gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

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The application of pulsed radio frequency in chronic pain

Meeting Abstract

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  • D. Koulousakis - Klinik für Neurochirurgie, Klinikum München-Bogenhausen, Akademisches Lehrkrankenhaus der TU München
  • A. Koulousakis - Klinik für Stereotaxie und Funktionelle Neurochirurgie, Universitätsklinikum Köln
  • V. Sturm - Klinik für Stereotaxie und Funktionelle Neurochirurgie, Universitätsklinikum Köln

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP 032

doi: 10.3205/12dgnc419, urn:nbn:de:0183-12dgnc4190

Published: June 4, 2012

© 2012 Koulousakis et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: In the last 25 years, neuromodulative techniques, such as spinal cord stimulation (SCS) or the intrathecal application of opioids, have replaced the old ablative neurosurgical methods. The application of pulsed radio frequency (PRF) represents another addition to the arsenal of non-ablative techniques. This study was performed in order to find out if the application of PRF can be integrated in the algorithm for the invasive treatment of chronic pain.

Methods: 50 Patients with chronic, non-maligne pain, who underwent a PRF treatment using the PASHA Multi-Cath Electrode, from Jan. 2005– July 2007, were included in this study. The major part, namely 19% suffered from FBSS (Failed Back Surgery Syndrome). The patients were treated with various stimulation parameters, including duration and number of pulses. After lumbar puncture, the electrode is placed epiduraly, at the dorsolateral region of the spinal column, right above the dorsal root entry zone. The dorsal roots are then stimulated, until noticed by the patient. Very low voltages (<0.8 V) are used, in order to ensure the best possible proximity to the nerve root.

Results: Results were assessed, using a questionnaire, which included the severity of pain (using the visual analogue scale (VAS)), pain reduction, reduction of pain medication, as well as various parameters, which contribute to the patients' quality of life, such as overall activity, mood, mobility, the ability to work, sleep and vitality. The latter variables were used to determine a mean value, which represented quality of life. Follow-ups were conducted after four weeks, 3, 6, 12 and 18 months respectively. The results show, that half the patients experienced a significant pain reduction of up to 61%, in comparison to their initial pain severity, which lasted for about six months. Thirteen patients remained after 18 months, displaying a mean pain reduction of 78%, the other patients dropped out, mainly due to recurring pain.

Conclusions: The application of PRF to the spinal roots can be considered as a viable first-line, minimal invasive method, which can be easily repeated and has next to no side effects. The ability to conduct an SCS trial, as well as to apply a test-bolus of opioids in addition to the application of PRF, make the PASHA-Cath Electrode the perfect tool for determining the best course of action in the invasive treatment of chronic pain.