EFFICACY AND SAFETY OF Pulsed radiofrequency treatment in CHRONIC pain syndromes
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Transcript of EFFICACY AND SAFETY OF Pulsed radiofrequency treatment in CHRONIC pain syndromes
EFFICACY AND SAFETY OF PULSED RADIOFREQUENCY TREATMENT IN
CHRONIC PAIN SYNDROMES
Introdução à Medicina II | Teacher Luís Filipe Azevedo | Class 14
Summary
Introdução à Medicina II | Teacher Luís Azevedo | Class 14
1. Introduction
2. Methods
3. Results
4. Planning and development of future tasks
5. References
1.Introduction Research question and aims
What is the efficacy and safety of Pulsed Radiofrequency treatment in chronic pain
syndromes?
Aim:
To systematically review the evidence about efficacy and safety of pulsed radiofrequency in patients with chronic pain syndromes.
Introdução à Medicina II | Teacher Luís Azevedo | Class 14
1.Introduction
What is pain?
PAIN
Acute Chronic
The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage."
“Chronic pain has been increasing in prevalence. It is considered the most underestimated health care problem impacting quality of life. A number of epidemiological studies conducted in different parts of the world, reported prevalence rates of chronic pain ranging from 12-80%. Chronic pain has detrimental effects on physical and mental health, daily activities, family relationships, employment and economic well-being of the sufferers and family caregivers. Since the epidemiological studies about chronic pain in Lebanon are limited, the aim of this article is to help understand the magnitude of the problem and to depict strategies for the prevention and management of chronic pain.” [1]
Introdução à Medicina II | Teacher Luís Azevedo | Class 14
[1] 1. Huijer H, Abu-saad. Chronic pain: a review. J Med Liban; 2010
Relieves pain and improves
movement and function
Alters pain signals as
they travel to the brain
1.Introduction
Different treatments for chronic pain [2]
Electrical Stimulation Therapies
Relaxation Techniques
Physical Therapy
Helps reduce stress levels
Introdução à Medicina II | Teacher Luís Azevedo | Class 14[2] Van Zundert J, Huntoon M, Patijn J, Lataster A, Mekhail N, van Kleef M. Cervical Radicular Pain. Pain Pract; 2009 Oct.
Radiofrequency treatment
1.Introduction
A development of heat based radiofrequency denervation [3]
To treat especially chronic pain
Minimally invasive target selective technique
Uses brief pulses of high voltage (Rf range – 300kHz) to produce
controlled tissue destruction
Heat dissipates between pulses, avoiding thermocoagulation
Reduces pain by modullating pain transmission
Produces transient inibition of evoked synaptic activity [4]
Introdução à Medicina II | Teacher Luís Azevedo | Class 14[3] Pevzner E, David R, Leitner Y, Pekarsky I, Folman Y, Gepstein R. Pulsed radiofrequency treatment of severe radicular pain. Harefuah; 2005 Mar.[4] Byrd D, Mackey S. Pulsed radiofrequency for chronic pain. Curr Pain Headache Rep; 2008 Jan.
Project Development Phases
1. Research question formulation
2. Definition of selection criteria (inclusion and exclusion)
3. Definition and implementation of literature search methods and resources
4. Study selection using defined selection criteria
5. Data extraction from included studies
6. Critical appraisal and quality assessment of included studies
7. Data analysis and synthesis from included primary studies
8. Writing and disseminating final report
2. Methods
Introdução à Medicina II | Teacher Luís Azevedo | Class 14
Type of study
Systematic Review
Units of analysis
Articles
Data Search
PubMed
ISI Web of Knowledge
Scopus
Central
2. Methods
Introdução à Medicina II | Teacher Luís Azevedo | Class 14
Key-words
Pain
Chronic
Pulsed
Radiofrequency
Query
PubMed:pulsed[All Fields] AND radiofrequency[All Fields] AND (("pain"[MeSH Terms] OR "pain"[All Fields]) AND chronic[All Fields])
Scopus:TITLE-ABS-KEY(radiofrequency) AND TITLE-ABS-KEY(pulsed) AND TITLE-ABS-KEY(pain) AND TITLE-ABS-KEY(chronic)
ISITS=(Radiofrequency SAME pulsed) AND TS=pain AND TS=chronic
Central#1 MeSH descriptor Pain explode all trees#2 (Chronic): ti, ab, kw#3 (Radiofrequency Near Pulsed): ti, ab, kw
2. Methods
MeSH Term: Pain
Introdução à Medicina II | Teacher Luís Azevedo | Class 14
Research Limits
2. Methods
Exclusion Criteria Inclusion Criteria
1. Theme does not match the expected
1. Articles that mention the radiofrequency treatment in chronic pain
2. Treatment is not used for chronic pain
2. Articles that have, at least, two comparative groups - a group sbmited to pulsed radiofrequency and a control group.
3. Type of article is not the desired 3. Articles that mention the issue of efficacy and safety of pulsed radiofrequency
4. Study is not conducted in humans
5. Article does not mention the methods used and results Introdução à Medicina II | Teacher Luís Azevedo | Class 14
2. Methods
Articles found
78
PUBMED48
ISI Web32
SCOPUS65
CENTRAL3
13 not excluded
65 excluded
Introdução à Medicina II | Teacher Luís Azevedo | Class 14
2. Methods
Articles found
78
PUBMED48
ISI Web32
SCOPUS65
CENTRAL3
4
Introdução à Medicina II | Teacher Luís Azevedo | Class 14
8
20
0
3. Results
Articles Excluded
Exclusion Criteria Articles
1. Theme does not match the expected 2
2. Treatment is not used for chronic pain 1
3. Type of article is not the desired. 59
4. Study is not conducted in humans 3
5. Article does not mention the methods used and results
0
Introdução à Medicina II | Teacher Luís Azevedo | Class 14
3. Results
Introdução à Medicina II | Teacher Luís Azevedo | Class 14
Publication year
3. Results
Agreement / Disagreement
Reason for exclusion
4 disagreements
Non-exclusion 0
disagreements
4 times was necessary a 3rd reviewer74 times wasn’t necessary
Introdução à Medicina II | Teacher Luís Azevedo | Class 14
3. Results
Introdução à Medicina II | Teacher Luís Azevedo | Class 14
1. "Pain practice: the official journal of Word Institute of pain" - 13 articles
2. "Pain Physician" - 9 articles
3. "Pain medicine (Malden, Mass.)" - 7 articles
Articles and Journals
3. ResultsNon-excluded articles:
Title Author Journal Publication year
Percutaneous pulsed radiofrequency applied to the L-2 dorsal root ganglion for treatment of chronic low-back pain: 3-year
experience
Tsou J Neurosurg Spine
2010
Pulsed radiofrequency on L2 dorsal root ganglion as a therapeutic
method for lumbar discogenic pain
Assis Coluna/Columna
2009
Response to pulsed and continuous radiofrequency lesioning of the
dorsal root ganglion and segmental nerves in patients with chronic
lumbar radicular pain
Simopoulos
Pain Physician 2008
A comparison of conventional and pulsed radiofrequency denervation in the treatment of chronic facet
joint pain
Tekin Clin J Pain 2007
Title Author Journal Publication year
Pulsed radiofrequency adjacent to the cervical dorsal root ganglion in chronic cervical radicular pain: a
double blind sham controlled randomized clinical trial
Van Zundert
Pain 2007
Contemporary role of radiofrequency treatment for intractable pain syndromes
Park European Congress of
Neurorosurgery
2007
Pulsed radiofrequency treatment of the lumbar medial branch for facet
pain: a retrospective analysis
Lindner Pain Med 2006
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
Cohen Pain Physician 2006
3. ResultsNon-excluded articles:
Title Author Journal Publication year
Radiofrecuency in the treatment of chronic cervical spine
patology. Retrospective study
Abejon Revista de la Sociedad
Espanola del Dolor
2006
Sphenopalatine ganglion pulsed radiofrequency treatment in 30 patients
suffering from chronic face and head pain
Bayer Pain Pract 2005
Percutaneous pulsed radiofrequency treatment of the cervical dorsal root ganglion in the treatment of chronic cervical pain syndromes: A clinical
audit
Van Zundert
Neuromodulation
2003
Pulsed mode radiofrequency lesioning of the suprascapular nerve for the
treatment of chronic shoulder pain
Shah Pain Physician 2003
Pulsed radiofrequency application in treatment of chronic zygapophyseal
joint pain
Mikeladze Spine J 2003
3. ResultsNon-excluded articles:
4. Planning and development of future tasks
Oct Nov Dec Jan Feb Mar Apr May
Formulation of the question
Definition of selection’s criteria
Databases’ research
Abstracts’ reading
Articles selection
Analysis of the selected articles
Discussion of the results
Review article’s writing
Website’s building
Introdução à Medicina II | Teacher Luís Azevedo | Class 14
Introdução à Medicina II | Teacher Luís Azevedo | Class 14
Analysis of the selected articles
1. Second selection stage
2. Data extraction
3. Quality assessment (consort – clinical trials; strobe – observational studies, equator network)
Review Article’s writing
1. Abstract
2. Introduction
3. Methods
4. Results
5. Discussion
4. Planning and development of future tasks
5. References
Introdução à Medicina II | Teacher Luís Azevedo | Class 14
1. Huijer H, Abu-saad. Chronic pain: a review. J Med Liban; 2010
2. Van Zundert J, Huntoon M, Patijn J, Lataster A, Mekhail N, van Kleef M. Cervical Radicular Pain. Pain Pract; 2009 Oct.
3. Pevzner E, David R, Leitner Y, Pekarsky I, Folman Y, Gepstein R. Pulsed radiofrequency treatment of severe radicular pain. Harefuah; 2005 Mar.
4. Byrd D, Mackey S. Pulsed radiofrequency for chronic pain. Curr Pain Headache Rep; 2008 Jan.
5. Malik K, Ben Zon T. Pulsed radiofrequency: a critical review of its efficacy. Anaesth Intensive Care; 2007