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Pulsed radiofrequency treatment for radicular pain: where do we stand and where to go?

In this issue of Pain Medicine , Choi et al. report a retrospective case series of pulsed radiofrequency (PRF) treatment adjacent to the cervical dorsal root ganglion (DRG) for the management of patients with chronic cervical radicular pain. Out of 112 patients who received repeated transforaminal epidural steroid injections, 29 continued with persistent radicular pain. Twenty-one patients were treated with PRF on the symptomatic cervical level. Up to 1 year after a single PRF treatment, a positive long-term effect was found in 14 out of 21 patients. This is in line with the positive effect of PRF for carefully selected patients with chronic cervical radicular pain found in a small randomized controlled trial comparing PRF with sham intervention [1]. In the latter study, a significant difference in favor of the PRF group was reported at 3 months, whereas a nonsignificant reduction in pain was noted at the 6 months follow-up evaluation, probably due to a lack of power of the test population. At present, this is the only study with evidence of effectiveness of PRF in clinical practice, leading to a positive recommendation but limited to chronic cervical radicular pain [2]. To improve the evidence and justification for this procedure, we need more high-quality prospective (randomized) outcome studies.

Unfortunately, the present study of Choi et al. does not meet these criteria because of methodological flaws, e.g., patient selection is not clear and the study is a retrospective evaluation with consequently a limited number of outcome measures. An important concern is furthermore the use of transforaminal injection of corticosteroids for patients with cervical radicular pain, which the authors claim to have a moderate to strong effect. However, the efficacy of transforaminal epidural steroid administration was found not to be different from the efficacy of transforaminal administration of local anesthetic …