Efficacy of Radiofrequency as Therapy and Diagnostic Support in the Management of Musculoskeletal Pain: A Systematic Review and Meta-Analysis.

Radiofrequency (RF) is a minimally invasive procedure used to interrupt or alter nociceptive pathways for treating musculoskeletal pain. It seems a useful tool to relieve chronic pain syndromes, even if, to date, solid evidence is still needed about the effectiveness of this therapy. By this systematic review and meta-analysis, we aimed to evaluate the efficacy of RF in treating musculoskeletal pain. PubMed, Medline, Cochrane, and PEDro databases were searched to identify randomized controlled trials (RCTs) presenting the following: patients with chronic musculoskeletal pain as participants; RF as intervention; placebo, anesthetic injection, corticosteroid injection, prolotherapy, conservative treatment, physiotherapy, and transcutaneous electrical nerve stimulation as comparisons; and pain and functioning as outcomes. Continuous random-effect models with standardized mean difference (SMD) were used to compare the clinical outcomes. Overall, 26 RCTs were eligible and included in the systematic review. All of them analyzed the efficacy of RF in four different regions: cervical and lumbar spine, knee, sacroiliac (SI) joint, shoulder. The outcomes measures were pain, disability, and quality of life. A medium and large effect in favor of the RF treatment group (SMD < 0) was found for the shoulder according to the Visual Analogical Scale and for the SI joint according to the Oswestry Disability Index. A small effect in favor of the RF treatment group (SMD > 0) was found for the spine according to the 36-item Short Form Survey. Non-significant SMD was found for the other outcomes. RF represents a promising therapy for the treatment of chronic musculoskeletal pain, especially when other approaches are ineffective or not practicable. Further studies are warranted to better deepen the effectiveness of RF for pain and joint function for each anatomical region of common application.

Therapeutic exercise and radiofrequency in the rehabilitation project for hip osteoarthritis pain.

BACKGROUND: Severe hip osteoarthritis is responsible for disabling pain and functional impairment of the joint. Although total hip arthroplasty (THA) is a successful treatment, some patients have multiple comorbidities that represent contraindications for THA. Conventional drug therapies are often ineffective or responsible for numerous side effects. For these patients, it is difficult to draw up an acceptable rehabilitation path, as the main limitation is intense pain. New rehabilitation strategies that relieve pain and improve articular function need to be developed. The combination of traditional treatments such as education and therapeutic exercise with innovative, minimally-invasive therapies such as continuous radiofrequency (CRF) appears to reduce hip pain by determining the neurolysis of the joint. AIM: The aim of our study was to describe the reduction in pain and improvements in joint function when CRF is combined with the therapeutic exercise in rehabilitation of patients with severe hip osteoarthritis. DESIGN: Case series study. SETTING: Rehabilitation service outpatients. POPULATION: Twenty-five patients with severe hip osteoarthritis causing disabling pain and with contraindications to THA, and for whom conventional drug therapies were ineffective or responsible for numerous side effects. METHODS: The study design included: initial clinical-functional assessment using the Harris Hip Score (HHS), the Numeric Rating Scale (NRS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); a pre-lesion anaesthetic block; hip neuroablation with CRF; a three-week kinesitherapy protocol (3 sessions per week); two further assessments using the same scales one month (T1) and six months (T2) after CRF. RESULTS: Improvements at T1 and T2 follow-ups, after CRF (P=0.000) were recorded for articular pain and function. However, results at T2 were worse than those at T1 (P=0.000). CONCLUSIONS: CRF combined with therapeutic exercise in rehabilitation of severe hip osteoarthritis is an attractive option for significant pain relief as it allows patients to carry out kinesitherapy more easily. CLINICAL REHABILITATION IMPACT: CRF could represent a valid alternative in the rehabilitation of patients with severe hip osteoarthritis especially when other therapeutic approaches are unworkable.

Percutaneous radiofrequency denervation in patients with contraindications for total hip arthroplasty.

Multiple comorbidities sometimes represent a contraindication for total hip arthroplasty (THA). Major symptoms of patients with hip pain include groin, thigh, and trochanteric pain. Groin and thigh pain arise from sensory branches of the obturator nerve, whereas trochanteric pain arises from sensory branches of the femoral nerve. Between January 2009 and October 2010, eighteen patients with chronic hip pain with several contraindications for THA were selected for a prospective study. Predenervation diagnosis was osteoarthritis in 16 patients and prolonged postoperative hip pain in 2 (1 THA, 1 Girdlestone). Hip joint pain was treated by percutaneous radiofrequency lesioning of the sensory branches of the obturator and femoral nerves. Six-month follow-up data revealed a statistically significant decrease in visual analog scale (VAS) scores and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and a statistically significant increase of Harris Hip Score. Before radiofrequency and at 6-month follow-up, mean VAS scores were 9.52 (range, 7-10; standard deviation [SD], 0.79) and 6.35 (range, 3-10; SD, 2.17), respectively; mean Harris Hip Scores were 28.64 (range, 19-41; SD, 6.98) and 43.88 (range, 23-71; SD, 16.38), respectively; and mean WOMAC scores were 75.70 (range, 92-59; SD, 9.70) and 63.70 (range, 78-44; SD, 11.37), respectively. All values were statistically significant (P<.05) for Student's t test and Wilcoxon signed-rank test. Eight patients reported ≥50% pain relief at 6-month follow-up. No side effects were reported. Use of this technique for hip pain control is controversial. In our experience, percutaneous radiofrequency lesioning of the sensory branches of the nerves innervating the hip joint can be an option for patients with intractable hip joint pain.