Radio-Frequency (RF) Procedures

Radiofrequency (RF) energy-based procedures, are performed for chronic pain in a variety of musculoskeletal and neuropathic conditions.

Radiofrequency (RF) energy-based procedures, are performed for chronic pain in a variety of musculoskeletal and neuropathic conditions. They are of two types:

Conventional or ablative (nerve burning) – CRF
Pulsed (nerve sparing).- PRF

The procedure is performed using a radiofrequency generator which can be connected to specialised cannulas and electrodes. Under the guidance of Ultrasonography the targeted nerves are located and the cannulas are placed next to them. The nerve proximity is confirmed using sensory and motor stimulation of it. The radiofrequency procedure is then performed either on the pulsed mode or conventional mode.

The key difference between the two is as follows

The temperature and duration at which the radiofrequency energy is transmitted
- 42 degrees for 8 mins- PRF
- 80-90 degrees for 90 secs – CRF
The pattern of Radiofrequency energy
- Pulsed manner or discontinuous – PRF
- Continuous – CRF
Result
- PRF- Neuromodulation and decreased pain carrying signals
- CRF- Nerve burning and loss of function

Mechanism of Action:

In Conventional radiofrequency (CRF) a thermal lesion is created to interrupt the function of the nerve.
The application of PRF is based on the delivery of a train of sinusoidal electrical bursts (5–20 ms length) in the radiofrequency range (500 kHz) at a repetitive rate of a few hertz (2–5 Hz). The changes produced by electrical fields are selective for small unmyelinated and lightly myelinated nerve fibers, producing a motor-sparing effect. The pain relief commonly seen after PRF treatment can last up to several months. This effect is due to a neuromodulatory-type process, which alters the synaptic transmission or the excitability of C-fibers. These fibers are responsible for pain and temperature sensations and are involved in most neuropathic pain syndromes

Indications:

Radicular pain
Occipital neuralgia
Trigeminal neuralgia
Frozen shoulder
Shoulder osteoarthritis
Knee osteoarthritis
Post Surgical Neuropathy
Complex regional pain syndrome
Post traumatic neuropathic pain
Diabetic Neuropathy
Post herpetic Neuralgia Migraine
Chronic Pelvic Pain

Applications in Cancer Patients:

Post Surgical Neuropathy
Post Radiation Neuropathy
Post Chemotherapy Neuropathy
Metastatic tumors involving nerve plexuses
Abdominal and Pelvic malignancy

Complications:

Although both techniques have been reported to be effective (pulsed and ablative RF), there are some limitations more related to the ablative RF, such as failure to completely denervated the nerve, disrupt nociceptive sensation, worsening of symptoms due to aberrant neuronal regeneration, neuroma formation, and reduced motor function, neuritis, paresthesia and deafferentation pain syndrome.

Radio-Frequency (RF) Procedures

Mechanism of Action:

Indications:

Applications in Cancer Patients:

Complications:

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