Pulsed radio frequency treatment offers an alternative to conventional thermocoagulation. By continuously and intermittently emitting pulsed RF energy, this technique stimulates nerves without risk of thermal injury.
Pain management specialists often utilize this procedure for conditions such as shoulder ache, cervical and lumbar radicular pain and occipital neuralgia. It has proven both effective and safe.
What is PRF?
Pulse Radio Frequency Treatment (PRF) uses low-level electrical current to target painful nerves to help reduce firing and associated pain, using minimally invasive needle and electrode to access target nerve tissues guided by fluoroscopy or ultrasound guidance systems. This cutting-edge technology offers fast, safe, and effective relief to treat back pain.
Although the exact mechanism behind PRF’s beneficial effects remains elusive, several studies suggest it to be neuromodulatory. Research on rats has demonstrated its effect on altering synaptic transmission of pain signals, changing sensitivity to stimuli, activating MAPKs (linked with proinflammatory cytokines and matrix metalloproteinases expression in neurons and glial cells), as well as inhibiting C- and A-delta nerve fibers sensitivity to pain stimuli. Additionally, an application of PRF may reduce nociceptive pain signaling by inhibiting C- and A-delta nerve fibers.
Clinical trials demonstrating PRF as an effective form of pain management therapy have demonstrated its efficacy with most participants reporting complete relief, and few needing surgical intervention after using PRF and TFESI combined together compared with an epidural anesthetic injection alone. Short and long term follow up studies both demonstrated significant decreases in pain levels as a result.
PRF’s pain-reducer effects may also be attributable to its effect on pain signaling in the dorsal root ganglion, where this process occurs via various mechanisms including inhibition and injury of nociceptive nerve fibers, deactivation of microglia, and an increase in endogenous opioid precursor mRNA production. Furthermore, activation of descending pain inhibitory pathways also plays a part in its pain-reducing properties.
PRF may be effective, but may not be suitable for every pain patient. If your discomfort cannot be managed through conservative means such as diagnostic medial branch blocks or medications, Dr. Attaman would be pleased to discuss available treatment options and suggest the ideal course of action.
The procedure
Radiofrequency neurotomy involves using pulsed RF heat to damage or disable nerves that carry pain signals. A health care provider uses imaging scans to precisely position needles. Many patients experience relief within days; benefits may last for several months or even a year for some. Furthermore, this non-destructive procedure compares favorably to Continuous Radiofrequency (CRF), which uses high temperatures and long bursts of current to destroy targeted tissue.
Pulsed RF has been demonstrated to cause selective long-term depression of C-fiber spinal nerve sensitization, leading to reduced pain signaling to the brain and reduced pain signaling from C-fibers in the neck, back, and buttocks. One study demonstrated significant pain relief following PRF treatment of patients suffering sacroiliac joint discomfort.
One study demonstrated PRF as an effective treatment for coccydynia (tailbone pain). Applying it directly to sacrococcygeal nerves resulted in pain relief and improved quality of life for most patients treated; further follow-up studies confirmed these effects lasting up to one year in some cases.
Even with its success, more research must be conducted into the role of PRF in treating other conditions. Studies should include a control group so as to compare its efficacy against alternative treatments.
As this procedure involves injections, some discomfort should be expected over the following few days. If they become painful to you, ice may help alleviate discomfort.
Trials combining PRF with tetanus toxin-induced fasciculations (TFESI) to treat TN have yielded mixed results. One such trial found that patients receiving both treatments were more satisfied than those receiving only TFESI; additionally, this combination proved more cost-effective than invasive surgeries or medications. Although the authors acknowledge the trial was small and single center without an in-place control group for comparison purposes; nonetheless they believe the combination could provide longer lasting pain relief than either approach alone.
Side effects
Pulsed radio frequency neuromodulation helps relieve chronic neck, back, shoulder, and hip pain that has not responded to more traditional therapies such as physical therapy and medication. It may be used alone or alongside these other pain management strategies for maximum effectiveness.
Radio waves are used to target specific nerves and block their ability to transmit pain signals back into the brain. It is most often employed as a method for treating back, neck, and buttock (sacroiliac joint) pain but may also help treat chronic knee, shoulder, or hip discomfort.
Interventional pain specialists use imaging scans to ensure the needles are precisely placed during this procedure, before administering small amounts of numbing medication into the area of pain before inserting a hollow needle with an even smaller electrode on its tip into its location. Finally, these needles can then be guided directly to where they’re needed with fluoroscopy or ultrasound guidance.
PRF treatments employ electrodes that emit radiofrequency current in short bursts at high voltage followed by silent periods lasting 480 milliseconds that allow heat elimination – often keeping target tissue temperatures below 42 degrees C to avoid thermal lesions that destroy nerve tissue and cause pain.
Studies indicate that PRF treatments of the occipital nerve can effectively alleviate pain associated with occipital neuralgia. One such study saw pain scores on both a Visual Analog Scale (VAS) and Medication Quantification Scale drop by an average of 3.6 units and 8 units respectively after 6 months; no adverse side effects were noted.
Studies have also demonstrated that PRF can effectively relieve neuropathies in the lower back, armpits and legs. Furthermore, PRF may help treat pelvic inflammatory disease and premature ejaculation (which affects 20-30% of men but resists other treatments), two conditions afflicting 20-30%.
As part of your treatment, a healthcare professional will monitor your vital signs and comfort levels during each step. They may administer local anesthetic to ensure you remain relaxed during the procedure; prior to receiving it you’ll also be advised against drinking alcohol, caffeinated drinks, or taking any medications which interfere with blood pressure or heart rate regulation.
Recovery
Pulsed radio frequency therapy is an easy and safe procedure, though some patients may experience slight pain at the injection sites following treatment; this should fade within a day or two. Radiofrequency neurotomy won’t cure your neck or back issues permanently; rather it will temporarily alleviate symptoms for several months at most and repeat treatments may be required in some instances.
At the beginning of your procedure, you’ll lie on a fluoroscope (real time X-ray) table and receive an IV line delivering light anaesthetic. A thin needle will then be inserted into the painful area using guidance provided by fluoroscope – electrical current is passed through it then, heating nerves enough that they cease transmitting pain signals – this process typically only takes minutes!
Once the procedure is over, you will be taken back into a recovery room for monitoring. An ice pack may help relieve soreness in injection areas. Once this process has concluded, instructions will be given about when you can resume normal daily activities as well as pain-relief medication to take.
Clinical trials demonstrated that PRF can be an extremely effective pain-relief technique. Patients suffering from chronic lumbar facet joint pain that had not responded to traditional treatments (medication, physical therapy) saw significant relief after going through PRF; moreover, NRS and DN4 scores saw gradual decreases over time post procedure.
PRF’s mechanism of action is still being researched, but initial observations show that it changes nerve signalling pathways, creating a neuromodulatory type effect. Although some tissue destruction occurs during treatment, its effect appears minimal and doesn’t result in systemic damages.
As with any medical procedure, pulsed radiofrequency treatment involves some risk. Studies to date have demonstrated that such risks are minimal compared with conventional surgery procedures and, indeed, far lower.
