49 research outputs found
A retrospective study on patients with chronic knee pain treated with ultrasound-guided radiofrequency of the genicular nerves (RECORGEN trial)
No full textIntroduction Radiofrequency (RF) treatment of the genicular nerves is a promising treatment for chronic osteoarthritic and persistent postsurgical knee pain (PPSP), refractory to conventional medical management. Methods The RECORGEN study is a retrospective single-center cohort study of patients treated with ultrasound-guided conventional RF of the genicular nerves for chronic knee pain in Hospital Oost-Limburg, Genk from September 2017 to June 2020. Subgroup analysis based on etiology of pain (PPSP and degenerative knee pain) was performed in addition to the total study population analysis. Outcome parameters were global perceived effect (GPE), Numeric Rating Scale for pain, consumption of strong opioids, and safety of the treatment at 6 weeks and cross-sectionally at a variable time point. Treatment success was defined as GPE >= 50%. Results Sixty-eight cases were screened of which 59 (46 diagnosed with PPSP and 13 with degenerative knee pain) were included in the study. Treatment success at 6 weeks was achieved in 19 of 59 interventions (32.2%) and was similar in both groups. Seventeen responders were evaluated at follow-up. 45.1% (8/17) continued to have a positive effect at the second time point. The mean duration of effect of the RF treatment was 8.3 months. Safety analysis at 6 weeks and at the second time point showed a good safety profile of the treatment. Conclusion Conventional RF of the genicular nerves was clinically successful in more than 30% of the study population refractory to conventional medical management. Overall, the treatment was well tolerated. The mean duration of effect was 8.3 months
Cooled versus conventional radiofrequency treatment of the genicular nerves for chronic knee pain:12-month and cost-effectiveness results from the multicenter COCOGEN trial
No full textBackground Radiofrequency (RF) treatment of the genicular nerves reduces chronic knee pain in patients with osteoarthritis (OA) or persistent postsurgical pain (PPSP) after total knee arthroplasty (TKA). The objective of this study is to compare long-term outcomes of cooled and conventional RF and perform an economic evaluation. Methods The COCOGEN trial is a double-blinded, non-inferiority, pilot, randomized controlled trial that compared the effects up to 12 months of cooled and conventional RF in patients with chronic knee pain suffering from OA or PPSP after TKA following a 1:1 randomization rate. Outcomes were knee pain, functionality, quality of life, emotional health, medication use, and adverse events. A trial-based economic evaluation was performed with a 12-month societal perspective. Here, the primary outcome was the incremental costs per quality-adjusted life year (QALY). Results 41 of the 49 included patients completed the 12-month follow-up. One patient in the PPSP cooled RF group had substantial missing data at 12-month follow-up. The proportion of patients with ≥50% pain reduction at 12 months was 22.2% (4/18) in patients treated with conventional RF versus 22.7% (5/22) in patients treated with cooled RF (p>0.05). There was a statistically significant difference in the mean absolute numerical rating scale at 12 months after cooled RF and conventional RF in patients with PPSP (p=0.02). Differences between other outcomes were not statistically significant. The health economic analysis indicated that cooled RF resulted in lower costs and improved QALYs compared with conventional RF in PPSP but not in OA. There were no serious adverse events. Conclusions Both RF treatments demonstrated in approximately 22% of patients a ≥50% pain reduction at 12 months. In patients with PPSP, contrary to OA, cooled RF seems to be more effective than conventional RF. Additionally, cooled RF has in patients with PPSP, as opposed to OA, greater effectiveness at lower costs compared with conventional RF.</p
Long-Term Outcome in Patients With Spinal Cord Stimulation for Failed Back Surgery Syndrome:A 20-Year Audit of a Single Center
No full textSTUDY DESIGN: This is a retrospective, observational study.INTRODUCTION: Spinal cord stimulation (SCS) has found its application in chronic pain treatment, with failed back surgery syndrome (FBSS) as one of the most important indications. However, to date, little is known about the long-term effectiveness of the treatment. The aim of this study is to analyze retrospectively the long-term outcomes of SCS treatment in a single multidisciplinary pain center on predominant radicular pain, using devices of a single manufacturer.MATERIALS AND METHODS: Patient data on overall patient satisfaction, pain intensity, and adverse events were retrospectively collected in our clinical practice between January 1998 and January 2018, for 191 patients who received a permanent SCS implant. Secondary health measures included the influence of opioid and nicotine use on pain reduction after therapy.RESULTS: The trial-to-implant ratio was 93.6%. At a mean follow-up of 10.6 years, 78.5% of the patients were satisfied with the treatment outcome, with a significant pain reduction of an average three points on a Numeric Rating Scale. Opioid and nicotine usage did not have a significant link with the pain reduction one year after the treatment. Furthermore, devices had an average battery lifespan of 8.4 years. A total of 248 revisions were recorded. A total of 24 patients (11.7%) acquired an infection; 7 of 204 patients had an infection during the trial period, 2 of 191 patients had an infection in the first postoperative year, and 15 of 191 patients had an infection after the first year. The average time to infection, if not in the first year, was 10.1 years.CONCLUSIONS: A successful long-term outcome regarding pain relief in patients with predominant radicular pain due to FBSS is established with SCS therapy.</p
Comparison of cooled versus conventional radiofrequency treatment of the genicular nerves for chronic knee pain: a multicenter non-inferiority randomized pilot trial (COCOGEN trial)
No full textBackground Radiofrequency (RF) treatment of the genicular nerves has the potential to reduce chronic knee pain due to osteoarthritis or persistent postsurgical pain, however, a direct comparison between the two main modalities used, conventional and cooled, is lacking.Methods This double blind, non-inferiority, pilot, randomized controlled trial compared the effects of cooled and conventional RF in chronic knee pain patients suffering from osteoarthritis or persistent postsurgical pain after total knee arthroplasty. Patients were randomized following a 1:1 rate. The primary outcome was the proportion of patients with >= 50% pain reduction at 3 months postintervention. Other outcomes were knee pain, functionality, quality of life, emotional health, and adverse events up to 6 months postintervention. Conventional RF treatment was tested for non-inferiority to cooled in reducing knee pain at 3 months follow- up. Results Forty- nine of 70 patients were included, of which 47 completed a 3- month follow- up. The primary outcome was achieved in 4 of 23 patients treated with conventional RF (17%) vs in 8 of 24 with cooled (33%) (p=0,21). Results from the non-inferiority comparison were inconclusive in relation to the non-inferiority margin. There was no statistically significant difference between secondary outcomes. There were no serious adverse events.Conclusions Both conventional and cooled RF treatment reduced pain in the osteoarthritis and persistent postsurgical pain population. This pilot study did not demonstrate statistically significant differences in the proportion of patients experiencing >= 50% pain reduction between techniques. The non-inferiority analysis was inconclusive. These results warrant further research
Radiofrequency Treatment Adjacent to the Cervical Dorsal Root Ganglion
No full textCervical radicular pain is pain perceived in the arm, shooting or electric in quality, caused by irritation or injury of a cervical spinal nerve root. It affects approximately 1 in 1000 adults annually. When cervical radicular pain does not resolve spontaneously within 3 months, serious underlying pathologies, such as infection and cancer, should be excluded before offering further symptomatic treatment. The neurological examination includes sensory, motor, and reflex evaluation. The clinical tests: neck compression test or Spurling test, shoulder abduction test, Valsalva maneuver, axial traction test, and Elvey’s upper limb tension test have a high specificity but a low sensitivity. The determination of the symptomatic level is done with diagnostic selective nerve root blocks. The prognostic block is performed by injecting a radio-opaque mixture of iohexol and lidocaine around the nerve. The block is considered positive when it results in minimum 50% pain reduction, measured on the visual analogue scale within 30 min. Radiofrequency treatment applies high frequency current adjacent to the dorsal root ganglion. The aim is to increase the electrode tip temperature to 67°C. This temperature is maintained during 60s. The pulsed radiofrequency current is applied in small bursts at 45 V and the temperature is kept below 42°C. There is evidence from two randomized controlled trials that radiofrequency treatment could be used for the treatment of cervical radicular pain. The outcome of pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion is supported by observational studies and a randomized controlled trial. There a few side effects with radiofrequency treatment and when they occur, they are usually minor and transient. Deafferentation pain is rarely occurring with conventional radiofrequency. No side effects and complications of pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion have been reported
Injection therapy and denervation procedures for chronic low back pain: a systematic review—clinical value?
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Radiofrequency and Pulsed Radiofrequency Treatment of Chronic Pain Syndromes: The Available Evidence
No full textResponse to Ter Meulen et al Effect of Transforaminal Epidural Corticosteroid Injections in Acute Sciatica
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