Cohen Steven P, Peterlin B Lee, Fulton Larry, Neely Edward T, Kurihara Connie, Gupta Anita, Mali Jimmy, Fu Diana C, Jacobs Michael B, Plunkett Anthony R, Verdun Aubrey J, Stojanovic Milan P, Hanling Steven, Constantinescu Octav, White Ronald L, McLean Brian C, Pasquina Paul F, Zhao Zirong
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.
Pain. 2015 Dec;156(12):2585-2594. doi: 10.1097/j.pain.0000000000000373.
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.
枕神经痛（ON）的特征是枕神经分布区域出现刺痛和压痛。类固醇注射和脉冲射频（PRF）都用于治疗枕神经痛，但很少有临床试验评估其疗效，也没有研究对这两种治疗方法进行比较。我们对81名患有枕神经痛或伴有枕神经压痛的偏头痛患者进行了一项多中心、随机、双盲、比较疗效的研究，目的是确定哪种治疗方法更优。42名参与者被随机分配接受局部麻醉剂和生理盐水，并对每条目标神经进行3个120秒周期的PRF治疗，39名参与者被随机分配接受与德宝松混合的局部麻醉剂和3轮假PRF治疗。患者、治疗医生和评估人员对干预措施均不知情。与类固醇组相比，PRF组在主要结局指标（6周时的平均枕部疼痛，从基线的平均变化为-2.743±2.487 vs -1.377±1.970；P<0.001）上有更大程度的减轻，这种差异在6个月的随访中持续存在。在3个月内，PRF组在最严重枕部疼痛方面（从基线的平均变化为-1.925±3.204 vs -0.541±2.644；P = 0.043）以及6周内平均总体头痛疼痛方面（从基线的平均变化为-2.738±2.753 vs -1.120±2.1；P = 0.037）也获得了有利于PRF的类似益处。两组的不良事件相似，在非疼痛结局方面几乎没有显著差异。我们得出结论，虽然与类固醇注射相比，PRF可为枕神经痛和伴有枕神经压痛的偏头痛提供更大程度的疼痛缓解，但这种更好的镇痛效果可能不会伴随着其他结局指标的类似改善。
