PULSED RADIOFREQUENCY TREATMENT IN PAIN SYNDROMES Introdução à Medicina I | Teacher José Gustavo Martins | Class 14 WHAT IS THE EVIDENCE?

? Problem Is there any evidence that proves the efficacy of this treatment? What are the cases that its use is well stabilised and with efficacies proved? Abstract Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Background Pulsed radiofrequency is a development of heat based radiofrequency denervation Is used in medicine to treat especially chronic pain This type of treatment does not provoke lesions of the nervous structures, but changes in the conduction of the pain stimulus by creating an electromagnetic field Unlike heat based radiofrequency treatment, pulsed radiofrequency does no direct damage to the nerve. Introdução à Medicina I | Teacher José Gustavo Martins | Class 14 Abstract

Aims 1. Investigate if pulsed radiofrequency has any evidence in treatment of chronic syndromes 2. Study the patients’ life quality improvement 3. Compare this therapy to others more commonly applied procedures, focusing on the advantages of pulsed radiofrequency therapy. Abstract Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Methods  Type of study Systematic Review and Meta-Analysis  Units of analysis Articles found in databases  Data Search PubMed ISI Web of Knowledge Abstract Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Methods  Key-words Pain Chronic Syndrome Pulsed Radiofrequency  Query pulsed[All Fields] AND radiofrequency[All Fields] AND ("pain"[MeSH Terms] OR "pain"[All Fields])) AND (("syndrome"[MeSH Terms] OR "syndrome"[All Fields]) OR chronic[All Fields] Abstract Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Methods  Research Limits Exclusion Criteria Other types of articles, such as reviews, letter to editor or comments Articles contemplating pulsed radiofrequency used not as a treatment for pain syndromes Articles which don’t mention the methods used or the results Inclusion Criteria Language: English No date of publication limits Abstract Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Methods Work Fases 1. Formulation of a clear question: “Pulsed radiofrequency treatment in pain syndromes - What is the evidence?” 2. Definition of selection’s criteria 3. Databases’ research 4. Abstracts’ reading 5. Articles selection, by application of inclusion an exclusion criteria (each article should be read by two people. Divergences will be solved by consensus) 6. Analysis of the selected articles 7. Discussion of the results 8. Review article’s writing 9. Website’s building Abstract Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Expected results  To reassure the knowledge previously acquired mainly in subjects regarding scientific research tools and information selection.  Verify the article’s credibility and if the method is applicable in clinic procedures.  To improve the quality of our research both in terms of knowledge and information, and also time.  To have a solid review about this subject.  Manage to present it correctly to the public  Verify the credibility and the success of the method by the analysis of various articles. Abstract Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Basic concepts Pulsed Radiofrequency Pain syndromes Introduction Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

 Pulsed Radiofrequency (PRF):  A development of heat based radiofrequency denervation  To treat especially chronic pain  Minimally invasive target selective technique  Uses brief pulses of high voltage (Rf range – 300kHz) to produce controlled tissue destruction  Heat dissipates between pulses, avoiding thermocoagulation  Reduces pain by modullating pain transmission  Produces transient inibition of evoked synaptic activity Introduction Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

 Main location of neuropathic pain: Dorsal root ganglia (DRG) Peripheral nerves Trigeminal ganglions Sphenopalatine ganglion Intervertebral disc Sacroiliac joint Glossopharyngeal nerve Introduction Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

 Clinical Procedure: 1- Insulated neddle placed in the vicinity of the nerve to be lesioned 2- Multiple fluoroscopic X-ray views to check needle position 3- Motor and sensory nerve stimulation testing 4- Grounded electrode passed through the insulated needle to the tip 5- Electric current through the electrode heats up the surrounding tissue Introduction Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Main side effects: - The pain is greater the days after the treatment - Pain during the procedure - Global anesthetic - Damage blood vessels or other nerves close to the area Clinical Experience on Radiofrequency:  in clinical use for 30 years  demonstrated success at reducing pain in several chronic pain condition  useful tool in the overall management of refractory neuropathic pain. Introduction Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Introduction Success in chronic pain has not been adequately reproduced in randomized controlled trials (RCTs), its use in the management of neuropathic pain is under some debate:  conventional radiofrequency occasionally leads to worsening and even new onset of neuropathic pain.(Kornik et al., 2004)  pulsed radiofrequency may offer new opportunities and a broader perspective for therapy with radiofrequency. (Racz et al, 2006) Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Justification of the study Pulsed radiofrequency is a minimally invasive treatment that has been used in many pain syndromes Need to check if there is any conclusion on the evidence published. Curiosity about the subject Research on the topic (Sum up the published studies and articles) Pulsed radiofrequency treatment in pain syndromes – What is the evidence? Introduction Introdução à Medicina I | Teacher José Gustavo Martins | Class 14

Class 14  ANA LUIS FARIA  INES PINTO  JORGE PINTO  JORGE SOARES  JOSE BARRETO  JOSE VICENTE FORMOSO  LUÍS OLIVEIRA  MAFALDA PINTO  MAFALDA PAIS CARRINGTON  MARIA TERESA SILVERIO  MARIA LEONOR GODINHO  MIGUEL VALENTE  PAULA TEIXEIRA  PEDRO MONTEIRO

References 1. Kornick, C., Meng, F.C., Xu, S.J., Liu, Y.G., Wang, H.W. Selective percutaneous radiofrequency thermocoagulation in the treatment of trigeminal neuralgia:report on 1860 cases. Chinese Medical Journal 2004; 117: RACZ, G.B, RUIZ-LOPEZ, R. Radiofrequency Procedures: Review Article, Pain Practice, 2006; p Van Zundert J, Huntoon M, Patijn J, Lataster A, Mekhail N, van Kleef M. Cervical Radicular Pain, 05/05/ KESKINBORA K, AYDINLI I. Long-term results of suprascapular pulsed radiofrequency in chronic shoulder pain, Jan. 2009; p Misra S, Ward S, Coker C.Pain. Pulsed radiofrequency for chronic testicular pain-a preliminary report, 19/03/2009, p Byrd D, Mackey S. Curr Pain Headache Rep. Pulsed radiofrequency for chronic pain Jan, p