Interventional Treatment for Cervical Pain

Radiofrequency current is simply a tool used to create discrete thermal lesions in neural pathways in order to interrupt transmission. In pain medicine, radiofrequency lesions have been used to interrupt nociceptive pathways at various sites. This is a palliative treatment accompanying complications, so its use should be limited to those patients with cancer pain or chronic non-cancer pain when conservative non-surgical therapies have proven to be ineffective or intoerable. With the development of alternatives such as intrathecal opioid infusion and neuromodulation technologies, the number of patients considered for neuroablative therapy may dwindle. Nevertheless, there is a line of evidence that radiofrequency neurotomy has an important role in the management of trigeminal neuralgia, nerve root avulsion and spinal pain. This article introduces the radiofrequency lesioning as an interventional treatment modality of cervical pain.

Radiofrequency Neurotomy of Cervical Medial Branches for Chronic Cervicobrachialgia

Chronic neck and arm pain or cervicobrachialgia commonly occurs with the degeneration of cervical spine. Authors investigated the usefulness of radiofrequency (RF) neurotomies of cervical medial branches in patients with cervicobrachialgia and analyzed the factors which can influence the treatment outcome. Demographic data, types of pain distribution, responses of double controlled blocks, electrical stimulation parameters, numbers and levels of neurotomies, and surgical outcomes were evaluated after mean follow-up of 12 months. Pain distribution pattern was not significantly correlated with the results of diagnostic blocks. Average stimulation intensity was 0.45 V, ranging from 0.3 to 0.69, to elicit pain response in cervical medial branches. The most common involvement of nerve branches was C4 (89%), followed by C5 (82%), C6 (75%), and C7 (43%). Among total of 28 patients, nineteen (68%) reported successful outcome according to outcome criteria after 6 months of followup (p=0.001), and eight (42%) of 19 patients reported complete relief (100%) of pain. Four patients showed recurrence of pain between 6 and 12 months. It was therefore concluded that cervical medial branch neurotomy is considered useful therapeutic modality for the management of cervicobrachialgia in selected patients, particularly in degenerative zygapophyseal disorders.

A influência psicossomática em pacientes com cervicalgia e cervicobraquialgia ­ relato de caso / The psychossomatic influence in patients with cervical and cervicobrachial pain ­ case report

No presente estudo relata-se o caso de um paciente do sexo feminino de 44 anos que apresenta quadro de "depressão" associada ao uso compulsivo do computador, levando a encurtamentos musculares da região cervical e ombros, com manifestações dolorosas caracterizando cervicobraquialgia bilateral. O tratamento fisioterapêutico constituiu inicialmente por eletroterapia associada a cinesioterapia clássica, que não apresentou bons resultados, posteriormente optou-se por técnicas fisioterapêuticas manuais e reeducação do padrão respiratório, obtendo resultados satisfatórios, com a remissão dos sintomas

This study reports a forty-four old female patient that showed depression associated to compulsive computer use. The situation caused muscle shortness at the cervical region and shoulders, with painful manifestations featuring bilateral cervicobrachialgia. The physiotherapeutic treatment consisted initially of electrotherapy coupled to classic kinesiotherapy, which not yielded good results. Later, manual physiotherapic techniques and re-education of the respiratory pattern were chosen. Satisfactory results were obtained, with remission of the symptoms after 15 sections.