Location
Suwanee, GA
Start Date
11-5-2023 1:00 PM
End Date
11-5-2023 4:00 PM
Description
Introduction: Radiofrequency ablation (RFA) is a procedure done for chronic pain which uses thermal energy to nociceptive pathways with the goal of disrupting pain signaling. The thermal energy leads to nervous tissue disruption using radiofrequency currents through an electrode placed near the target area. RFA has been shown to have an increase in pain reduction as well as an increase in functional ability when compared to corticosteroid injections (CSI), another common treatment for both acute and chronic pain. Many clinicians have logically combined RFA and CI together to achieve a synergistic effect. This study aims to look at the current literature available to determine if the research supports this idea.
Methods: The authors independently went through the database collections of scopus, DANS easy literature, PubMed, EMBase, google scholar, and Cochrane library using free text terms in appendix 1. The inclusion criteria to be included in this paper were as follows: a direct comparison of RFA alone vs RFA w/ CSI and include a form of measure in either pain scale or functional ability in their outcomes. Literature before 2005 was not included in this paper. Each paper was assessed for their primary outcomes and an EPHPP rating was assigned to assess the quality of the paper.
Results: In progress.
Discussion: Radiofrequency ablation is one of the most common interventions for the treatment of pain suspected to be coming from a specific structure. In the past, this has been mostly done for chronic facet-joint pain, but peripheral nerve ablations have become more common. Radiofrequency ablation covers a wide variety of ablation techniques including pulsed radiofrequency (PRF), cooled radiofrequency ablation, and thermal radiofrequency ablation. While the modalities at which the nerve in target is ablated may differ, the end-goal remains the same; to achieve neurotomy leading to improvement in pain and possibly functional capacity.
Corticosteroids are a class of medication which work like the naturally occurring hormone, cortisol, and can have strong anti-inflammatory effects. This has been proposed to be due to a decrease in inflammatory cytokines including TNFa, IL1, and other pro-inflammatory cytokines like PGE-2. They have also been found to decrease pro-inflammatory genes by inhibition of transcription factors. For this reason, they have played a standard role in the treatment of chronic joint pain.
In more recent years, clinicians have logically added corticosteroids to the axial space before or after the ablation of the nerve to achieve higher rates of pain reduction. Another effect is likely a decrease in thermal lesion size. While there are no human studies analyzing this, it would be reasonable to conclude that corticosteroids have the possibility to decrease lesion size based on the already known mechanisms of actions. Importantly, the risks of the addition of corticosteroids must be weighed against the potential benefit. The goal of this study is to determine if any current literature exists that supports the addition of corticosteroids to RFA in terms of pain improvement of functional ability.
Embargo Period
6-22-2023
Included in
Is there any benefit to adding corticosteroids to radiofrequency ablation treatments: A systemic review.
Suwanee, GA
Introduction: Radiofrequency ablation (RFA) is a procedure done for chronic pain which uses thermal energy to nociceptive pathways with the goal of disrupting pain signaling. The thermal energy leads to nervous tissue disruption using radiofrequency currents through an electrode placed near the target area. RFA has been shown to have an increase in pain reduction as well as an increase in functional ability when compared to corticosteroid injections (CSI), another common treatment for both acute and chronic pain. Many clinicians have logically combined RFA and CI together to achieve a synergistic effect. This study aims to look at the current literature available to determine if the research supports this idea.
Methods: The authors independently went through the database collections of scopus, DANS easy literature, PubMed, EMBase, google scholar, and Cochrane library using free text terms in appendix 1. The inclusion criteria to be included in this paper were as follows: a direct comparison of RFA alone vs RFA w/ CSI and include a form of measure in either pain scale or functional ability in their outcomes. Literature before 2005 was not included in this paper. Each paper was assessed for their primary outcomes and an EPHPP rating was assigned to assess the quality of the paper.
Results: In progress.
Discussion: Radiofrequency ablation is one of the most common interventions for the treatment of pain suspected to be coming from a specific structure. In the past, this has been mostly done for chronic facet-joint pain, but peripheral nerve ablations have become more common. Radiofrequency ablation covers a wide variety of ablation techniques including pulsed radiofrequency (PRF), cooled radiofrequency ablation, and thermal radiofrequency ablation. While the modalities at which the nerve in target is ablated may differ, the end-goal remains the same; to achieve neurotomy leading to improvement in pain and possibly functional capacity.
Corticosteroids are a class of medication which work like the naturally occurring hormone, cortisol, and can have strong anti-inflammatory effects. This has been proposed to be due to a decrease in inflammatory cytokines including TNFa, IL1, and other pro-inflammatory cytokines like PGE-2. They have also been found to decrease pro-inflammatory genes by inhibition of transcription factors. For this reason, they have played a standard role in the treatment of chronic joint pain.
In more recent years, clinicians have logically added corticosteroids to the axial space before or after the ablation of the nerve to achieve higher rates of pain reduction. Another effect is likely a decrease in thermal lesion size. While there are no human studies analyzing this, it would be reasonable to conclude that corticosteroids have the possibility to decrease lesion size based on the already known mechanisms of actions. Importantly, the risks of the addition of corticosteroids must be weighed against the potential benefit. The goal of this study is to determine if any current literature exists that supports the addition of corticosteroids to RFA in terms of pain improvement of functional ability.
Comments
Presented by Nikolas Jen.