Pulsed radiofrequency relieves acute back pain and sciatica

A safe and effective therapy involving minimally invasive procedure in which pulses of energy from a probe are applied directly to nerve roots showed an overall improvement in pain and disability in people suffering from lower back pain. The findings of the study were presented at the annual meeting of the Radiological Society of North America (RSNA).

The technique involves CT-guided pulsed radiofrequency (pRF) which applies energy through an electrode under CT guidance to the portion of the nerve responsible for sending pain signals. Of the different therapies available, pulsed radiofrequency is among the least invasive and treatment lasts only for 10 minutes, and one session is enough in a large number of treated patients.

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Conventional treatment options for herniated disks range from over-the-counter pain medications to injections of corticosteroids directly into the affected area of the spine. If the medications were not effective then the surgery is the next best alternative in which the entire disk is removed and the vertebra fused together for stability.

"Pulsed radiofrequency creates a nerve modulation, significantly reducing inflammation and its associated symptoms," said study senior author Alessandro Napoli.

Dr. Napoli and his associates studied the approach in patients with back pain from lumbar disk herniation that had not responded to prolonged conservative treatment. In 128 patients, the pRF treatment was delivered directly under CT guidance to the root of the nerve. The treatment was applied for 10 minutes.

The control group included 120 patients who received one to three sessions of CT-guided steroid injection on the same anatomical target with no pRF.

In a similar study published in JAMA, Medical Dialogues has earlier reported that treatment of chronic low back pain with radiofrequency denervation resulted in either no improvement or no clinically important improvement in chronic low back pain.

Read Also: No improvement with Radiofrequency Denervation in chronic low back pain : JAMA

The one-year outcomes demonstrated that CT-guided pRF was superior to the injection-only strategy. Patients who received pRF saw greater overall improvement in pain and disability scores during the first year. Relief of leg pain was faster in patients assigned to pRF, and they also reported a faster rate of perceived recovery. The probability of perceived recovery after one year of follow-up was 95 percent in the pRF group, compared with 61 percent in the injection only group.

According to Dr. Napoli when pulsed radiofrequency is followed by a steroid injection, the result is long lasting and more efficacious than injection only.

Lumbar disk herniation is a common, often debilitating, condition that affects the disks that act as cushions between the vertebrae of the lower spine. Herniation occurs where the jelly-like material in the center of the disk bulges through a tear in the disk's tough exterior layer and puts pressure on the roots of the nerves. Herniated disks are often the source of sciatica or pain that radiates downward from the lower back into the leg.