Pietro M Schianchi 1, *, Menno E Sluijter 2, Susan E Balogh 2
1 S. Anna Clinic, Lugano, Switzerland
2 Centre for Pain Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
*Corresponding author: Pietro M. Schianchi, S. Anna Clinic, Lugano, Switzerland. Tel: +41-919233978, Fax: +41-919238917, E-mail: email@example.com.
Received: January 13, 2013; Accepted: February 20, 2013
Anesthesiology and Pain Medicine. 2013 September; 3(2):250-5. DOI: 10.5812/aapm.10259
Published Online 2013 September 01. Research Article
The intra-articular (IA) application of pulsed radiofrequency (PRF) for pain in small and large joints represents a recent development that has proven to be effective in many cases. We performed a retrospective study of 89 such procedures in 57 consecutive patients with chronic articular pain.
Objectives: The aim of this retrospective study is to evaluate the effectiveness of intraarticular PRF in a group of 57 consecutive patients with chronic joint pain.
Patients and Methods: Patients with intractable joint pain for more than 6 months were treated with IA PRF 40-45V for 10-15 min in small joints and 60V for 15 min in large joints using fluoroscopic confirmation of correct needle position. A total of 28 shoulders, 40 knees, 10 trapezio-metacarpal, and 11 first metatarso-phalangeal joints were treated. Results were evaluated at 1, 2, and 5 months. The procedure was repeated after 1 month in 10 patients with initial suboptimal results. Success was defined as a reduction of pain score by at least 50%.
Results: All groups showed significant reductions in pain scores at all three follow-up visits. Success rates were higher in small joints (90% and 82%, respectively) than large ones (64% and 60%, respectively). Interestingly, IA PRF was successful in 6 out of 10 patients who had undergone previous surgery, including 3 with prosthetic joint replacement and in 6 of the 10 repeated procedures. There were no significant adverse effects or complications.
Conclusions: IA PRF induced significant pain relief of long duration in a majority of our patients with joint pain. The exact mechanism is unclear, but may be related to the exposure of immune cells to low-strength RF fields, inducing an anti-inflammatory effect. The success rate appears to be highest in small joints. We recommend additional research including control groups to further investigate and clarify this method; our data suggest that it may represent a useful modality in the treatment of arthrogenic pain.
Keywords: Osteoarthritis; Pulsed Radiofrequency reatment; Chemokines; Arthralgia; Allostasis; Joint Prosthesis