Department of Anesthesiology, University of Wisconsin, Madison, Wisconsin, USA.
Pain Pract. 2024 Nov;24(8):1068-1073. doi: 10.1111/papr.13402. Epub 2024 Jul 31.
Chronic pain, defined as pain persisting for more than 3-6 months, has a mean one-year prevalence in the United States of 25.8% and is one of the most frequent reasons adults seek medical care. Treatment options include physical therapy, analgesics, anticonvulsants, exercise, and muscle relaxants. Even with conventional treatment modalities, in a subset of patients, pain may persist. Cooled radiofrequency ablation (c-RFA), a minimally invasive therapy, employs thermal energy generated by electrical currents to disrupt the transmission of pain stimuli along nociceptive pathways. This leads to an attenuation of pain impulses, primarily through nerve tissue necrosis. The potential of c-RFA to alleviate chronic pain for patients who struggle to find relief elsewhere accentuates the importance of rigorously investigating its outcomes. This study investigates whether patients receiving c-RFA for relief of chronic neck pain caused by cervical facet joint arthropathy experience a reduction in pain scores, the length of this reduction in pain scores, and the magnitude of this reduction in pain.
This study was a retrospective analysis of data extracted from UW-Health Electronic Medical Health records (EMR), encompassing cervical c-RFA procedures performed from 2015 through 2022. Patient data were obtained, including diagnosis, pre-operative pain score, post-operative pain score, duration of relief, patient age, sex, and BMI. A two-tailed paired t-test was used to statistically analyze the pre-operative and post-operative pain scores, in which a p-value ≤0.05 was considered significant.
A total of 450 cervical c-RFA procedures were reviewed, 152 were excluded due to absent pre- or post-op pain scores. 298 were included in the analysis, comprising 203 unique patients: 129 females and 74 males with an average age of 56.03 ± 12.76 and a BMI of 28.76 ± 6.05. Improvement of pain symptoms was reported in 85.23% (n = 263), 6% (n = 19) reported complete pain remission, 8.72% (n = 26) reported no change, and 3.02% (n = 9) reported worsening symptoms. Patients reported an average pre-operative pain score of 6.15 (M = 6.15, SD = 1.55) and an average post-operative pain score of 3.64 (M = 3.64, SD = 2.09) this achieved significance (p < 0.0001). Of the 85.23% (n = 263) charts that noted improvement, there is an average of 48.04% ± 26.53 reduction from their pre-operative pain scores. The average duration of relief lasted 6.67 ± 4.84 months.
This study supports the potential efficacy of c-RFA as a minimally invasive treatment for chronic neck pain secondary to cervical facet joint arthropathy refractory to conventional treatment measures, demonstrating significant relief for a substantial length of time. Due to chronic pain's detrimental effect on one's quality of life, finding effective treatment options is essential, especially for those refractory to conventional treatments.
慢性疼痛是指持续时间超过 3-6 个月的疼痛，在美国的一年患病率为 25.8%，是成年人寻求医疗护理的最常见原因之一。治疗选择包括物理治疗、镇痛药、抗惊厥药、运动和肌肉松弛剂。即使采用常规治疗方法，在一部分患者中，疼痛可能仍然存在。冷却射频消融术（c-RFA）是一种微创治疗方法，利用电流产生的热能来破坏伤害感受途径中疼痛刺激的传递。这导致疼痛冲动的衰减，主要是通过神经组织坏死。c-RFA 为在其他地方难以找到缓解的患者缓解慢性疼痛的潜力，凸显了严格调查其结果的重要性。本研究调查了接受 c-RFA 治疗颈椎小关节关节炎引起的慢性颈痛的患者是否会降低疼痛评分、疼痛评分降低的持续时间以及疼痛降低的程度。
这是一项对从 2015 年至 2022 年在 UW-Health 电子病历 (EMR) 中提取的数据进行的回顾性分析，包括颈椎 c-RFA 手术。获得了患者数据，包括诊断、术前疼痛评分、术后疼痛评分、缓解持续时间、患者年龄、性别和 BMI。使用双尾配对 t 检验对术前和术后疼痛评分进行统计学分析，p 值≤0.05 被认为具有统计学意义。
共回顾了 450 例颈椎 c-RFA 手术，由于术前或术后疼痛评分缺失，152 例被排除在外。298 例被纳入分析，包括 203 名独特的患者：129 名女性和 74 名男性，平均年龄为 56.03±12.76 岁，BMI 为 28.76±6.05。85.23%（n=263）的患者报告疼痛症状改善，6%（n=19）报告完全缓解疼痛，8.72%（n=26）报告无变化，3.02%（n=9）报告症状恶化。患者报告术前平均疼痛评分为 6.15（M=6.15，SD=1.55），术后平均疼痛评分为 3.64（M=3.64，SD=2.09），这具有统计学意义（p<0.0001）。在报告改善的 85.23%（n=263）的图表中，平均有 48.04%±26.53 从术前疼痛评分中减轻。缓解的平均持续时间为 6.67±4.84 个月。
本研究支持 c-RFA 作为一种微创治疗颈椎小关节关节炎引起的慢性颈痛的潜在疗效，在相当长的一段时间内显著缓解疼痛。由于慢性疼痛对生活质量有不利影响，因此寻找有效的治疗方法至关重要，特别是对于那些对常规治疗方法无反应的患者。
