1. EFFICACY AND SAFETY OF PULSED RADIOFREQUENCY TREATMENT IN CHRONIC PAIN SYNDROMES Introdução à Medicina II | Teacher Luís Filipe Azevedo | Class 14

2. Summary Introdução à Medicina II | Teacher Luís Azevedo | Class 14 1.Introduction 2.Methods 3. Results 4. Planning and development of future tasks 5. References

3. 1.Introduction Research question and aims What is the efficacy and safety of Pulsed Radiofrequency treatment in chronic pain syndromes? Aim: To systematically review the evidence about efficacy and safety of pulsed radiofrequency in patients with chronic pain syndromes. Introdução à Medicina II | Teacher Luís Azevedo | Class 14

4. 1.Introduction What is pain? PAINPAIN Acute Chronic The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." “Chronic pain has been increasing in prevalence. It is considered the most underestimated health care problem impacting quality of life. A number of epidemiological studies conducted in different parts of the world, reported prevalence rates of chronic pain ranging from 12-80%. Chronic pain has detrimental effects on physical and mental health, daily activities, family relationships, employment and economic well-being of the sufferers and family caregivers. Since the epidemiological studies about chronic pain in Lebanon are limited, the aim of this article is to help understand the magnitude of the problem and to depict strategies for the prevention and management of chronic pain.” [1] Introdução à Medicina II | Teacher Luís Azevedo | Class 14 [1] 1. Huijer H, Abu-saad. Chronic pain: a review. J Med Liban; 2010

5. Relieves pain and improves movement and function Alters pain signals as they travel to the brain 1.Introduction Different treatments for chronic pain Different treatments for chronic pain [2] Electrical Stimulation Therapies Relaxation Techniques Physical Therapy Helps reduce stress levels Introdução à Medicina II | Teacher Luís Azevedo | Class 14 [2] Van Zundert J, Huntoon M, Patijn J, Lataster A, Mekhail N, van Kleef M. Cervical Radicular Pain. Pain Pract; 2009 Oct.

6. Radiofrequency treatment 1.Introduction  A development of heat based radiofrequency denervation [3]  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 [4] Introdução à Medicina II | Teacher Luís Azevedo | Class 14 [3] Pevzner E, David R, Leitner Y, Pekarsky I, Folman Y, Gepstein R. Pulsed radiofrequency treatment of severe radicular pain. Harefuah; 2005 Mar. [4] Byrd D, Mackey S. Pulsed radiofrequency for chronic pain. Curr Pain Headache Rep; 2008 Jan.

7. Project Development Phases 1.Research question formulation 2.Definition of selection criteria (inclusion and exclusion) 3.Definition and implementation of literature search methods and resources 4.Study selection using defined selection criteria 5.Data extraction from included studies 6.Critical appraisal and quality assessment of included studies 7.Data analysis and synthesis from included primary studies 8.Writing and disseminating final report 2. Methods Introdução à Medicina II | Teacher Luís Azevedo | Class 14

8.  Type of study Systematic Review  Units of analysis Articles  Data Search PubMed ISI Web of Knowledge Scopus Central 2. Methods Introdução à Medicina II | Teacher Luís Azevedo | Class 14

9.  Key-words Pain Chronic Pulsed Radiofrequency  Query PubMed: pulsed[All Fields] AND radiofrequency[All Fields] AND (("pain"[MeSH Terms] OR "pain"[All Fields]) AND chronic[All Fields]) Scopus: TITLE-ABS-KEY(radiofrequency) AND TITLE-ABS-KEY(pulsed) AND TITLE-ABS-KEY(pain) AND TITLE-ABS- KEY(chronic) ISI TS=(Radiofrequency SAME pulsed) AND TS=pain AND TS=chronic Central #1 MeSH descriptor Pain explode all trees #2 (Chronic): ti, ab, kw #3 (Radiofrequency Near Pulsed): ti, ab, kw 2. Methods  MeSH Term: Pain Introdução à Medicina II | Teacher Luís Azevedo | Class 14

10.  Research Limits 2. Methods Exclusion CriteriaInclusion Criteria 1. Theme does not match the expected1. Articles that mention the radiofrequency treatment in chronic pain 2. Treatment is not used for chronic pain2. Articles that have, at least, two comparative groups - a group sbmited to pulsed radiofrequency and a control group. 3. Type of article is not the desired3. Articles that mention the issue of efficacy and safety of pulsed radiofrequency 4. Study is not conducted in humans 5. Article does not mention the methods used and results Introdução à Medicina II | Teacher Luís Azevedo | Class 14

11. 2. Methods Articles found 78 PUBMED 48 ISI Web 32 SCOPUS 65 CENTRAL 3 13 not excluded 65 excluded Introdução à Medicina II | Teacher Luís Azevedo | Class 14

12. 2. Methods Articles found 78 PUBMED 48 ISI Web 32 SCOPUS 65 CENTRAL 3 4 Introdução à Medicina II | Teacher Luís Azevedo | Class 14 8 20 0

13. 3. Results Articles Excluded Exclusion CriteriaArticles 1. Theme does not match the expected 2 2. Treatment is not used for chronic pain 1 3. Type of article is not the desired.59 4. Study is not conducted in humans3 5. Article does not mention the methods used and results0 Introdução à Medicina II | Teacher Luís Azevedo | Class 14

14. 3. Results Introdução à Medicina II | Teacher Luís Azevedo | Class 14 Publication year

15. 3. Results Agreement / Disagreement Reason for exclusion 4 disagreements Non-exclusion 0 disagreements Introdução à Medicina II | Teacher Luís Azevedo | Class 14

16. 3. Results Introdução à Medicina II | Teacher Luís Azevedo | Class 14 1."Pain practice: the official journal of Word Institute of pain" - 13 articles 2. "Pain Physician" - 9 articles 3."Pain medicine (Malden, Mass.)" - 7 articles Articles and Journals

17. 3. Results Non-excluded articles: TitleAuthorJournalPublication year Percutaneous pulsed radiofrequency applied to the L-2 dorsal root ganglion for treatment of chronic low-back pain: 3-year experience TsouJ Neurosurg Spine2010 Pulsed radiofrequency on L2 dorsal root ganglion as a therapeutic method for lumbar discogenic pain AssisColuna/Columna2009 Response to pulsed and continuous radiofrequency lesioning of the dorsal root ganglion and segmental nerves in patients with chronic lumbar radicular pain SimopoulosPain Physician2008 A comparison of conventional and pulsed radiofrequency denervation in the treatment of chronic facet joint pain TekinClin J Pain2007

18. TitleAuthorJournalPublication year Pulsed radiofrequency adjacent to the cervical dorsal root ganglion in chronic cervical radicular pain: a double blind sham controlled randomized clinical trial Van Zundert Pain2007 Contemporary role of radiofrequency treatment for intractable pain syndromes ParkEuropean Congress of Neurorosurgery 2007 Pulsed radiofrequency treatment of the lumbar medial branch for facet pain: a retrospective analysis LindnerPain Med2006 Pulsed radiofrequency of the dorsal root ganglia is superior to pharmacotherapy or pulsed radiofrequency of the intercostal nerves in the treatment of chronic postsurgical thoracic pain CohenPain Physician2006 3. Results Non-excluded articles:

19. TitleAuthorJournalPublication year Radiofrecuency in the treatment of chronic cervical spine patology. Retrospective study AbejonRevista de la Sociedad Espanola del Dolor 2006 Sphenopalatine ganglion pulsed radiofrequency treatment in 30 patients suffering from chronic face and head pain BayerPain Pract2005 Percutaneous pulsed radiofrequency treatment of the cervical dorsal root ganglion in the treatment of chronic cervical pain syndromes: A clinical audit Van ZundertNeuromodulation2003 Pulsed mode radiofrequency lesioning of the suprascapular nerve for the treatment of chronic shoulder pain ShahPain Physician2003 Pulsed radiofrequency application in treatment of chronic zygapophyseal joint pain MikeladzeSpine J2003 3. Results Non-excluded articles:

20. 4. Planning and development of future tasks OctNovDecJanFebMarAprMay Formulation of the question Definition of selection’s criteria Databases’ research Abstracts’ reading Articles selection Analysis of the selected articles Discussion of the results Review article’s writing Website’s building Introdução à Medicina II | Teacher Luís Azevedo | Class 14

21.  Analysis of the selected articles 1.Second selection stage 2.Data extraction 3.Quality assessment (consort – clinical trials; strobe – observational studies, equator network)  Review Article’s writing 1.Abstract 2.Introduction 3.Methods 4.Results 5.Discussion 4. Planning and development of future tasks

22. 5. References Introdução à Medicina II | Teacher Luís Azevedo | Class 14 1. Huijer H, Abu-saad. Chronic pain: a review. J Med Liban; 2010 2. Van Zundert J, Huntoon M, Patijn J, Lataster A, Mekhail N, van Kleef M. Cervical Radicular Pain. Pain Pract; 2009 Oct. 3. Pevzner E, David R, Leitner Y, Pekarsky I, Folman Y, Gepstein R. Pulsed radiofrequency treatment of severe radicular pain. Harefuah; 2005 Mar. 4. Byrd D, Mackey S. Pulsed radiofrequency for chronic pain. Curr Pain Headache Rep; 2008 Jan. 5. Malik K, Ben Zon T. Pulsed radiofrequency: a critical review of its efficacy. Anaesth Intensive Care; 2007