Department of Anesthesia and Pain Management, University Health Network-Toronto Western Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Eur J Pain. 2021 May;25(5):986-1011. doi: 10.1002/ejp.1735. Epub 2021 Feb 6.
Studies have reported relief of chronic shoulder pain with non-ablative pulsed neuromodulatory (pRF) or ablative radiofrequency (aRF) procedures on innervation of the shoulder joint but interpretation of these reports is hampered by inconsistent indications, anatomic targets and follow-up. This systematic review was conducted to synthesize the existing literature on procedures employing pRF or aRF for treating chronic shoulder pain.
MEDLINE and other medical literature databases were reviewed up to 31 December 2019 for publications on pRF or aRF procedures on shoulder joint innervation to relieve chronic pain. Data on analgesic and functional outcomes measured at any time point following the interventions were extracted. Existing knowledge on innervation of the shoulder joint with relevance to RF procedures was also synthesized.
In all, 42 publications, 7 randomized controlled trials (RCTs) and 35 observational studies, case series or reports were identified. Thirty-six of these publications were on pRF procedure and 29 of these reported procedures exclusively targeting the suprascapular nerve. A meta-analysis of the seven RCTs evaluating pRF indicated no analgesic benefit or functional improvement with this treatment over conventional medical management. Case series and reports on aRF indicate a potential for analgesic benefit but the quality of this evidence was low.
RF treatments targeting the sensory innervation of the shoulder joint affected by degenerative conditions have the potential to reduce pain but the current evidence does not suggest analgesic or functional benefit (GRADE certainty of evidence-low). Studies of high methodological quality are required to further investigate the role of these interventions.
This is a comprehensive review of literature on pulsed (non-ablative) and ablative radiofrequency (RF) procedures for chronic shoulder pain. The systematic review and meta-analysis of 7 trials found that pulsed RF for chronic shoulder pain provided similar analgesia and functional improvement as conservative medical management at three months after the procedures. The case series and reports on ablative RF for shoulder pain indicate possible analgesic benefit but their quality was low. This review highlights the need for studies of a high quality on ablative RF treatments for chronic shoulder pain.
研究报告称，通过非消融脉冲神经调节（pRF）或消融射频（aRF）对肩关节神经支配进行治疗，可以缓解慢性肩部疼痛，但由于适应证、解剖靶标和随访不一致，这些报告的解释受到阻碍。本系统评价旨在综合现有关于使用 pRF 或 aRF 治疗慢性肩部疼痛的文献。
截至 2019 年 12 月 31 日，检索 MEDLINE 和其他医学文献数据库，以获取关于肩关节神经支配的 pRF 或 aRF 程序治疗慢性疼痛的出版物。提取干预后任何时间点的镇痛和功能结果数据。还综合了与 RF 程序相关的肩关节神经支配的现有知识。
共纳入 42 篇文献，包括 7 项随机对照试验（RCT）和 35 项观察性研究、病例系列或报告。其中 36 篇为 pRF 程序，29 篇报道的程序仅针对肩胛上神经。对 7 项评估 pRF 的 RCT 的荟萃分析表明，与常规医学管理相比，这种治疗方法没有镇痛或功能改善。aRF 的病例系列和报告表明有潜在的镇痛益处，但证据质量较低。
针对退行性疾病影响的肩关节感觉神经支配的 RF 治疗具有减轻疼痛的潜力，但目前的证据并不表明有镇痛或功能获益（证据质量为低）。需要高质量的研究来进一步探讨这些干预措施的作用。
这是对慢性肩部疼痛的脉冲（非消融）和消融射频（RF）程序文献的全面综述。7 项试验的系统评价和荟萃分析发现，慢性肩部疼痛的脉冲 RF 在程序后 3 个月提供了与保守医学管理相似的镇痛和功能改善。肩部疼痛的消融 RF 的病例系列和报告表明可能有镇痛益处，但它们的质量较低。本综述强调了需要进行高质量的关于慢性肩部疼痛消融 RF 治疗的研究。
