Radiofrequency ablation for shoulder pain: an updated systematic review.

BACKGROUND: Radiofrequency ablation (RFA) is a treatment modality that has been increasingly used for the management of chronic shoulder pain. Serious conditions that can identified as the cause of chronic shoulder pain include rotator cuff disorders, adhesive capsulitis, osteoarthritis, glenohumeral instability, and acromioclavicular joint disorders. Treatment of chronic shoulder pain typically consists of physical therapy, oral and topical medications, intra-articular corticosteroid injections, and even surgery. The aim of this study was to examine the most recent primary and secondary outcomes of RFA for chronic shoulder pain. METHODS: A systematic review was conducted using three different databases including PubMed, MEDLINE, and the Cochrane Database. The key concepts of "radiofrequency ablation" and "shoulder pain" were used. The search took place in June 2023, and it included articles from the past 20 years. RESULTS: Of the 396 articles found, 29 were included in the review. Most studies focused on reduction in pain scores, duration of relief, function, and patient satisfaction. In several studies, RFA was compared to conservative options such as physical therapy or corticosteroid injections. CONCLUSIONS: Overall, RFA shows positive outcomes in terms of the management of chronic shoulder pain. Therefore, RFA can serve as another treatment option for patients who fail conservative management or are not strong surgical candidates. Understanding the outcomes of RFA for chronic shoulder pain can provide patients and clinicians with evidence for the most appropriate treatment.

Radiofrequency ablation for headache pain: an updated systematic review.

BACKGROUND: Radiofrequency ablation (RFA) has many treatment capabilities, one of which includes long term management of chronic headache. As a result, it has been increasingly used, especially in cases of refractory headache pain. Headaches can be classified as primary and secondary and can result from a variety of serious conditions. Types of primary headaches include tension, migraine, and cluster headaches whereas secondary headaches include headaches because of infection or vascular disease, and cervicogenic headaches. Both types can result in serious debility and diminished quality of life. The treatment of chronic headache pain commonly consists of lifestyle modifications, oral medications, and injectable medications. The aim of this study was to investigate the primary and secondary outcomes of RFA for chronic headache pain. METHODS: A systematic review was conducted using three different databases including PubMed, MEDLINE, and the Cochrane Database. The key concepts of "radiofrequency ablation" and "headache" were used. The search took place in June 2023, and it included articles from the past twenty years. RESULTS: Of the 580 articles found, 32 were included in the review. Most studies focused on pain scores, duration of relief, function, and patient satisfaction. In several studies, RFA was used to target various nerves as the pain generator and compared with modalities such as local anesthetic or corticosteroid. CONCLUSIONS: Overall, RFA shows favorable outcomes in the management of chronic headache pain. Therefore, RFA can serve as an alternative treatment option for patients who fail other conservative treatment regimens. Understanding the outcomes of RFA for headache pain can provide patients and clinicians with evidence for the most appropriate treatment strategies.

Efficacy of Cooled-Radiofrequency Ablation of the Genicular Nerve as Treatment for Chronic Knee Pain: A Retrospective Study.

INTRODUCTION: Chronic pain is one of the leading causes of reduced quality of life in the USA, with knee pain commonly reported. Multiple therapeutic modalities are traditionally utilized for pain management; however, some patients may have pain refractory to these techniques. Cooled radiofrequency ablation (c-RFA) of the geniculate nerve is a growing and promising therapy offering a potentially long-term solution to chronic knee pain. METHODS: This study assessed the efficacy, average duration of relief, and potential adverse events using a retrospective chart review of 406 procedures. A two-tailed paired t test was used to assess the statistical significance between pre-RFA vs. post-RFA visual analog scale (VAS) pain scores self-reported by patients. An analysis of variance (ANOVA) test was used to evaluate for statistical differences in pre-RFA pain scores and post-RFA pain scores among the categories of age, sex, body mass index (BMI), and diagnosis group. RESULTS: The mean percent in pain improvement calculated was 65.5% with an average duration of relief of 7.20 months. The average pre-RFA pain score on the VAS was 6.26 out of 10 and 2.59 out of 10 post-RFA. The ANOVA post-RFA pain scores demonstrated statistically significant differences among the categories of age and sex. A total of 54 adverse events were reported, including worsening pain, numbness, paresthesia, and knee swelling. CONCLUSION: The study demonstrated that c-RFA can potentially be utilized as an alternative safe therapy for chronic knee pain, providing pain relief with a relatively prolonged duration. Inherent challenges of retrospective studies remain a part of the limitations of this study.

Neuromodulation's Role in Functional Restoration in Paraplegic and Quadriplegic Patients.

Neuromodulation is an alternative, minimally invasive treatment option that, at times, is used as a last resort for chronic pain conditions that are often refractory to other treatment modalities. Moreover, it offers promising prospects for individuals grappling with the formidable challenges posed by paraplegia and quadriplegia resulting from spinal cord injuries. This review article provides a comprehensive assessment of current treatment modalities specifically tailored for paraplegic and quadriplegic patients. We aim to evaluate the existing surgical and non-surgical interventions while delving into the role of neuromodulation in the restoration of function for individuals afflicted with these debilitating conditions. Additionally, we review the efficacy, limitations, and comparative outcomes of diverse treatment strategies available for the management of paraplegia and quadriplegia. Emphasizing the critical need for effective interventions beyond the initial 24 h surgical window, we elucidate the challenges associated with conventional therapies and their limited success in achieving comprehensive functional restoration. Central to this review is an in-depth exploration of neuromodulation's transformative potential in ameliorating the deficits caused by spinal cord injuries. With a particular focus on spinal cord stimulation (SCS), we analyze and compare the outcomes of neuromodulation modalities and traditional treatment regimens, shedding light on the promising strides made in fostering sensory perception, motor function, and patient satisfaction.

Infrapatellar Branch of the Saphenous Nerve: Therapeutic Approaches to Chronic Knee Pain.

PURPOSE OF REVIEW: The infrapatellar branch of the saphenous nerve (IPS) is an under-investigated nerve that can be a source of chronic knee pain. This literature review aims to deliver an up-to-date review of chronic pain transmitted via the IPS along with therapeutic approaches available for pain refractory to conservative measures. RECENT FINDINGS: Knee pain transmitted via the IPS can arise from several etiologies. Damage to the IPS is often iatrogenic and develops following total knee arthroplasty, anterior cruciate ligament reconstruction, and other knee surgical procedures. Other causes of IPS-derived pain include entrapment of the nerve, neuromas, Schwannomas, and pain from knee osteoarthritis transmitted through the IPS.This article investigated therapeutic approaches to pain derived from the IPS. Common approaches included radiofrequency ablation, neuroma excisions, Schwannoma excision, nerve blocks, surgical exploration, surgical release of an entrapped nerve, cryoablation, and peripheral nerve stimulation. Pain scores, duration of pain relief, adverse events, and secondary outcomes were all included in this review. A subset of the patient population experiences chronic pain deriving from the IPS that is refractory to conservative treatment measures. This review aims to evaluate the etiologies and therapeutic approaches for chronic pain arising from the IPS refractory to conservative treatments.

Radiofrequency ablation of the occipital nerves for treatment of neuralgias and headache.

OBJECTIVE: The purpose of this study was to retrospectively assess the efficacy of radiofrequency ablation (RFA) therapy as a treatment for occipital neuralgias and headaches at health clinics in the United States between January 1, 2015 and June 20, 2022. We hypothesize that RFA is a minimally invasive treatment that provides significant pain relief long-term for occipital neuralgias and associated headaches. METHODS: This retrospective analysis studies data collected from 277 occipital nerve RFA patients who had adequate pre-procedure and post-procedure follow-up for data analysis. Data collected includes the patient's age, biological sex, BMI, headache diagnosis, pre-procedure, and post-procedure pain score using the visual analog scale (VAS), subjective percent improvement in symptom(s), and duration of symptom relief. Statistical analysis used SPSS software, version 26 (IBM), using a paired t-test to assess the significance between pre and post-occipital RFA therapy pain scores. p-values were significant if found to be ≤0.05. RESULTS: The mean pre-procedure pain score before RFA therapy for patients who completed at least 6 months of follow-up was 5.57 (SD = 1.87) and the mean post-procedure pain score after RFA therapy was 2.39 (SD = 2.42). The improvement in pain scores between pre-procedure and post-procedure was statistically significant with a p-value < 0.001. The mean patient-reported percent improvement in pain following RFA therapy was 63.53% (SD = 36.37). The mean duration of pain improvement was 253.9 days after the initiation of therapy (SD = 300.5). When excluding patients who did not have any relief following their RFA procedure, the average pre-procedure pain score was 5.54 (SD = 1.81) and post-procedure pain score was 1.71 (SD = 1.81) with a p-value < 0.001. CONCLUSION: This study demonstrates the minimally invasive, safe, and effective treatment of RFA in patients with refractory occipital neuralgias and headaches. Additional studies are necessary to illuminate ideal patient characteristics for RFA treatment and the potential for procedural complications and long-term side effects associated with occipital nerve RFA therapy.

Temporary Peripheral Nerve Stimulation as Treatment for Chronic Pain.

INTRODUCTION: Chronic pain is a growing problem across the world, and in the midst of an opioid epidemic, it is imperative that alternative treatment measures are identified to help alleviate the pain experienced by these patients. Chronic pain greatly affects ones quality of life and many patients do not experience adequate relief with conventional treatment measures. The purpose of this retrospective analysis is to assess the efficacy of peripheral nerve stimulation (PNS) therapy in adult patients suffering from chronic pain refractory to conventional treatment measures who underwent therapy on various anatomical locations. METHODS: This retrospective analysis consisted of data collected from electronic health records for n = 89 patients who underwent PNS therapy. Data collected relates to patient age, sex, weight, height, body mass index (BMI), diagnosis, targeted nerves, follow-up encounters, pain scores from before and after PNS therapy, and duration of improvement. Statistical analysis used SPSS software, version 26 (IBM), using a paired t test to assess significance between pre and post PNS therapy pain scores. P values were significant if found to be ≤ 0.05. Further analysis assessed the correlation between age and BMI with visual analog scale (VAS) pain improvement and subjective percentage pain relief. RESULTS: The mean pre-operative (pre-op) pain score before PNS therapy was 6.36 (standard deviation (SD) = 2.18, SEM = 0.23) and the mean post-operative (post-op) pain score after PNS therapy was 4.19 (SD = 2.70, SEM = 0.29). The mean patient-reported percent improvement in pain following PNS therapy was 49.04% (SD = 34.79). The improvement in pain scores between pre-op and post-op was statistically significant (M = 2.17, SD = 2.82, SEM = 0.30, t(88) = 7.26, p < .001), 95% confidence interval (CI) [1.57, 2.76]. The mean duration of improvement for patients was 123 days after therapy initiation (min = 6, max = 683, SD = 126). CONCLUSIONS: This study demonstrated the potential role for PNS therapy in improving patient-reported pain levels for various neuropathies, targeting various nerves. With PNS therapy's use as a chronic pain treatment and available research being limited, further study needs to be done on the efficacy of PNS therapy for pain management and complications associated with PNS device placements at various locations.

Cooled Radiofrequency Ablation for Intercostal Neuralgia.

Background: Intercostal neuralgia is pain associated with the intercostal nerves along the rib, chest, and upper abdominal wall. Intercostal neuralgia has various etiologies, and current conventional treatment options include intercostal nerve blocks, nonsteroidal anti-inflammatory drugs, transcutaneous electrical nerve stimulation, topical medications, opioids, tricyclic antidepressants, and anticonvulsants. For a subset of patients, these conventional treatment options provide little relief. Radiofrequency ablation (RFA) is an emerging procedure for the treatment of chronic pain and neuralgias. Cooled RFA (CRFA) is a specific type of RFA that has been trialed as a treatment for intercostal neuralgia in patients refractory to conventional treatment modalities. This case series assesses the efficacy of CRFA for the treatment of intercostal neuralgia in 6 patients. Case Series: Three female and 3 male patients underwent CRFA of the intercostal nerves to treat intercostal neuralgia. The patients had an average age of 50.7 years and demonstrated an average pain reduction of 81.3%. Conclusion: This case series suggests that CRFA may be an effective treatment option for patients with intercostal neuralgia that is not responsive to conservative treatment options. To determine the duration of pain improvement, large research studies need to be conducted.

Use of Spinal Cord Stimulators in Patients With Pacemakers or Implantable Cardiac Defibrillators: A Review of Documented Accounts of Interference.

OBJECTIVES: To assess the currently available evidence regarding associations between spinal cord stimulator (SCS) lead type, clinical indications for device placement, and interference between SCSs and cardiac pacemakers (CPMs)/implantable cardioverter-defibrillators (ICDs). STUDY DESIGN: Review of case reports and original research studies assessing the interference between SCS and CPM/ICD. MATERIALS AND METHODS: PubMed and Cochrane databases were searched for articles commenting on the interference between SCS and CPM/ICD. The search criteria which generated the greatest number of relevant studies was (spinal cord stimulator AND [pacemaker OR implantable cardioverter defibrillator]). Additional, empiric review was conducted using JSTOR, ScienceDirect, and EBSCOhost databases; however, no additional eligible studies were identified. Data were extracted, summarized into tables, and quantitatively analyzed using LibreTexts and MedCalc software. RESULTS: There was no statistically significant interference observed between SCS and CPM/ICD devices in patients regardless of indication for SCS placement and SCS lead polarity. LIMITATIONS: Limited by variability of patient cases and variability in maximum frequency and amplitude of SCS devices tried in individual cases. Also limited by small sample size and the absence of a standard definition for device interference across studies. CONCLUSIONS: Interference between cardiac devices and SCSs is a rare occurrence. As there are currently no published guidelines, devices should be interrogated on a case-by-case basis in the SCS trial period (if implanted after cardiac device), during permanent implantation, and during scheduled follow-up visits. Peri-operative testing should include increasing the SCS settings to maximally tolerated levels with cardiac device set at its maximum sensitivity.

Pulsed Radiofrequency for the Treatment of Trigeminal Neuralgia.

PURPOSE OF REVIEW: Trigeminal neuralgia is a sudden, unilateral, stabbing pain in the distribution of one or more branches of the fifth cranial nerve, with an overall prevalence ranging between 0.03 and 0.3%. While conservative treatments may offer temporary relief, many patients experience chronic headaches associated with their neuralgia. Invasive treatments are available for patients with intractable neuralgia; however, they may cause permanent tissue damage and often do not provide relief. This article examines pulsed radiofrequency (PRF) ablation (RFA) of the trigeminal nerve as a minimally invasive procedure that offers a promising alternative to invasive procedures for relief of trigeminal neuralgia while minimizing tissue damage. RECENT FINDINGS: Efficacy of PRF and RFA in treating trigeminal neuralgia has been studied before, but literature lacks large size studies. The results of this retrospective study indicate that PRF can be used as a safe and effective treatment for patients suffering from trigeminal neuralgia that is refractory to conservative measures.

Lumbar Level Peripheral Nerve Stimulation for Low Back Pain.

Background: Low back pain affects the lives of millions of people in the United States and the world. Not only does low back pain affect the quality of life for the individual patient, but it also accounts for many emergency department and health care visits. For a subset of patients, conservative measures such as medications and physical therapy, nonsurgical interventions, and surgery are not effective. Peripheral nerve stimulation is an emerging treatment option for patients with chronic low back pain. This case series assesses 6 patients' experiences with lumbar level peripheral nerve stimulation. Case Report: Three male and 3 female patients underwent lumbar level peripheral nerve stimulation as a treatment for chronic low back pain. The average age of the patients was 63.5 years, and they demonstrated an average pain reduction of 64.8%. Conclusion: This series provides evidence that lumbar level peripheral nerve stimulation may be an efficacious treatment for chronic low back pain that is refractory to conservative measures. Large studies are needed to assess the outcomes and durations of improvement associated with this treatment.

Safe Opioid Prescribing for Pediatric Patients: An Interprofessional Learning Activity.

INTRODUCTION: An innovative online course on safe opioid prescribing for pediatric patients was designed by an interprofessional team of experts for an interprofessional target audience of clinicians in Wisconsin. METHODS: The 2-hour accredited course included recorded TED Talks-style presentations and interactive patient cases. A total of 227 course completers responded to pre- and posttests and a 20-item Interprofessional Collaborative Competency Attainment Scale (ICCAS). A Fisher exact test was used to compare pre/post first-attempt test responses and a 2-tailed t test compared the before/after ratings of ICCAS statements. RESULTS: Improvement on pre/posttest assessment was not significant. ICCAS showed significant increase of interprofessional competence for each statement. DISCUSSION: Interprofessional learning can be effectively incorporated in opioid-related continuing education.

Intrathecal Drug Delivery Systems Survey: Trends in Utilization in Pain Practice.

Background: The use of intrathecal drug delivery for chronic and cancer pain medicine has been established for decades. However, optimization and utilization of this technique still lag behind other modalities for pain control. Some of this may be due to variability of surgical technique, medication usage and education. It is currently unclear on whether or not practitioners follow available algorithms for the use of intrathecal drug delivery systems. Methods: A survey developed by the American Society of Pain and Neuroscience (ASPN) was sent to its members via email using the cloud-based SurveyMonkey. After 30 days of being available, 159 different providers responded to the survey that consisted of 31 various multiple choice and free response questions. Each question was not required and the number of responses to each varied from 128 to 159. Results: Approximately 9% of those who successfully received and opened the email containing the survey responded, likely due to a small number of providers working with intrathecal drug delivery systems. Eighty-six of respondents practice medicine in the United States, and 87% of the respondents were attending physicians. A majority of respondents, approximately 74%, were board certified in pain medicine with 69% of respondents being train in anesthesiology. The first and second most used medications for intrathecal pump trial were morphine and fentanyl, respectively. Most respondents, approximately 96%, provide pre-operative/intra-operative antibiotics. The most common first-choice medication for implanted intrathecal pumps was also morphine with the most common implanted location being the abdomen. Conclusion: Interestingly, there is currently fairly substantial variation in the way providers utilize intrathecal pump delivery for both chronic and cancer pain. There is variation from the training background of the providers providing care, to the pre-implantation trial medications, to where the pump is implanted for each patient, to if the patient has the option to give themselves boluses once implanted. Further research is needed to elucidate current and best practices for intrathecal drug delivery system trials, implantations, and utilization.

Post-COVID Pain Syndromes.

Although the number of SARS-CoV-2 new cases may be declining due to the implementation of the vaccine in the USA, there is a rising cohort of people with long-term effects from the virus. These long-term effects include loss of taste, heart palpitations, and chronic pain syndromes. In this commentary, we assess the current literature to appraise the knowledge of long-term COVID-19 effects related to long-term pain syndromes including testicular pain, headache, chronic pain, and chest pain.

Radiofrequency Ablation of the Trochanteric Branches of the Femoral Nerve for the Treatment of Greater Trochanteric Syndrome.

BACKGROUND: Approximately 10-15% of the population over the age of 60 suffers from hip pain. Greater trochanteric pain syndrome (GTPS) is one of the most common diagnoses in patients with chronic hip pain, includes a number of disorders, and has a broad differential diagnosis. Conservative managements of GTPS, including pharmacologic interventions, physical therapy, chiropractic intervention, acupuncture, and more invasive techniques, such as intra-articular injections, commonly fail to provide patients with sufficient, long-term relief. While radiofrequency ablation (RFA) has been used to treat intra-articular hip pain in the past, there is little evidence for the feasibility of RFA for managing patients with GTPS. This case series builds on previous evidence that cooled radiofrequency ablation (CRF) of the trochanteric branch of the femoral nerve may offer patients with GTPS effective, safe, and lasting pain improvement. CASES: A series of eight patients with GTPS underwent CRF of the nervus females to the trochanter. CRF procedures were either targeted at the left, right, or bilateral nerves. CONCLUSION: This case series provides additional evidence for the safety and effectiveness of CRF of the nervus femoralis to the trochanter for offering long-term pain relief in patients with GTPS. All patients experienced at least two months of relief, with most patients experiencing ongoing relief from the procedure.

Prescription Drugs and the US Workforce: Results from a National Safety Council Survey.

BACKGROUND: The cost of chronic pain in the United States is extremely high. Opioids are one of the most common medications prescribed for the treatment of chronic pain, and their misuse and addiction have been of concern. It has been found that opioids are frequently abused and negatively impact the American workforce. OBJECTIVES: The objective of this study was to obtain data on US employers' concerns and priorities, perceptions of prescription drug abuse, perceived impact of prescription drug use on the workplace, identification of and response to drug abuse, perceived ability to handle prescription drug abuse in the workplace, and workplace initiatives, employee assistance programs, employee drug testing, workplace prescription drug training, insurance coverage of alternative treatment, and overall preparedness to deal with the issue. STUDY DESIGN: This research used an employer proprietary questionnaire created by members of the National Safety Council in cooperation with market research experts at B2B International. SETTING: Employers surveyed via an online survey represent diverse industries and geographical areas. METHODS: The research was conducted using a proprietary questionnaire. Participants were recruited from a sample of verified panelists through Research Now, and fieldwork was conducted online by B2B International. This report is on 501 interviews that each represent a US employer with 50 or more employees. The employers sampled are extremely diverse in not only size and industry, but also geography and centralization. RESULTS: Our results showed that 67% of employers reported concerns related to prescription drug misuse, which was comparable to workplace violence and more concerning than the use of illegal drugs. Sixty-one percent reported concerns related to prescription opioids, which was a higher concern than using anti-anxiety medications, stimulants, and even heroin. LIMITATIONS: Survey study with descriptive analysis with limited sample. CONCLUSIONS: Prescription drug misuse and abuse concern American employers. Their side effects are clear, but employers are less likely to acknowledge their detrimental business effect. Employers report being unprepared for dealing with issues related to this; however, the firms with programs in place feel more prepared to deal with misuse and abuse. KEY WORDS: Prescription drugs, US workforce, chronic pain.

Efficacy of Electrical Spinal Cord Stimulation with Neuromodulating Medications: A Systematic Review.

Background: Chronic pain is a prevalent and debilitating problem for millions of people and spinal cord stimulation (SCS) is one option for treatment. It has been shown to have membrane stabilizing properties and is often used in conjunction with medications that are also believed to offer pain control through membrane stabilization. Objective: The goal of this review is to analyze the effects of SCS combined with medications to evaluate for augmentative therapeutic effect. Setting: Systematic review. Methods: A systematic computerized search of the literature was conducted using PubMed, the Cochrane Library, and EMBASE for articles published in English. Results: We report three articles that discuss the potential for augmentative effects of medication in combination with SCS. Located articles related primarily to SCS combined with Gabapentin, TCA, or SNRI. Limitations: The limited number of articles reflects a need for more investigation in this area. Conclusion: Based on the suspected mechanisms for SCS and neuromodulating medications, there is reason to believe adding these medical therapies may enhance the effects of SCS.