Comparison of tibial nerve pulsed radiofrequency and intralesional radiofrequency thermocoagulation in the treatment of painful calcaneal spur and plantar fasciitis: A randomized clinical trial.

OBJECTIVE: Ultrasound-guided tibial nerve pulsed radiofrequency (US-TN PRF) and fluoroscopy-guided intralesional radiofrequency thermocoagulation (FL-RFT) adjacent to the painful calcaneal spur are two interventions for pain management in painful calcaneal spur (PCS) and plantar fasciitis (PF). This study aimed to compare the effectiveness of the two procedures. DESIGN: A prospective, randomized, single-blind study. SETTING: Single-center pain clinic. SUBJECTS: Forty-nine patients who met the inclusion criteria were randomized into two groups. METHODS: 25 patients (group U) received US-TN PRF at 42 °C for 240 s, while 24 patients (group F) received intralesional FL-RFT at 80 °C for 90 s. The most severe Numeric Rating Scale (NRS) score during the first morning steps and the American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scores were used to evaluate the effectiveness of the procedures. The study's primary outcome assessed treatment effectiveness using the NRS, whereas the secondary outcomes included changes in the AOFAS score and the incidence of procedure-related mild adverse events. RESULTS: NRS and AOFAS scores significantly improved in groups U and F at 1 and 3 months compared to baseline (p < 0.05), and there was no significant difference between the groups. At month 1, 50% or greater pain relief was achieved in 72% of patients in group U and 75% in group F. No significant difference was observed in the incidence of mild adverse events between the groups. CONCLUSIONS: US-TN PRF and intralesional FL-RFT have shown significant effectiveness in the treatment of PCS and PF. Larger randomized controlled trials are needed.

Comparison of Selective Nerve Root Pulsed Radiofrequency Vs Paramedian Interlaminar Epidural Steroid Injection for the Treatment of Painful Cervical Radiculopathy.

BACKGROUND: Although there are studies evaluating ultrasound-guided selective nerve root pulsed radiofrequency (ULSD-SNRPRF) and fluoroscopy-guided paramedian cervical interlaminar epidural steroid injection (FL-CIESI) for the treatment of chronic cervical radicular pain, no study has compared the efficacy of these 2 methods. OBJECTIVES: This study aimed to compare the efficacy of these 2 methods, their superiority to each other, and the incidence of adverse events. STUDY DESIGN: A prospective, randomized controlled trial. SETTING: Outpatient department of a single-center pain clinic. METHODS: Sixty patients who did not respond to conservative treatments for lower cervical radicular pain were randomly divided into 2 groups. One group underwent ULSD-SNRPRF (Group U), and the other underwent paramedian FL-CIESI (Group F). Patients were evaluated pretreatment, and 3 and 6 months posttreatment. The Numeric Rating Scale (NRS-11) was used to assess clinical improvement, The Neck Disability Index (NDI) to assess improvement in functional disability, and the Self-Leeds Assessment of Neuropathic Symptoms and Signs Pain Score (S-LANSS) to assess the treatment's effect on neuropathic pain. Clinically significant pain relief was defined as a 50% or more pain reduction in the NRS-11. The posttreatment reduction in medication consumption was assessed using the Medication Quantification Scale Version III (MQS III). We also evaluated whether there was a difference in treatment-related characteristics, such as procedure time and adverse events. RESULTS: The procedure time was significantly longer in Group U. Blood aspiration was observed in 2 patients in Group U and vascular spread in one patient in Group F, with no significant difference. At 3 and 6 months posttreatment, NRS-11 and NDI scores showed a significant decrease compared to the pretreatment scores in both groups; there was no difference between the groups. Both treatments effectively improved neuropathic pain, with no significant difference between the S-LANSS scores. There was no difference in the reduction of medication consumption between the groups. LIMITATIONS: There was no sham or control group, and the follow-up period was limited to 6 months. CONCLUSIONS: Pain relief, functional improvement, and safety were similar between groups. ULSD-SNRPRF and paramedian FL-CIESI are 2 different effective techniques for chronic cervical radicular pain. The choice of method should depend on various factors, such as patient preference, operator experience, and availability of resources. An advantage of ULSD over fluoroscopy is that patients and physicians are not exposed to radiation.

Neuromodulation of the median nerve in carpal tunnel syndrome, a single-blind, randomized controlled study.

Background: This study aimed to evaluate the efficacy of pulsed radiofrequency applied using transcutaneous electrodes in carpal tunnel syndrome (CTS). Methods: After randomization, the patients received two cycles of noninvasive pulsed radiofrequency (NiPRF), once weekly, or splinting (the control group) for three months. Clinical evaluations were recorded at baseline and weeks 4 and 8. The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was used to determine the functional status and symptom severity. Results: Sixty-two patients were followed up for three months. There was no difference between the groups in the BCTQ scores before and after treatment. The NiPRF group found a significant difference between the BCTQ measurements at all time intervals (paired sample t -test; P < 0.001). In the splint group, there was a significant difference only between the basal-1st month and basal-3rd month (paired samples t -test; P < 0.001). The main effect of the time variable was statistically significant (ANOVA; P < 0.001), but the group variable was not. There was no correlation between the BCTQ results measured at any time and the electroneuromyelogragphy findings in either group. Conclusions: NiPRF effectively improves symptoms and functionality in patients with CTS for up to 3 months. Thus, NiPRF can be considered an easy, safe, and useful alternative treatment modality for CTS.

Ultrasound-Guided Coccygeal Nerve Radiofrequency Ablation and Steroid Injection: Combination Therapy for Coccydynia.

OBJECTIVES: Coccydynia is characterized by pain in tailbone region, which affects the quality of life. Various interventional procedures are performed for coccydynia that is unresponsive to conservative treatment. This study aimed to evaluate the efficacy of ultrasound (US)-guided radiofrequency ablation (RFA) and steroid injection of the coccygeal nerve in patients with idiopathic and traumatic coccydynia. METHODS: In this prospective study, 32 patients with coccydynia unresponsive to conservative treatments underwent US-guided RFA of the coccygeal nerve. Coccygeal nerves were visualized at the level of the coccygeal cornua with US, 1 mL lidocaine 2% was injected into both areas and radiofrequency ablation was performed at 90°C for 60 seconds. After RFA, 2 mL dexamethasone and 2 mL bupivacaine 0.5% were injected. Visual Analog Scale (VAS) and Paris scales were used to evaluate the effect of treatment on pain and functionality before and at 1, 4, and 12 weeks after treatment. RESULTS: We found that 54% of the patients had a >50% reduction in VAS score and 66% of the patients had a >50% reduction in Paris scores measured between baseline and week 12. Additionally, the main effect of time on the VAS and Paris scores was statistically significant (P < .001) in all measurements. Baseline P and VAS scores were higher than the post-treatment measurements (P < .001). CONCLUSIONS: Our study showed that US-guided steroid injection and RFA of the coccygeal nerve for chronic coccydynia significantly improved pain and function scores at weeks 1, 4, and 12. RFA also results in a lower rate of adverse events. This study is the first clinical trial of ultrasound-guided coccygeal nerve RFA in patients with coccydynia. We believe that this new less invasive method may be an alternative to other interventional treatments.

Parasagittal Interlaminar and Transforaminal Epidural Steroid Injections for Radicular Low Back Pain; Which is More Comfortable?

Objective: This study aimed to compare parasagittal interlaminar (PS) and transforaminal (TF) epidural steroid injections for unilateral L5 and S1 radicular lower back pain in terms of patient comfort, efficacy, safety, contrast enhancement, and radiation exposure. Methods: This was a prospective randomized single-blind study. A total of 59 participants were included in this study. The visual analog scale (VAS) and Oswestry Disability Index (ODI) were obtained. A comfort questionnaire was administered to all participants. The total fluoroscopy time and contrast distribution levels were recorded. Results: Pre- and post-treatment VAS scores were similar between the groups. The ODI scores increased in favor of the PS group at week 2 (P < 0.041); however, there was no difference between the two groups at other times. The VAS and ODI scores improved significantly with treatment in both the groups (P < 0.001). Total fluoroscopy time was shorter in the PS group (P < 0.001). PS application was more comfortable (P < 0.001). While no complications were observed in the PS group, three complications occurred in the TF group. Anterior epidural contrast spread to three or more levels was observed in 57% of the participants in the PS group, whereas no spread to more than two levels was observed in the TF group. Conclusion: The PS epidural approach is superior to the TF approach in terms of a low incidence of side effects, less radiation exposure, better patient comfort, higher epidural contrast spread, and single-level needle access.

A new neuromodulation method in chronic migraine; non-invasive pulsed radiofrequency, a single-blinded, randomised, controlled trial.

OBJECTIVE: Non-invasive pulsed radiofrequency (NipRF) therapy, a neuromodulation method for peripheral nerves, is a new treatment modality for pain. We aimed to show the changes in pain severity and frequency per month in chronic migraine with NipRF treatment. METHODS: We treated patients diagnosed with chronic migraine according to the International Classification of Headache Disorders III beta diagnostic criteria. In half of the patients, we applied pulsed radiofrequency (pRF) treatment with transcutaneous electrodes to the greater occipital nerve (GON) trace. In the other half, we applied the GON block under ultrasound guidance. The Migraine Disability Assessment Scale (MIDAS) was administered to the participants, and those with scores > 2 were included in the study. Pain intensity and frequency were evaluated using the visual analog scale (VAS) and a headache diary completed before and 4 weeks after treatment. RESULTS: When both groups were compared, the pre- and post-treatment VAS scores and headache frequencies were similar. Comparing the pre-treatment and post-treatment values within the groups, VAS scores and headache frequency decreased significantly after treatment in both groups (p < 0.001). CONCLUSION: In this study, we observed that NipRF treatment is safe and effective for treating chronic migraine. Pain intensity and frequency decreased with NipRF treatment, similar to that in the GON block group. CLINICAL TRIALS REGISTRATION NUMBER: NCT05499689, Date: 08/11/2022.

Comparison of the efficacy of genicular nerve phenol neurolysis and radiofrequency ablation for pain management in patients with knee osteoarthritis.

Background: : Genicular nerve neurolysis with phenol and radiofrequency ablation (RFA) are two interventional techniques for treating chronic refractory knee osteoarthritis (KOA) pain. This study aimed to compare the efficacy and adverse effects of both techniques. Methods: : Sixty-four patients responding to diagnostic blockade of the superior medial, superior lateral, and inferior medial genicular nerve under ultrasound guidance were randomly divided into two groups: Group P (2 mL phenol for each genicular nerve) and Group R (RFA 80°C for 60 seconds for each genicular nerve). The numeric rating scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to evaluate the effectiveness of the interventions. Results: : RFA and phenol neurolysis of the genicular nerves provided effective analgesia within groups at 1 week, 1 month, and 3 months compared to baseline. There was no significant difference between the groups in terms of NRS and WOMAC scores at all measurement times. At the 3rd month follow-up, 50% or more pain relief was observed in 53.1% of patients in Group P and 50% of patients in Group R. The rate of transient paresthesia was 34.4% in Group P and 6.3% in Group R, and this was significantly higher in Group P. Conclusions: : Neurolysis of the genicular nerves with both RFA and phenol is effective in the management of KOA pain. Phenol may be a good alternative to RFA. Further studies are needed on issues such as dose adjustment to prevent transient paresthesia response.

Easy to treat when the diagnosis is made: Three cases of clunealgia and the advantage of ultrasonography.

In this article, we present three cases of clunealgia admitted with low back pain. Their pain relieved with superior cluneal nerve block. The posterior side of the iliac crest, which is the location where the superior cluneal nerve passes, was identified using a high-frequency linear transducer. The drug injected separates the erector spinae muscle and thoracolumbar fascia and accumulates between these two structures. All patients were discharged with a complete pain relief. This report highlights the fact that superior cluneal nerve entrapment should be kept in mind in patients with low back pain and that ultrasound guidance can correctly identify the infiltration and eliminate anesthetization of other surrounding structures.

The effectiveness of conventional radiofrequency ablation for chronic plantar heel pain due to heel spur.

OBJECTIVES: The purpose of this study was to investigate the effectiveness of conventional radiofrequency (CRF) ablation treatment on chronic plantar heel pain due to heel spur. METHODS: A total of 20 patients with heel spur who did not respond to conservative treatments were recruited for the study. Under fluoroscopy guidance, CRF was performed to three points at the top, above, and below the heel spur in the longitudinal plane of the foot. Pain intensity, the pressure pain threshold (PPT), and functional status were assessed using a visual analog scale (VAS), pressure algometers, and the Foot Function Index (FFI). All measurements were taken before the procedure, as well as 1, 3, and 6 months following the procedure. RESULTS: CRF was applied to 20 patients - 16 (80%) females and 4 (20%) males. Their mean age was 51.40+-8.10 years, the mean body mass index was 33.80+-5.47 kg/m2, the mean duration of symptoms was 18.30+-9.02 months, and pes planus was present in 5 patients (25%). A statistically significant decrease was observed in VAS score and PPT and FFI measurements at the 1st, 3rd, and 6th month following CRF compared to before CRF (p<0.001). CONCLUSION: CRF is an effective, safe, minimally invasive method to reduce pain severity in patients with chronic heel pain due to heel spur in the short (0-3 months) and intermediate term (3-6 months).

Ultrasound-Guided Erector Spinae Plane Block and Trapezius Muscle Injection for Myofascial Pain Syndrome.

OBJECTIVE: There were two goals to this study: the first goal was to research the analgesic effectiveness of erector spinae plane block (ESPB) added to the treatment after trapezius muscle injection (TMI) and the second was to investigate whether repeated TMI increases the analgesic effect in myofascial pain syndrome (MPS). METHODS: Sixty patients with a diagnosis of MPS were randomized into two groups. The TMI group (n = 30) received ultrasound-guided (USG) TMI with 5 mL of 0.25% bupivacaine two times, with a 1-week interval in between. The ESPB group (n = 30) received USG TMI with 5 mL of 0.25% bupivacaine in the first week and USG ESPB with 20 mL of 0.125% bupivacaine in the second week. The pain severity of the patients was evaluated using the visual analog scale (VAS). The data obtained before (week 0) and after (weeks 1, 2, 3, and 4) the injections were statistically compared between the groups. RESULTS: In both groups, the mean VAS score decreased in the first week compared to the mean pretreatment score (p < .001). When the VAS scores were compared between the first and second weeks, a decrease was observed in both groups (p < .001), but it was more evident in the ESPB group. Compared to previous weeks, there was no significant difference in VAS scores at the third and fourth weeks. CONCLUSIONS: The analgesic effect of repeated TMI for MPS was superior to a single injection, but ESPB combined with TMI provided more effective analgesia than repeated TMI.

The effect of popliteal sciatic nerve block with methylprednisolone in the management of postinjection sciatic neuropathy after clinical and electrophysiological examination.

BACKGROUND: This study aimed to investigate the effects of popliteal sciatic nerve block (PSNB) in the treatment of postinjection sciatic neuropathy (PISN) resistant to conservative treatments. METHODS: Patients diagnosed with PISN were included in the study. A damaged branch of the sciatic nerve was detected after neurological and electrophysiologic studies (EPSs). Visual analogue scale (VAS) was administered before, one hour after, and one month after the procedure. Also Leeds Assessment of Neuropathic Symptoms and Signs pain scale (LANSS) was administered before and one month after the procedure. The effects of EPSs findings and loss of muscle strength on the VAS and LANSS scores that measured after PSNB were evaluated. RESULTS: PSNB was performed in 17 patients (12 males and 5 females) with a diagnosis of PISN. Their mean age was 54.95 ± 12.55 years, and the mean duration of symptoms was 3.53 ± 1.28 months. The EPS findings revealed a lateral truncus injury in 5, a medial truncus injury in 3, and injury to both in 9 patients. The initial muscle power scale scores were grade 0 in 2, grade 2 in 1, grade 3 in 7, grade 4 in 5, and grade 5 in 2 patients. The initial VAS and LANSS scores were 7.53 ± 1.06 and 17.35 ± 3.12. The mean VAS scores at the first hour and one month after the procedure decreased to 2.53 ± 1.70 and 4.18 ± 1.74 while the mean LANSS score one month after the procedure was reduced to 7.88 ± 5.84. The effects of EPSs findings and loss of muscle strength were found significant (p = 0.001), but the duration of symptoms was not found significant (p = 0.36) on the VAS and LANSS scores that measured after PSNB. DISCUSSION: The outcome of this research proved the effectiveness of PSNB with methylprednisolone in the management of PISN, especially in patients whose pain was located below the knee. EPSs findings and loss of muscle strength indicated the severity of the nerve damage affect the success of PSNB in pain management, but the length of time that elapsed after the nerve injury did not.

Acute rhabdomyolysis following epidural steroid injection: An unusual complication in a patient with low back pain.

Epidural steroid injection is a very common intervention in the treatment of low back pain and sciatic symptoms. The most common complication for epidural steroid injection is transient headache with or without identifiable dural puncture. Other complications have also been reported, including intravascular entry, local hematoma, bleeding, increased back pain, facial flushing, vasovagal reactions, nausea, and fever. We report a case of rhabdomyolysis following epidural steroid injection for lumbar radiculopathy.

[Thoracic outlet syndrome: A case of scalene muscle hypertrophy in long-term follow-up of diagnosis of cervical discopathy]. / Uzun süre servikal diskopati tanisi ile izlenen skalen kas hipertrofisinin neden oldugu torasik outlet sendromu.

Described in this article is diagnosis and treatment of mixed type of thoracic outlet syndrome (TOS) resulting from scalene muscle hypertrophy. Many diseases should be considered in the differential diagnosis to definitively diagnose this syndrome, and it is necessary to ask about activities of daily life, in addition to adding provocative tests to physical examination and examining electrophysiological and imaging results. Once diagnosed, even if complaints decrease with conservative treatment, surgery may be required. However, in patients diagnosed late, despite decrease in complaints after surgery, neurological deficit may remain.