Since the epidemiological studies about chronic pain in Lebanon are limited, the aim of this article is to help understand the magnitude of the problem and to depict strategies for the prevention and management of chronic pain.” [1]

Introdução à Medicina II | Teacher Luís Azevedo | Class 14

[1] 1. Huijer H, Abu-saad. Chronic pain: a review. J Med Liban; 2010

Relieves pain and improves

movement and function

Alters pain signals as

they travel to the brain

1.Introduction

Different treatments for chronic pain [2]

Electrical Stimulation Therapies

Relaxation Techniques

Physical Therapy

Helps reduce stress levels

Introdução à Medicina II | Teacher Luís Azevedo | Class 14[2] Van Zundert J, Huntoon M, Patijn J, Lataster A, Mekhail N, van Kleef M. Cervical Radicular Pain. Pain Pract; 2009 Oct.

Radiofrequency treatment

1.Introduction

A development of heat based radiofrequency denervation [3]

To treat especially chronic pain

Minimally invasive target selective technique

Uses brief pulses of high voltage (Rf range – 300kHz) to produce

controlled tissue destruction

Heat dissipates between pulses, avoiding thermocoagulation

Reduces pain by modullating pain transmission

Produces transient inibition of evoked synaptic activity [4]

Introdução à Medicina II | Teacher Luís Azevedo | Class 14[3] Pevzner E, David R, Leitner Y, Pekarsky I, Folman Y, Gepstein R. Pulsed radiofrequency treatment of severe radicular pain. Harefuah; 2005 Mar.[4] Byrd D, Mackey S. Pulsed radiofrequency for chronic pain. Curr Pain Headache Rep; 2008 Jan.

Project Development Phases

1. Research question formulation

2. Definition of selection criteria (inclusion and exclusion)

3. Definition and implementation of literature search methods and resources

4. Study selection using defined selection criteria

5. Data extraction from included studies

6. Critical appraisal and quality assessment of included studies

7. Data analysis and synthesis from included primary studies

8. Writing and disseminating final report

2. Methods

Introdução à Medicina II | Teacher Luís Azevedo | Class 14

Type of study

Systematic Review

  Units of analysis

Articles

  Data Search

PubMed

ISI Web of Knowledge

Scopus

Central

2. Methods

Introdução à Medicina II | Teacher Luís Azevedo | Class 14

Key-words

Pain

Chronic

Pulsed

Radiofrequency

  Query

PubMed:pulsed[All Fields] AND radiofrequency[All Fields] AND (("pain"[MeSH Terms] OR "pain"[All Fields]) AND chronic[All Fields])

Scopus:TITLE-ABS-KEY(radiofrequency) AND TITLE-ABS-KEY(pulsed) AND TITLE-ABS-KEY(pain) AND TITLE-ABS-KEY(chronic)

ISITS=(Radiofrequency SAME pulsed) AND TS=pain AND TS=chronic

Central#1 MeSH descriptor Pain explode all trees#2 (Chronic): ti, ab, kw#3 (Radiofrequency Near Pulsed): ti, ab, kw

2. Methods

MeSH Term: Pain

Introdução à Medicina II | Teacher Luís Azevedo | Class 14

Research Limits

 

2. Methods

Exclusion Criteria Inclusion Criteria

1. Theme does not match the expected

1. Articles that mention the radiofrequency treatment in chronic pain

2. Treatment is not used for chronic pain

2. Articles that have, at least, two comparative groups - a group sbmited to pulsed radiofrequency and a control group.

3. Type of article is not the desired 3. Articles that mention the issue of efficacy and safety of pulsed radiofrequency

4. Study is not conducted in humans

5. Article does not mention the methods used and results Introdução à Medicina II | Teacher Luís Azevedo | Class 14

2. Methods

Articles found

78

PUBMED48

ISI Web32

SCOPUS65

CENTRAL3

13 not excluded

65 excluded

Introdução à Medicina II | Teacher Luís Azevedo | Class 14

2. Methods

Articles found

78

PUBMED48

ISI Web32

SCOPUS65

CENTRAL3

4

Introdução à Medicina II | Teacher Luís Azevedo | Class 14

8

20

0

3. Results

Articles Excluded

Exclusion Criteria Articles

1. Theme does not match the expected 2

2. Treatment is not used for chronic pain 1

3. Type of article is not the desired. 59

4. Study is not conducted in humans 3

5. Article does not mention the methods used and results

0

Introdução à Medicina II | Teacher Luís Azevedo | Class 14

3. Results

Introdução à Medicina II | Teacher Luís Azevedo | Class 14

Publication year

3. Results

Agreement / Disagreement

Reason for exclusion

4 disagreements

Non-exclusion 0

disagreements

4 times was necessary a 3rd reviewer74 times wasn’t necessary

Introdução à Medicina II | Teacher Luís Azevedo | Class 14

3. Results

Introdução à Medicina II | Teacher Luís Azevedo | Class 14

1. "Pain practice: the official journal of Word Institute of pain" - 13 articles

2. "Pain Physician" - 9 articles

3. "Pain medicine (Malden, Mass.)" - 7 articles

Articles and Journals

3. ResultsNon-excluded articles:

Title Author Journal Publication year

Percutaneous pulsed radiofrequency applied to the L-2 dorsal root ganglion for treatment of chronic low-back pain: 3-year

experience

Tsou J Neurosurg Spine

2010

Pulsed radiofrequency on L2 dorsal root ganglion as a therapeutic

method for lumbar discogenic pain

Assis Coluna/Columna

2009

Response to pulsed and continuous radiofrequency lesioning of the

dorsal root ganglion and segmental nerves in patients with chronic

lumbar radicular pain

Simopoulos

Pain Physician 2008

A comparison of conventional and pulsed radiofrequency denervation in the treatment of chronic facet

joint pain

Tekin Clin J Pain 2007

Title Author Journal Publication year

Pulsed radiofrequency adjacent to the cervical dorsal root ganglion in chronic cervical radicular pain: a

double blind sham controlled randomized clinical trial

Van Zundert

Pain 2007

Contemporary role of radiofrequency treatment for intractable pain syndromes

Park European Congress of

Neurorosurgery

2007

Pulsed radiofrequency treatment of the lumbar medial branch for facet

pain: a retrospective analysis

Lindner Pain Med 2006

Pulsed radiofrequency of the dorsal root ganglia is superior to

pharmacotherapy or pulsed radiofrequency of the intercostal

nerves in the treatment of chronic postsurgical thoracic pain

Cohen Pain Physician 2006

3. ResultsNon-excluded articles:

Title Author Journal Publication year

Radiofrecuency in the treatment of chronic cervical spine

patology. Retrospective study

Abejon Revista de la Sociedad

Espanola del Dolor

2006

Sphenopalatine ganglion pulsed radiofrequency treatment in 30 patients

suffering from chronic face and head pain

Bayer Pain Pract 2005

Percutaneous pulsed radiofrequency treatment of the cervical dorsal root ganglion in the treatment of chronic cervical pain syndromes: A clinical

audit  

Van Zundert

Neuromodulation

2003

Pulsed mode radiofrequency lesioning of the suprascapular nerve for the

treatment of chronic shoulder pain 

Shah Pain Physician 2003

Pulsed radiofrequency application in treatment of chronic zygapophyseal

joint pain

Mikeladze Spine J 2003

3. ResultsNon-excluded articles:

4. Planning and development of future tasks

Oct Nov Dec Jan Feb Mar Apr May

Formulation of the question

Definition of selection’s criteria

Databases’ research

Abstracts’ reading

Articles selection

Analysis of the selected articles

Discussion of the results

Review article’s writing

Website’s building

Introdução à Medicina II | Teacher Luís Azevedo | Class 14

Introdução à Medicina II | Teacher Luís Azevedo | Class 14

Analysis of the selected articles

1. Second selection stage

2. Data extraction

3. Quality assessment (consort – clinical trials; strobe – observational studies, equator network)

Review Article’s writing

1. Abstract

2. Introduction

3. Methods

4. Results

5. Discussion

4. Planning and development of future tasks

5. References

Introdução à Medicina II | Teacher Luís Azevedo | Class 14

1. Huijer H, Abu-saad. Chronic pain: a review. J Med Liban; 2010

2. Van Zundert J, Huntoon M, Patijn J, Lataster A, Mekhail N, van Kleef M. Cervical Radicular Pain. Pain Pract; 2009 Oct.

3. Pevzner E, David R, Leitner Y, Pekarsky I, Folman Y, Gepstein R. Pulsed radiofrequency treatment of severe radicular pain. Harefuah; 2005 Mar.

4. Byrd D, Mackey S. Pulsed radiofrequency for chronic pain. Curr Pain Headache Rep; 2008 Jan.

5. Malik K, Ben Zon T. Pulsed radiofrequency: a critical review of its efficacy. Anaesth Intensive Care; 2007