title: Occipital nerve pulsed radiofrequency treatment: a multi-center study evaluating predictors of outcome.
abstract: OBJECTIVE
  Occipital neuralgia (ON) is a challenging condition for which there is no reference standard for treatment. The purpose of this study was to provide outcome data on the largest study to date evaluating pulsed radiofrequency (PRF) for ON and to determine whether any demographic, clinical, or treatment characteristics are associated with success.
  
  
  METHODS
  Retrospective data analysis was conducted in 102 subjects evaluating the effect of myriad factors on treatment success.
  
  
  METHODS
  This study was conducted in academic civilian and military pain treatment centers.
  
  
  METHODS
  One hundred and two consecutive patients with a primary diagnosis of ON were treated with PRF of the greater and/or lesser occipital nerve.
  
  
  METHODS
  A positive primary outcome was predefined as ≥50% pain relief lasting at least 3 months. The secondary outcome measure was procedural satisfaction.
  
  
  RESULTS
  Fifty-two (51%) patients experienced ≥50% pain relief and satisfaction with treatment lasting at least 3 months. Variables associated with a positive outcome included a traumatic inciting event (65.7% success rate; P=0.03), lower diagnostic block volumes (odds ratio [OR]: 0.72; 95% confidence interval [CI]: 0.62-0.82; P<0.0001), and employment of multiple rounds of PRF (OR: 2.95; 95% CI: 1.77-4.92; P<0.0001). Factors correlating with treatment failure included extension of pain anterior to the scalp apex (OR: 0.32; 95% CI: 0.14-0.73; P=0.006) and ongoing secondary gain issues (OR: 0.19; 95% CI: 0.11-0.33; P<0.0001).
  
  
  CONCLUSIONS
  PRF may provide intermediate-term benefit in ON to a significant proportion of refractory cases. Careful attention to selection criteria and treatment parameters may further improve treatment outcomes.
authors.affiliation: Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21029, USA.
authors.forename: Julie H Y
authors.initials: JH
authors.lastname: Huang
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Galvagno
authors.forename: Mariam
authors.initials: M
authors.lastname: Hameed
authors.forename: Indy
authors.initials: I
authors.lastname: Wilkinson
authors.forename: Michael A
authors.initials: MA
authors.lastname: Erdek
authors.forename: Amit
authors.initials: A
authors.lastname: Patel
authors.forename: Chester
authors.initials: C
authors.lastname: Buckenmaier
authors.forename: Jason
authors.initials: J
authors.lastname: Rosenberg
authors.forename: Steven P
authors.initials: SP
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D020773:Headache Disorders / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013127:Spinal Nerves / Q000503:physiopathology*; D016896:Treatment Outcome; D055815:Young Adult