Cooled Radiofrequency Ablation of the Articular Sensory Branches of the Obturator and Femoral Nerves using Fluoroscopy and Ultrasound Guidance: A Large Retrospective Study.

BACKGROUND: We previously reported on a combined technique and initial data of hip denervation using an anterior approach and cooled radiofrequency. OBJECTIVES: A large retrospective study to evaluate the long-term effectiveness of cooled radiofrequency ablation (CRFA) in the general chronic hip pain population. STUDY DESIGN: Retrospective electronic chart review. SETTING: A single specialty private practice. METHODS: Retrospective chart review of 235 consecutive (CRFA) in 136 patients with chronic hip pain. RESULTS: Out of 235 CRFA, 178 (96 initial procedures and 82 repeats) were performed in 84 patients with 12 or more months follow-up. The average decrease in visual analog scale (VAS) pain scores was 7.3 ± 1.3 to 2.3 ± 1.5 and 2.48 ± 1.5 for the first and second diagnostic block, respectively, and was statistically significant (P < 0.001). Similarly, the average decrease in VAS pain scores at 6 and 12 months after CRFA denervation was 3.44 ± 2.5 and 4.23 ± 2.5, respectively; P < 0.001. Out of the 96 initial procedures in 84 patients, 66 procedures (69%) provided more than 50% relief at 6 months, and 50 (52%) at 12 months. There were 82 repeat denervations in 36 patients. Repeated procedures in the same patients provided a similar degree of pain relief with no statistically significant difference in the median pain scores (2.8 ± 2.1 cm vs 3.1 ± 1.7 cm ; P = 0.197) or time interval of pain relief (12.7 ± 10.9 vs 10.3 ± 4.7;  P = 0.508). There were 3 minor complications. LIMITATIONS: Retrospective nature of the study. CONCLUSION: Improvements in pain scores and longevity of pain relief from chronic hip pain using a simple, anterior approach to radiofrequency denervation of the lateral obturator and lateral femoral nerves justifies further randomized prospective trials. Repeated CRFAs demonstrated consistency in pain relief and absolute safety of repeated denervation.

Clinical efficacy assessment of cooled radiofrequency ablation of the hip in patients with avascular necrosis.

Aim: This pilot case series examined feasibility of anterior radiofrequency approach under combined ultrasound and fluoroscopy guidance to control pain from avascular necrosis of the hip. Patients & methods: Data on 11 consecutive patients were collected on longevity of cooled radiofrequency ablation (CRFA), pain relief and opioid use. Results: The average age was 56 (28-66), BMI 29.5 (16.5-34), in four women and three men. Their average opioid use was 92 mg MS04 equivalents (median 35 mg). The pain score decreased to 3.3 after the CRFA. Five patients claimed more than 50% of pain relief. The average time interval of greater than 50% of pain relief from the CRFA was 70-250 days. Conclusion: CRFA may be an effective treatment of chronic pain from avascular necrosis.

Long-term control of abdominal pain related to POTS: two case reports in pediatrics.

AIM: To describe two consecutive cases of Postural Orthostatic Tachycardia Syndrome (POTS)-related chronic abdominal pain control in children after bilateral splanchnic block. PATIENTS & METHODS: Two pediatric patients with chronic abdominal pain related to POTS received celiac and T11 splanchnic plexus block for pain control. RESULTS: While celiac plexus block did not provide any substantial relief of their pain, splanchnic block provided a long-term improvement in pain scores, nausea and vomiting cessation. CONCLUSION: Bilateral T11 splanchnic block should be considered in patients with POTS-related chronic abdominal pain, nausea and vomiting.

Immediate Return to Ambulation and Improved Functional Capacity for Rehabilitation in Complex Regional Pain Syndrome following Early Implantation of a Spinal Cord Stimulation System.

Complex regional pain syndrome (CRPS) is a neuropathic pain condition that is characterized by vasomotor, sensory, sudomotor, and motor symptoms. Spinal cord stimulation (SCS) has been successfully utilized for the treatment of pain refractory to conventional therapies. We present a case of a previously highly functioning 54-year-old female who developed a rarely reported case of idiopathic CRPS of the right ankle which spontaneously occurred four months after an uncomplicated anterior cervical disc fusion. This condition resulted in severe pain and functional impairment that was unresponsive to pharmacological management. The patient's rehabilitation was severely stymied by her excruciating pain. However, with the initiation of spinal cord stimulation, her pain was adequately controlled allowing for progression to full unassisted ambulation, advancing functional capacity, and improving quality of life. This case report supports the concept that rapid progression to neuromodulation, rather than delays that occur due to attempts at serial sympathetic blocks, may better control symptoms leading allowing for a more meaningful recovery.