Koen Van Boxem1,2, Nelleke de Meij1, Alfons Kessels3, Maarten Van Kleef1,4, Jan Van Zundert5. 1. Department of Anesthesiology & Pain Management, Maastricht University Medical Center MUMC, Maastricht, The Netherlands. 2. Department of Anesthesiology - Critical Care and Multidisciplinary Pain Center, Sint-Jozefkliniek Bornem & Willebroek, Bornem, Belgium. 3. Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, The Netherlands. 4. Department of Anesthesiology and Pain management, VUMC Amsterdam, Amsterdam, The Netherlands. 5. Department of Anesthesiology, Critical Care and Multidisciplinary Pain Center, ZOL, Genk, Belgium.
Abstract
BACKGROUND AND OBJECTIVES: There is little evidence concerning the medical management of lumbosacral radicular pain. The prognosis for patients suffering pain for more than 3 months is poor. Pulsed radiofrequency (PRF) treatment of the dorsal root ganglion (DRG) has been suggested as a minimally invasive treatment. We studied the effect on pain and quality of life of PRF treatment of the DRG in patients with chronic, severe lumbosacral radicular pain. METHODS: Patients with lumbosacral radicular pain were screened to select a homogeneous population. PRF treatment of the DRG was performed at L5 or S1. Evaluation was carried out at 6 weeks, 3 months, and 6 months. Pain reduction and "fully recovered" or "much improvement," in terms of the global perceived effect, were the primary outcomes. Quality of life (RAND-36), disability (Oswestry Disability Index), and the neuropathic pain scales leeds assessment of neuropathic symptoms and signs (LANSS) and DN4 were registered at each time point. Medication use was scored with the Medication Quantification Scale. RESULTS: Out of 461 screened patients, 65 were included. According to the intention to treat analysis, clinical success was achieved in 56.9%, 52.3%, and 55.4% of the patients at respectively 6 weeks, 3 months, and 6 months. DN4, Oswestry Disability Index and physical component for the RAND-36 quality of life improved significantly while the mental component remained unchanged. The number of patients on opioids was reduced. CONCLUSIONS: PRF treatment of the DRG may be considered for patients with chronic, severe lumbosacral radicular pain refractory to conventional medical management. Wiley Periodicals, Inc.
BACKGROUND AND OBJECTIVES: There is little evidence concerning the medical management of lumbosacral radicular pain. The prognosis for patients suffering pain for more than 3 months is poor. Pulsed radiofrequency (PRF) treatment of the dorsal root ganglion (DRG) has been suggested as a minimally invasive treatment. We studied the effect on pain and quality of life of PRF treatment of the DRG in patients with chronic, severe lumbosacral radicular pain. METHODS:Patients with lumbosacral radicular pain were screened to select a homogeneous population. PRF treatment of the DRG was performed at L5 or S1. Evaluation was carried out at 6 weeks, 3 months, and 6 months. Pain reduction and "fully recovered" or "much improvement," in terms of the global perceived effect, were the primary outcomes. Quality of life (RAND-36), disability (Oswestry Disability Index), and the neuropathic pain scales leeds assessment of neuropathic symptoms and signs (LANSS) and DN4 were registered at each time point. Medication use was scored with the Medication Quantification Scale. RESULTS: Out of 461 screened patients, 65 were included. According to the intention to treat analysis, clinical success was achieved in 56.9%, 52.3%, and 55.4% of the patients at respectively 6 weeks, 3 months, and 6 months. DN4, Oswestry Disability Index and physical component for the RAND-36 quality of life improved significantly while the mental component remained unchanged. The number of patients on opioids was reduced. CONCLUSIONS: PRF treatment of the DRG may be considered for patients with chronic, severe lumbosacral radicular pain refractory to conventional medical management. Wiley Periodicals, Inc.
Authors: Robbert C Maatman; Monique A H Steegers; Oliver B A Boelens; Toine C Lim; Hans J van den Berg; Sandra A S van den Heuvel; Marc R M Scheltinga; Rudi M H Roumen Journal: Trials Date: 2017-08-02 Impact factor: 2.279