EFFICACY AND SAFETY OF Pulsed radiofrequency treatment in CHRONIC pain syndromes

1. EFFICACY AND SAFETY OF Pulsed radiofrequency treatment in CHRONIC pain syndromes Introdução à Medicina II | Teacher Luís Filipe Azevedo | Class 14

2. Summary • Introduction • Methods • Results • Discussion • Conclusion • Website • References Introdução à Medicina II | Teacher Luís Azevedo | Class 14

3. 1.IntroductionResearchquestionandaims 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

4. 1.Introduction 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." [1] Whatispain? PAIN Chronic Acute Introdução à Medicina II | Teacher Luís Azevedo | Class 14 [1] Abu-SaadHuijer H. Chronic pain: a review. J Med Liban 2010 Jan-Mar;58(1):21-7

5. 1.Introduction Differenttreatments for chronicpain[2] 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 5.4

6. 1.Introduction Radiofrequencytreatment[3] • Is a recently developed treatment modality for pain syndromes such as chronic pain. • It uses brief pulses of high voltage to produce controlled tissue destruction, reducing pain by modulating its transmission. Its apparent lack of side effects which is appealing for those who suffer from chronic pain which has detrimental effects on physical and mental health. [1] Importanceofthistreatment Introdução à Medicina II | Teacher Luís Azevedo | Class 14 [3] Byrd D, Mackey S. Pulsed radiofrequency for chronic pain. Curr Pain Headache Rep. 2008 Jan;12(1):37-41

7. 2. Methods Project Development Phases • Research question formulation • Definition of selection criteria (inclusion and exclusion) • Definition and implementation of literature search methods and resources • Study selection using defined selection criteria • Data extraction from included studies • Critical appraisal and quality assessment of included studies • Data analysis and synthesis from included primary studies • Writing and disseminating final report Introdução à Medicina II | Teacher Luís Azevedo | Class 14

8. 2. Methods • Type of study Systematic Review • Units of analysis Articles • Data Search PubMed ISI Web of Knowledge Scopus Central Introdução à Medicina II | Teacher Luís Azevedo | Class 14

9. 2. Methods • 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) ISI TS=(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 • MeSHTerm: • Pain Introdução à Medicina II | Teacher Luís Azevedo | Class 14

10. 2. Methods • Research Limits Introdução à Medicina II | Teacher Luís Azevedo | Class 14

11. 2. Methods 65 excluded 13 included 2nd selectionstage 5 includedarticles Introdução à Medicina II | Teacher Luís Azevedo | Class 14

12. 3. Results ArticlesExcluded Introdução à Medicina II | Teacher Luís Azevedo | Class 14

13. 3. Results ArticlesExcluded Introdução à Medicina II | Teacher Luís Azevedo | Class 14

14. 3. Results Publicationyear Introdução à Medicina II | Teacher Luís Azevedo | Class 14

15. 3. Results Agreement / Disagreement 4 times was necessary a 3rd reviewer 74 times wasn’t necessary Introdução à Medicina II | Teacher Luís Azevedo | Class 14

16. 3. ResultsIncludedArticles:

17. 3. ResultsIncludedArticles:

18. 3. ResultsIncludedArticles:

19. 3. ResultsQuantitative results: VAS – Visual Analogue Scale

20. 3. ResultsChecklist for randomizedcontrolledtrials • CONSORTchecklist

21. 3. ResultsChecklist for observationalstudies • STROBEchecklist

22. 3. Results

23. 3. Results • Side-effects and complications of PRF: • Although a potential for bleeding, nerve damage, infection and burns from incorrect needle or grounding pad placement have been suggested [4], none of the studies reviewed reported any noticeable complications of PRF application. [4] Cohen S, Foster A. Pulsed radiofrequency as treatment for groin pain and orchialgia. Urology. 2003, 61:645

24. 4. Discussion • The majority of the clinical studies of PRF reported its clinical efficacy. • There are many articles about PRF, which report small un-controlled prospective trials, retrospective studies with only one group or reviews. • The articles refer almost uniform beneficial effects of PRF. • It is possible that therapeutic failures with PRF were not reported. • The randomized, controlled clinical data available on PRF is limited and the articles about them are recent. • There probably exists a significant margin of safety because no neurological deficits were found in patients treated with PRF and CRF. [5] [5] Simopoulos TT, Kraemer J, Nagda JV, Aner M, Bajwa ZH; Pain Physician; 2008

25. 5. Conclusion • The controlled clinical data on pulsed radiofrequency is limited and provide a level 2 or 3 of evidence of its efficacy. • Despite the weakness of the controlled clinical data, the apparent lack of complications and the wider applicability of PRF call for further RCTs. … in order to achieve a clear understanding about PRF’s role in the treatment of different and various chronic pain syndromes.

26. 6. Website

27. 7. References • [1] Abu-Saad H. Chronic pain: a review. J MedLiban. 2010; 58(1):21-7 • [2] Van Zundert J, Huntoon M, Patijn J, Lataster A, Mekhail N, van Kleef M. Cervical Radicular Pain. Pain Pract. 2009 Oct 5.4 • [3] Byrd D, Mackey S. Pulsed radiofrequency for chronic pain. Curr Pain Headache Rep. 2008 Jan;12(1):37-41. • [4] Cohen S, Foster A. Pulsed radiofrequency as treatment for groin pain and orchialgia. Urology. 2003, 61:645 • [5] Simopoulos TT, Kraemer J, Nagda JV, Aner M, Bajwa ZH; Response to pulsed and continuous radiofrequency lesioning of the dorsal root ganglion and segmental nerves in patients with chronic lumbar radicular pain; Pain Physician; 2008;11(2):137-44. • [6] Sackett DL, Strauss SE, Richardson WS, et al. Evidence-Based Medicine: How to Practice and Teach EBM. Philadelphia, Pa: Churchill-Livingstone; 2000. • [7] Malik K. Pulsed radiofrequency: a critical review of its efficacy. Anaesthesia and Intensive Care; 2007; 35:6 • [8] Green, S. Systematic reviews and meta-analysis; Singapore Med J. 2005; 46: 270 • [9] Moher, D., Schulz, KF., Altman, DG.; CONSORT Group. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Clin Oral Investig 2003; 7:2–7 • [10] Bidstrup, B. Who Reviews the Reviewers?. Asian CardiovascThorac Ann. 2006; 14:357-358 • [11] Jadad, A.R., Moore, R.A., Carroll, D., Jenkinson, C., Reynolds, D.J.M., Gavaghan, D.J., Carroll, D.C., McQuay, H.J. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. ContrClin Trials. 1996; 17:1-12 • [12] von Elm, E., Altman, D., Egger, M., Pocock, S., Gøtzsche, P., Vandenbroucke, J.; STROBE Initiative. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007; 335:806-808 • [13] Gan, W., Man, S., Senthilselvan, A., Sin, D. Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis. Thorax. 2004; 59:574-580 Introdução à Medicina II | Teacher Luís Azevedo | Class 14