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Pulsed radiofrequency treatment relieves back pain and sciatica

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People with acute lower back pain and sciatica benefit from a minimally invasive procedure known as pulsed radiofrequency, new research shows.

CT-guided pulsed radiofrequency (pRF) applies energy through an electrode under CT guidance to the part of the nerve responsible for sending pain signals, according to the Radiological Society of North America (RSNA).

A study presented at the annual meeting of the RSNA shows that this treatment is safe and effective for patients whose symptoms have not responded to conservative treatment.

“Pulsed radiofrequency creates a nerve modulation, significantly reducing inflammation and its associated symptoms,” explained study senior author Dr Alessandro Napoli, professor of interventional radiology at Sapienza University of Rome in Italy.

Existing treatment options for herniated disks — a common cause of sciatica — range from over-the-counter pain medications to injections of corticosteroids directly into the affected area of the spine. Those who don’t respond may be referred for surgery, which in some cases involves removing the entire disk and fusing the vertebra together for stability.

Dr Napoli and colleagues studied the use of pRF applied directly to nerve roots near the spine in 128 patients with back pain from lumbar disk herniation who had not responded to prolonged conservative treatment. Patients had one treatment lasting 10 minutes.

For comparison, a group of 120 patients received one to three sessions of CT-guided steroid injection on the same anatomical target with no pRF.

Results at one year showed that CT-guided pRF was superior to the injection-only strategy.

Patients who received pRF saw greater overall improvement in pain and disability scores during the first year. They had faster relief of leg pain, and reported a faster rate of perceived recovery. Notably, the probability of perceived recovery after one year of follow-up was 95% in the pRF group, compared with 61% in the injection-only group.

The treatment may help a substantial number of patients with sciatic disk compression to avoid surgery, and could also improve outcomes for patients set to receive corticosteroid injections.

“We learned that when pulsed radiofrequency is followed by steroid injection, the result is longer lasting and more efficacious than injection only,” Dr Napoli said. “The effect of pulsed radiofrequency is fast and without adverse events.”