South Egypt Cancer Institute, Assuit University, Egypt.
Department of Anesthesia and Pain Management, South Egypt Cancer Institute, Assuit University, Assuit, Egypt.
Pain Physician. 2020 Jan;23(1):23-35.
Pharmacologic treatment is not successful in all cases of postmastectomy pain syndrome (PMPS). Some patients continue suffering pain while taking their medications, and others cannot tolerate the side effects of antineuropathic analgesics. Radiofrequency technology has provided promising results in the management of chronic neuropathic pain.
Considering that affection of intercostobrachial nerves are the main reason behind PMPS, we aimed to evaluate and compare the analgesic efficacy of pulsed radiofrequency (PRF) when delivered either on thoracic dorsal root ganglion (DRG) of intercostobrachial nerves (thoracic DRG 2, 3, and 4) or their corresponding thoracic paravertebral nerves (PVNs).
Prospective randomized-controlled clinical trial.
Interventional pain unit, tertiary center, university hospital.
Sixty-four patients complaining of PMPS were randomized to either group DRG (n = 32) that received PRF on thoracic DRG, or group PVN (n = 32) that received PRF on thoracic PVN. The outcome variables were that the patients showed > 50% reduction in their visual analog scale (VAS) pain score; the VAS pain score and global perceived effect (GPE) was evaluated during a 6-month follow-up period.
The percentage of patients who showed > 50% reduction of their VAS pain score was significantly higher in group DRG compared with group PVN, assessed at 4 and 6 months postprocedure (23/29:79.3% vs. 13/29:44.8%; P = 0.007) and (22/29:75.9% vs. 7/29:24.1%; P < 0.001), respectively, however, the 2 groups did not significantly differ at 1, 2, and 3 months postprocedure (DRG vs. PVN), (21/29: 72.4% vs. 21/29: 72.4%; P = 0.542), (24/29: 82.8% vs. 23/29: 79.9%; P = 0.778), and (24/29: 82.8% vs. 19/29: 65.5%; P = 0.136), respectively. There was a statistically significant reduction of VAS pain score at 4 and 6 months (DRG vs. PVN, mean ± standard deviation, 2.9 ± 2 vs. 3.9 ± 1.5; mean difference (95% confidence interval), 1 (0.06:1.9); P = 0.038; 3 ± 1.94 vs. 5.1 ± 1.5; mean difference (95% confidence interval), 1.9 (1:2.9); P < 0.001, respectively), however, the 2 groups did not significantly differ at 1, 2, and 3 months postprocedure. With regard to the patient's satisfaction (i.e., GPE), assessed at 3 and 6 months postprocedure, there was a significantly higher satisfaction in group DRG compared with group PVN (median [interquartile range (IQR)], 6 (5:7) vs. 3 (2:4);P < 0.001), however, the patient's satisfaction was similar between groups at 3 months postprocedure: median (IQR), 6 (4:7) vs. 6 (5:6); P = 0.327.
The study follow-up period is limited to 6 months only.
PRF of both the thoracic DRG and the thoracic PVN are effective treatments for PMPS; however, PRF of DRG provided a better long-term analgesic effect. Nevertheless, given the inherent risk of performing thoracic foraminal interventions and the technical difficulty of targeting thoracic DRG, we recommend that PRF of DRG should be reserved for cases that failed to gain adequate response to PRF of thoracic PVN in conjunction with medical treatment.
Postmastectomy pain syndrome, radiofrequency, dorsal root ganglion, paravertebral nerve.
药物治疗并非对所有乳腺癌根治术后疼痛综合征（PMPS）患者都有效。一些患者在服药时仍持续疼痛，而另一些患者则无法耐受抗神经病理性镇痛药的副作用。射频技术在慢性神经病理性疼痛的管理中提供了有希望的结果。
鉴于肋间臂神经的受累是 PMPS 的主要原因，我们旨在评估和比较脉冲射频（PRF）对肋间臂神经（胸 DRG 2、3 和 4）或其相应的胸椎间孔神经（PVN）胸 DRG 的镇痛效果。
前瞻性随机对照临床试验。
介入性疼痛单位，三级中心，大学医院。
64 名患有 PMPS 的患者被随机分为两组：DRG 组（n = 32），接受胸 DRG 上的 PRF；PVN 组（n = 32），接受胸 PVN 上的 PRF。主要观察指标是患者的视觉模拟量表（VAS）疼痛评分下降超过 50%；在 6 个月的随访期间评估 VAS 疼痛评分和总体感知效果（GPE）。
与 PVN 组相比，DRG 组在 4 个月和 6 个月时 VAS 疼痛评分下降超过 50%的患者比例显著更高，分别为 23/29（79.3%）比 13/29（44.8%）（P = 0.007）和 22/29（75.9%）比 7/29（24.1%）（P < 0.001）。然而，两组在 1、2 和 3 个月时差异无统计学意义（DRG 与 PVN，21/29：72.4%比 21/29：72.4%；P = 0.542），（24/29：82.8%比 23/29：79.9%；P = 0.778）和（24/29：82.8%比 19/29：65.5%；P = 0.136）。4 个月和 6 个月时 VAS 疼痛评分有统计学显著降低（DRG 与 PVN，平均值 ± 标准差，2.9 ± 2 比 3.9 ± 1.5；平均差异（95%置信区间），1（0.06：1.9）；P = 0.038），3 个月和 6 个月时 VAS 疼痛评分有统计学显著降低（DRG 与 PVN，平均值 ± 标准差，3 ± 1.94 比 5.1 ± 1.5；平均差异（95%置信区间），1.9（1：2.9）；P < 0.001），但两组在 1、2 和 3 个月时差异无统计学意义。关于患者的满意度（即 GPE），在 3 个月和 6 个月时进行评估，DRG 组明显高于 PVN 组（中位数[四分位间距（IQR）]，6（5：7）比 3（2：4）；P < 0.001），但在 3 个月时两组患者的满意度相似：中位数（IQR），6（4：7）比 6（5：6）；P = 0.327）。
研究随访时间仅为 6 个月。
胸 DRG 和胸椎间孔神经的 PRF 对 PMPS 都是有效的治疗方法；然而，DRG 的 PRF 提供了更好的长期镇痛效果。然而，鉴于进行胸椎间孔干预的固有风险和靶向胸 DRG 的技术难度，我们建议将胸 DRG 的 PRF 保留用于那些对胸椎间孔神经 PRF 联合药物治疗反应不足的病例。
乳腺癌根治术后疼痛综合征、射频、背根神经节、椎间孔神经。
