ABSTRACT
BACKGROUND: Monopolar radiofrequency ablation (MRFA) of the genicular nerves has been considered the main interventional treatment for chronic knee pain. However, the variable locations of these nerves could suggest that traditional MRFA of genicular nerves may be insufficient to cover the area needed to provide complete sensory denervation. For these reasons, some alternatives have been proposed to achieve an increase in the lesion area that offers better outcomes such a bipolar radiofrequency ablation (BRFA). OBJECTIVE: To describe the efficacy and safety of the bipolar radiofrequency ablation (BRFA) of the genicular nerves in the patients with chronic knee pain. METHODS: A retrospective study was conducted in the Pain Medicine Department. Institutional review board approval from the Hospital Ethical Committee and informed consent were obtained. We reviewed our database for BRFA of genicular nerves from January 2018 to December 2021 for patients with chronic knee pain. The cannulas were placed using ultrasound guidance (10 cm, 22-gauge and 10 mm active curved tip), and each pair of cannulas were subjected to BRFA for 90 seconds at 80∘C. Data analysis was conducted using T-test for paired variables (Visual analogue scale and EuroQol, an instrument intended to complement other forms of quality-of-life measures). RESULTS: Twenty-five patients met inclusion criteria after excluding 7 based on the study design. The mean improvement of our patients according to the VAS was -3.98 (95%CI: -4.37 to -3.59) p< 0.0001 and EuroQol +0.416 (95%CI: 0.364 to 0.468) p< 0.0001. The mean duration of improvement was 8 (6-11) months after BRFA. There were no reported serious adverse events related to the procedure, only local pain for 24 to 48 hours in 3 patients. CONCLUSIONS: We can conclude that BRFA reduces procedural pain and increases the treatment area, providing more complete sensory denervation and improved clinical outcomes.
Subject(s)
Chronic Pain , Osteoarthritis, Knee , Radiofrequency Ablation , Humans , Chronic Pain/surgery , Denervation/methods , Knee Joint/surgery , Knee Joint/innervation , Osteoarthritis, Knee/therapy , Retrospective Studies , Treatment OutcomeABSTRACT
Objetivo: Determinar el valor predictivo de las variables sintomatología depresiva, nivel de catastrofismo y expectativa en el éxito de la infiltración terapéutica de la articulación sacroilíaca para el tratamiento del dolor lumbar crónico. Material y métodos: Estudio piloto observacional, descriptivo de tipo transversal (mayo-junio de 2017) en pacientes nuevos con dolor lumbar crónico de origen sacroilíaco sin trastorno psicológico/psiquiátrico previo y a los que nunca se les había realizado ningún tipo de infiltración. Se hizo una valoración clínica inicial y se aplicó un cuestionario estructurado para determinar la presencia de las variables expectativa, catastrofismo y sintomatología depresiva. Se programó para la realización de una infiltración sacroilíaca ecoguiada y posteriormente se realizó una nueva valoración clínica comparativa a las 4 semanas. Resultados: Participaron 28 pacientes (75 % mujeres), con una media de edad de 60 +/- 11,8 años. La puntuación basal en la escala visual analógica (EVA) fue de 7,64 +/- 1,42 y la puntuación basal en el EuroQol fue de 0,451 +/- 0,202. A las 4 semanas del procedimiento la EVA fue de 6,32 +/- 1,66 y el EuroQol de 0,594 +/- 0,242. Si bien todas las variables estudiadas mostraron un papel relevante en la respuesta clínica, la variable catastrofismo fue la que presentó mayor asociación con una escasa mejoría clínica (p = 0,001). Conclusiones: La detección y tratamiento precoces de variables de vulnerabilidad como la sintomatología depresiva, el grado de catastrofismo y el nivel de expectativa son determinantes para la obtención de mejores resultados terapéuticos en los pacientes con dolor crónico
Objective: To determine the predictive value of psychological variables (depressive symptomatology, catastrophism and expectation) in the success of the therapeutic sacroiliac joint injection for the treatment of chronic low back pain. Methodology: An observational, descriptive crosssectional pilot study (May-June 2017) in new patients with chronic lumbar pain of sacroiliac origin without psychological/psychiatric previous disorder who had never undergone any type of infi ltration. An initial clinical assessment was made, a structured questionnaire was applied to determine the presence of the variables expectation, catastrophism and depressive symptomatology. An ultrasound-guided sacroiliac infiltration was scheduled and a new clinical comparative assessment was performed after 4 weeks. Results: 28 patients were obtained (75% women) with an average age of 60+/-11.8 years. A baseline VAS was 7.64+/-1.42 and basaline EuroQol of 0.451+/- 0.202. After 4 weeks of the procedure, the VAS was 6.32+/-1.66 and the EuroQol was 0.594+/-0.242. Although all the variables showed a relevant role in the clinical response, the catastrophism was the greatest associated with poor clinical improvement (p=0.001). Conclusions: The detection and early treatment of vulnerability variables such as depressive symptomatology, catastrophism and the level of expectation are determining factor to obtaining better therapeutic outcomes in patients with chronic pain
