title: Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness.
abstract: Occipital neuralgia (ON) is characterized by lancinating pain and tenderness overlying the occipital nerves. Both steroid injections and pulsed radiofrequency (PRF) are used to treat ON, but few clinical trials have evaluated efficacy, and no study has compared treatments. We performed a multicenter, randomized, double-blind, comparative-effectiveness study in 81 participants with ON or migraine with occipital nerve tenderness whose aim was to determine which treatment is superior. Forty-two participants were randomized to receive local anesthetic and saline, and three 120 second cycles of PRF per targeted nerve, and 39 were randomized to receive local anesthetic mixed with deposteroid and 3 rounds of sham PRF. Patients, treating physicians, and evaluators were blinded to interventions. The PRF group experienced a greater reduction in the primary outcome measure, average occipital pain at 6 weeks (mean change from baseline -2.743 ± 2.487 vs -1.377 ± 1.970; P < 0.001), than the steroid group, which persisted through the 6-month follow-up. Comparable benefits favoring PRF were obtained for worst occipital pain through 3 months (mean change from baseline -1.925 ± 3.204 vs -0.541 ± 2.644; P = 0.043), and average overall headache pain through 6 weeks (mean change from baseline -2.738 ± 2.753 vs -1.120 ± 2.1; P = 0.037). Adverse events were similar between groups, and few significant differences were noted for nonpain outcomes. We conclude that although PRF can provide greater pain relief for ON and migraine with occipital nerve tenderness than steroid injections, the superior analgesia may not be accompanied by comparable improvement on other outcome measures.
authors.affiliation: Departments of Anesthesiology and Critical Care Medicine, and Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA, and Uniformed Services University of the Health Sciences, Bethesda, MD, USA Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA Department of Health Organization Management, Texas Tech School of Medicine, Lubbock, TX, USA Departments of Neurology Surgery, and Nursing, Walter Reed National Military Medical Center, Bethesda, MD, USA Department of Anesthesiology, Drexel University, Philadelphia, PA, USA Womack Army Medical Center, Fort Bragg, NC, USA Department of Neurology, Naval Medical Center-San Diego, San Diego, CA, USA Departments of Physical Medicine and Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD, USA Department of Anesthesiology, Boston VA Hospital, Boston, MA, USA Department of Anesthesiology, Naval Medical Center-San Diego, San Diego, CA, USA Department of Surgery, Landstuhl Regional Medical Center, Landstuhl, Germany Department of Surgery, Tripler Army Medical Center, Honolulu, HI, USA Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA Departments of Internal Medicine and Neurology, DC VA Hospital, Washington, DC, USA.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Cohen
authors.forename: B Lee
authors.initials: BL
authors.lastname: Peterlin
authors.forename: Larry
authors.initials: L
authors.lastname: Fulton
authors.forename: Edward T
authors.initials: ET
authors.lastname: Neely
authors.forename: Connie
authors.initials: C
authors.lastname: Kurihara
authors.forename: Anita
authors.initials: A
authors.lastname: Gupta
authors.forename: Jimmy
authors.initials: J
authors.lastname: Mali
authors.forename: Diana C
authors.initials: DC
authors.lastname: Fu
authors.forename: Michael B
authors.initials: MB
authors.lastname: Jacobs
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Plunkett
authors.forename: Aubrey J
authors.initials: AJ
authors.lastname: Verdun
authors.forename: Milan P
authors.initials: MP
authors.lastname: Stojanovic
authors.forename: Steven
authors.initials: S
authors.lastname: Hanling
authors.forename: Octav
authors.initials: O
authors.lastname: Constantinescu
authors.forename: Ronald L
authors.initials: RL
authors.lastname: White
authors.forename: Brian C
authors.initials: BC
authors.lastname: McLean
authors.forename: Paul F
authors.initials: PF
authors.lastname: Pasquina
authors.forename: Zirong
authors.initials: Z
authors.lastname: Zhao
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000627:therapeutic use; D002045:Bupivacaine / Q000627:therapeutic use; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D008881:Migraine Disorders / Q000628:therapy*; D009437:Neuralgia / Q000628:therapy*; D009778:Occipital Lobe; D010147:Pain Measurement; D061208:Pulsed Radiofrequency Treatment / Q000379:methods*; D012535:Scalp; D013127:Spinal Nerves; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D003692:Delayed-Action Preparations; D005938:Glucocorticoids; D008012:Lidocaine; D008775:Methylprednisolone; D002045:Bupivacaine