Alexandre Teixeira

Intra-articular Application of Pulsed Radiofrequency for Arthrogenic Pain—Report of Six Cases

Invasive treatment of chronic pain emanating from joints is often difficult because of the complex anatomy of the nerve supply. In most joints, the innervation is derived from several segmental levels, with multiple peripheral nerve branches entering the joint capsule. For this reason, treatment aimed at the joint innervation is often incomplete. The intra-articular injection of steroids is a popular procedure, but the duration of action of such injections is limited and there may be deleterious effects if they are repeated too often. We have attempted to treat intractable arthrogenic pain by placing an electrode into the joint space and applying pulsed radiofrequency (PRF). We offered this treatment to patients with long-standing arthrogenic pain not responding to medication or other conventional conservative and invasive measures. The experimental nature of this procedure was extensively discussed with each patient and consent was obtained.

Pulsed radiofrequency for radicular pain due to a herniated intervertebral disc--an initial report.

Abstract:  Pulsed radiofrequency (PRF) has been used for the treatment of radicular pain, due to a herniated intervertebral disc, but so far the data are anecdotal. This is a retrospective study on 13 consecutive patients with this type of pain, at levels L3 to S1. All patients had a diagnosis confirmed by imaging, all had neurological abnormalities, and all were scheduled for surgical intervention. All 12 patients who had a profession had stopped working. Treatment consisted of application of PRF to the dorsal root ganglion of the affected segmental nerve, or in the case of S1 to the segmental nerve at the level of the S1 foramen.

Intravenous application of pulsed radiofrequency-4 case reports.

It has been suggested that PRF might possibly have an effect on the immune cells. We considered using the intravenous route to apply PRF in conditions that are caused by an unresolved immune action or connected to allostatic load, implicating an abnormally reacting immune system to obtain a systemic effect that could possibly be an additional tool in treating some of these conditions. These manuscript reports four cases that illustrate the wide variety of conditions where this new technique might be helpful.

Cooled Radiofrequency Ablation of Genicular Nerves for Knee Osteoarthritis Pain: A Letter to Editor

Cooled Radiofrequency Ablation of Genicular Nerves for Knee Osteoarthritis Pain: A Letter to Editor Menno E Sluijter, and Alexandre Teixeira Department of Pain Medicine, Swiss Paraplegic Center, Nottwil, Switzerland Clinica de Dor, Porto, Portugal Corresponding author: Menno E Sluijter, Department of Pain Medicine, Swiss Paraplegic Center, Nottwil, Switzerland. Tel: +41-419394920, E-mail: msluijter@mac.com

COMMENT ON: ERDINE S ET AL.; ULTRASTRUCTURAL CHANGES IN AXONS FOLLOWING EXPOSURE TO PULSED RADIOFREQUENCY FIELDS

1. Leclaire R, Fortin L, Lambert R, et al. Radiofrequency facet joint denervation in the treatment of low back pain. A placebo-controlled clinical trial to assess efficacy. Spine. 2001;26:1411–1417. 2. Datta S, Lee M, Falco FJ, et al. Systematic assessment of diagnostic accuracy and therapeutic utility of lumbar facet joint interventions. Pain Physician. 2009;12:437–460. 3. Bogduk N, Dreyfuss P, Govind J. A narrative review of lumbar medial branch neurotomy for the treatment of back pain. Pain Med. 2009;10:1035–1045. 4. Dreyfuss P, Schwarzer A, Lau P, et al. The target specificity of lumbar medial branch and L5 dorsal ramus blocks. A computed tomography study. Spine. 1997;22:895–902. 5. Kaplan M, Dreyfuss P, Halbrook B, et al. The ability of lumbar medial branch blocks to anesthetize the zygapophysial joint—a physiologic challenge. Spine. 1998;23:1847–1852. 6. Schwarzer A, Aprill C, Derby R, et al. The false positive rate of uncontrolled diagnostic blocks of the lumbar zygapophyseal joints. Pain. 1994;58:195–200.

Reply to Drs. Manchikanti and Singh

To the Editor: It was interesting to read the technical communication titled “Intra-articular Application of Pulsed Radiofrequency for Arthrogenic Pain—Report of Six Cases.” The authors start with the introduction that invasive treatment of chronic pain emanating from joints is often difficult because of the complex anatomy of the nerve supply. However, they lump in spinal facet joints, which includes cervical facet joints and atlanto-axial joints in the shoulder. They failed to explain the mechanism of action of intra-articular application of pulsed radiofrequency, either in cervical facet joints, the atlanto-axial joint, knee joints, the sacroiliac joint, or the shoulder. If we understand correctly, the needle is positioned in at one place in the joint and then a pulsed radiofrequency of 45 V is applied for 10 minutes. This fails to explain the mechanism of action. It needs to be clarified if the mechanism of pulsed radiofrequency is denervation of the nerve supply or the heating of the joint. If the denervation of the nerve supply is the mechanism, the readers are very much interested in knowing how denervation can be achieved by placing the needle in one place. Further, the authors have used pulsed radiofrequency for 10 minutes in the cervical facet joint, knee joint, sacroiliac joint, radiocarpal joint; whereas, for shoulder and atlanto-axial joint, 8 minutes of pulsed radiofrequency was utilized. Even though there was variation in the voltage, this does not explain the rationale of 40 V applied for 8 minutes in the shoulder and 45 V applied for 10 minutes in cervical facet joint. Overall, even though this is a technical report, it has substantial consequences on interventional pain management with potential abuse of the technology. At the present time, pulsed radiofrequency is considered as experimental even for medial branch nerves and other peripheral nerves.