Radicular pain arises by the ectopic activation of nociceptive afferent fibers in a spinal nerve or its root; the dorsal root ganglion (DRG). This activation is perceived as pain that travels or “radiates” from one site to another, following the course (dermatome) of the compromised spinal nerve root.
The underlying cause of radicular pain are lesions that either directly compromises the DRG (mechanical compression) or indirectly compromise the spinal nerve and/or its roots by causing ischemia or inflammation of the neuronal tracts (injury). Thereby, the most common causes of radiculopathy are disc herniation in the lumbar spine, failed back surgery syndrome (FBSS), and disc herniation and spondylosis in the cervical spine1.
Lumbosacral radicular pain, is probably the most commonly occurring form of neuropathic pain; with an annual prevalence of 9.9 to 25% (10-25 of 1000 adults). Cervical radicular pain affects approximately 1 of 1000 adults (0.1% prevalence). The health burden for patients with painful radiculopathy can be higher than the estimated for other major diseases including diabetes, heart failure and, cancer2.
The conservative treatment of radicular pain combines oral pharmacological management and physiotherapy. Interventional pain management is the alternative of choice for patients whose pain is refractory to conservative methods. Epidural corticosteroid injections can provide pain relief; however, the long-term efficacy of this approach is debated, due to procedural complications3.
EFFECTIVENESS OF RFA
Compelling clinical evidence demonstrating the clinical utility, long-term effectiveness and, safety of PRF stimulation in the management of radicular pain stems from a recent systematic review by Yang et al4; that thoroughly analyzed the PRF therapeutic outcomes reported in almost 40 publications -including 10 RCTs. This study concludes that PRF stimulation is effective for the treatment of cervical, lumbosacral and thoracic radicular disorders. Most importantly, none of the reviewed publications reported any serious complications associated with PRF treatment.