Pulsed radiofrequency of the dorsal root ganglia is superior to pharmacotherapy or pulsed radiofrequency of the intercostal nerves in the treatment of chronic postsurgical thoracic pain.
BACKGROUND
Chronic postsurgical thoracic pain (CPTP) represents a major therapeutic challenge characterized by an absence of clinical studies to guide treatment. Recently, the implementation of pulsed radiofrequency (RF) has generated intense interest in the medical community as a safe and potentially effective treatment for neuropathic pain. To date, there are no studies comparing pulsed RF to more conventional therapeutic modalities for any pain condition.


OBJECTIVE
To compare treatment outcomes between pharmacotherapy, pulsed RF of the intercostal nerves (ICN) and pulsed RF of the dorsal root ganglia (DRG) in CPTP.


METHODS
Retrospective data analysis involving 49 patients.


RESULTS
At 6-week follow-up, 61.5% of the pulsed RF DRG group reported > or =50% pain relief vs. 27.3% in the medical management (MM) group and 21.4% in the IC group (P = 0.12). At 3-month follow-up, 53.8% in the DRG group continued to report > or = 50% pain relief vs. 19.9% in the MM and 6.7% in the ICN groups, respectively (P = 0.02). Among the pulsed RF patients who did report a successful outcome, the mean duration of pain relief was 2.87 months in the ICN group and 4.74 months in the DRG group (P = 0.01).


CONCLUSIONS
Pulsed RF of the DRG was a superior treatment to pharmacotherapy and pulsed RF of the ICN in patients with CPTP. Prospective studies are needed to confirm these results and identify the best candidates for this treatment.
Cohen
Steven P
SP
Department of Anesthesiology & Critical Care Medicine, Pain Management Division, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA. scohen40@jhmi.edu
Sireci
Anthony
A
Wu
Christopher L
CL
Larkin
Thomas M
TM
Williams
Kayode A
KA
Hurley
Robert W
RW
D000328:Adult; D000588:Amines / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D002220:Carbamazepine / Q000031:analogs & derivatives / Q000627:therapeutic use; D017115:Catheter Ablation / Q000379:methods*; D002908:Chronic Disease; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D005260:Female; D005471:Fluoroscopy; D000077206:Gabapentin; D005727:Ganglia, Spinal / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008408:Mastectomy; D008875:Middle Aged; D009661:Nortriptyline / Q000627:therapeutic use; D000078330:Oxcarbazepine; D010149:Postoperative Pain / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D012189:Retrospective Studies; D013908:Thoracotomy; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
D000588:Amines; D000700:Analgesics; D000927:Anticonvulsants; D003509:Cyclohexanecarboxylic Acids; D002220:Carbamazepine; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D009661:Nortriptyline; D000078330:Oxcarbazepine