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PULSED RADIOFREQUENCY TREATMENT IN PAIN SYNDROMES
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
WHAT IS THE EVIDENCE?
?Problem
Is there any evidence that proves the efficacy of this treatment?
What are the cases that its use is well stabilised and with efficacies proved?
Abstract
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
Background
• Pulsed radiofrequency is a development of heat based radiofrequency denervation
• Is used in medicine to treat especially chronic pain
• This type of treatment does not provoke lesions of the nervous structures, but changes in the conduction of the pain stimulus by creating an electromagnetic field
• Unlike heat based radiofrequency treatment, pulsed radiofrequency does no direct damage to the nerve.
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
Abstract
Aims
1. Investigate if pulsed radiofrequency has any evidence in treatment of chronic syndromes
2. Study the patients’ life quality improvement
3. Compare this therapy to others more commonly applied procedures, focusing on the advantages of pulsed radiofrequency therapy.
Abstract
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
Methods
Type of study
Systematic Review and Meta-Analysis
Units of analysis
Articles found in databases
Data Search
PubMed
ISI Web of Knowledge
Abstract
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
Methods
Key-words
Pain
Chronic
Syndrome
Pulsed
Radiofrequency
Query
pulsed[All Fields] AND radiofrequency[All Fields] AND ("pain"[MeSH Terms] OR "pain"[All Fields])) AND (("syndrome"[MeSH Terms] OR "syndrome"[All Fields]) OR chronic[All Fields]
Abstract
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
Methods
Research Limits
Exclusion Criteria
Other types of articles, such as reviews, letter to editor or comments
Articles contemplating pulsed radiofrequency used not as a treatment for pain syndromes
Articles which don’t mention the methods used or the results
Inclusion Criteria
Language: English
No date of publication limits
Abstract
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
Methods
Work Fases
1. Formulation of a clear question: “Pulsed radiofrequency treatment in pain syndromes - What is the evidence?”
2. Definition of selection’s criteria
3. Databases’ research
4. Abstracts’ reading
5. Articles selection, by application of inclusion an exclusion criteria (each article should be read by two people. Divergences will be solved by consensus)
6. Analysis of the selected articles
7. Discussion of the results
8. Review article’s writing
9. Website’s building
Abstract
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
Expected results
To reassure the knowledge previously acquired mainly in subjects regarding scientific research tools and information selection.
Verify the article’s credibility and if the method is applicable in clinic procedures.
To improve the quality of our research both in terms of knowledge and information, and also time.
To have a solid review about this subject.
Manage to present it correctly to the public
Verify the credibility and the success of the method by the analysis of various articles.
Abstract
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
Basic concepts
Pulsed Radiofrequenc
y
Pain syndromes
Introduction
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
Pulsed Radiofrequency (PRF):
A development of heat based radiofrequency denervation
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
Introduction
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
Main location of neuropathic
pain:
Dorsal root ganglia (DRG)
Peripheral nerves
Trigeminal ganglions
Sphenopalatine ganglion
Intervertebral disc
Sacroiliac joint
Glossopharyngeal nerve
Introduction
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
Clinical Procedure:
1- Insulated neddle placed in the vicinity of the
nerve to be lesioned
2- Multiple fluoroscopic X-ray views to check needle
position
3- Motor and sensory nerve stimulation testing
4- Grounded electrode passed through the insulated
needle to the tip
5- Electric current through the electrode heats up
the surrounding tissue
Introduction
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
Main side effects:- The pain is greater the days after the treatment- Pain during the procedure- Global anesthetic- Damage blood vessels or other nerves close to the area
Clinical Experience on Radiofrequency: in clinical use for 30 years demonstrated success at reducing pain in several chronic pain
condition useful tool in the overall management of refractory neuropathic
pain.
Introduction
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
Introduction
Success in chronic pain has not been adequately reproduced in
randomized
controlled trials (RCTs), its use in the management of neuropathic
pain is under some debate:
conventional radiofrequency occasionally leads to worsening and even new onset of neuropathic pain.(Kornik et al., 2004)
pulsed radiofrequency may offer new opportunities and a broader perspective for therapy with radiofrequency. (Racz et al, 2006)
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
Justification of the study
Pulsed radiofrequency is a minimally invasive
treatment that has been used in many
pain syndromes
Need to check if there is any conclusion on
the evidence published.
Curiosity about the subject
Research on the topic (Sum up the published studies and articles)
Pulsed radiofrequency treatment in pain
syndromes – What is the evidence?
Introduction
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
Class 14
ANA LUIS FARIA INES PINTO JORGE PINTO JORGE SOARES JOSE BARRETO JOSE VICENTE FORMOSO LUÍS OLIVEIRA MAFALDA PINTO MAFALDA PAIS CARRINGTON MARIA TERESA SILVERIO MARIA LEONOR GODINHO MIGUEL VALENTE PAULA TEIXEIRA PEDRO MONTEIRO
References
1. Kornick, C., Meng, F.C., Xu, S.J., Liu, Y.G., Wang, H.W. Selective percutaneous radiofrequency thermocoagulation in the treatment of trigeminal neuralgia:report on 1860 cases. Chinese Medical Journal 2004; 117:467-470
2. RACZ, G.B, RUIZ-LOPEZ, R. Radiofrequency Procedures: Review Article, Pain Practice, 2006; p.46-50
3. Van Zundert J, Huntoon M, Patijn J, Lataster A, Mekhail N, van Kleef M. Cervical Radicular Pain, 05/05/2009.
4. KESKINBORA K, AYDINLI I. Long-term results of suprascapular pulsed radiofrequency in chronic shoulder pain, Jan. 2009; p.16-21
5. Misra S, Ward S, Coker C.Pain. Pulsed radiofrequency for chronic testicular pain-a preliminary report, 19/03/2009, p.673-8
6. Byrd D, Mackey S. Curr Pain Headache Rep. Pulsed radiofrequency for chronic pain. 2008 Jan, p.37-41.