Comparison of the efficacy of continuous radiofrequency thermocoagulation, pulsed radiofrequency denervation applications, and TENS therapies for lumbar facet syndrome: A single-blind randomized controlled trial.

OBJECTIVES: We aimed to compare the effectiveness of TENS, used in physical therapy departments, and continuous radiofrequency thermocoagulation (CRF) and pulsed radiofrequency denervation (PRF), used in algology departments, in patients with lumbar facet syndrome (LFS). METHODS: Subjects were selected from patients with LFS visiting outpatient clinics of physical therapy and algology departments at Ege University School of Medicine, whose pain was refractory to medical treatment for at least 3 months. Subjects were randomized into 3 groups. A total of 60 patients, with 20 in each group, were enrolled. The first group received CRF, the second group received TENS for 30 minutes a day for 15 days, and the third group received PRF. Patients were assessed at baseline, at the end of the first and sixth months, for a total of three times. RESULTS: Improvements at month 1 and month 6 were found to be statistically significant in all three treatment groups with respect to their pain scores, Oswestry Disability Indexes, hand-floor distance measurements, 20-meter walking times, 6-min walking distances, Beck Depression Inventory, and most of the SF-36 domain scores (p<0.05). A comparison of the treatment groups showed no superiority of any group over the others in any assessment parameters (p>0.05). CONCLUSION: We suggest that it might be more appropriate to use TENS, a non-invasive treatment, before trying more invasive procedures like CRF and PRF in these patients. However, it has been stated that further studies involving a larger patient sample are needed.

Ultrasound-guided interfascial blocks of the trapezius muscle for cervicogenic headache.

OBJECTIVES: Disorders in the cervical muscles, such as myofascial trigger points and tightness, are common factors in patients with cervicogenic headache (CEH). We aimed to evaluate the effectiveness of ultrasound-guided interfascial blocks of the trapezius muscle in patients with CEH who showed tenderness in the upper cervical muscle groups. METHODS: A total of 23 patients were evaluated in the prospective observational trial. The injection was performed between the trapezius muscle and levator scapula muscle fascia with a disposable 25-gauge, 10-cm Quincke-tip spinal needle. 10 mL of 0.125% bupivacaine was injected between the muscle fascia. Numeric rating scale (NRS), neck disability index (NDI), pain frequency, and analgesic consumption in the pre-treatment and post-treatment period were evaluated. RESULTS: The NRS scores at 10 min, 1 week, 2 weeks, and 4 weeks after treatment were significantly better than the pre-treatment NRS score. The NDI scores at 1, 2, and 4 weeks after treatment were significantly better than the pre-treatment NDI score. The pain frequency at 1 and 2 weeks after treatment was significantly lower than that recorded in the pre-treatment period. Statistically significant reductions were observed in analgesic consumption at 1, 2, and 4 weeks after treatment, in comparison with consumption in the pre-treatment period. CONCLUSION: We suggest that an ultrasound-guided interfascial block of the trapezius muscle is effective for the treatment of CEH caused by muscle disorders.

Quantitative sensory test findings in cervical radicular pain and their relationship with the symptoms.

OBJECTIVES: This study aims to define and compare sensory phenotypes in cervical radiculopathy patients exhibiting neuropathic pain (NP) components with healthy volunteers using clinical examination and quantitative sensory test (QST) findings. Another aim of the study is to show whether symptomatic components of the pain detect questionnaire (PDQ) are correlated with the QST findings, which may help clinicians indicate patients with sensory abnormalities without the use of specialized tests. METHODS: Fifty-seven participants were included in the study, including patients with NP (n=20) and healthy volunteers (n=37). After obtaining the sociodemographic and clinical data of the participants, the PDQ was performed in patients with pain followed by QST analysis in all participants. RESULTS: Analyses between painful and non-painful extremities yielded no differences in all groups for QST (p>0.05). Sensory thresholds were found to be higher in the NP group compared to healthy volunteers, and the pain threshold test was found to be lower (p<0.05) in the intergroup analyses. The changes described were found in both painful and non-painful limbs. Pain with slight pressure was found to be correlated with the lower heat pain threshold values (R=-0.602, p=0.005). CONCLUSION: Patients with NP were found to have lower thresholds for pain and higher sensory thresholds when compared to healthy volunteers. Moreover, pain with pressure component in PDQ was found to be associated with hyperalgesia in QST.

Results of ultrasound-guided interfascial block of the trapezius muscle for myofascial pain.

OBJECTIVES: Myofascial pain syndrome (MPS) is a regional pain syndrome that causes pain due to hyperirritable trigger points in the musculoskeletal system. Trapezius is one of the most commonly affected muscles in MPS. We aimed to evaluate the efficacy of an ultrasound-guided interfascial block of the trapezius muscle in patients with MPS. METHODS: The records of patients who underwent an ultrasound-guided interfascial block of the trapezius between November 2019 and October 2020 were retrospectively examined. The pain levels of the patients were evaluated with the numeric rating scale (NRS). Patients with a reduction in pain ≥50% after the procedure were considered to have benefited from the procedure. RESULTS: A total of 54 patients (41 women and 13 men) were evaluated. The mean NRS values of the patients were 7.16 (5-9) before the procedure, 3.31 (0-8) 10 min after the procedure, and 3.37 (0-8) 1 week after the procedure. The number of patients who benefited from the procedure was 40 (74.07%) 10 min after the procedure. The number of patients who benefited from the procedure for up to 1 week, 1-2 weeks, 2 weeks-1 month, 1-3 months, and more than 3 months after the procedure was 38 (70.37%), 36 (66.66%), 31 (57.40%), 26 (48.14%), and 17 (31.48%), respectively. CONCLUSION: Pain relief lasting for months was achieved in most of the patients. We believe that ultrasound-guided interfascial block of the trapezius is effective for the treatment of MPS.

Reflections of the sensory findings in the central nervous system in patients with neuropathic pain.

This study aimed to evaluate whether there was a difference in functional magnetic resonance imaging (fMRI) findings in patients who were found having hyperalgesia or hypoesthesia according to Quantitative Sensory Tests (QST). Forty participants were included in the study: 20 with neuropathic pain (NP) due to cervical disc pathology (NP group) and 20 healthy volunteers. After obtaining the socio-demographic and clinical data of the participants, the painDETECT questionnaire was administered, followed by QST analysis to show the presence of hypoesthesia and/or hyperalgesia, and fMRI examinations, which included sensory stimulation of both extremities. Sensory threshold tests were found to be higher in the NP group compared with the healthy volunteers, and the heat pain threshold was found to be lower in the tests showing pain thresholds in the intergroup analyses (p < 0.05). The changes described were found in both painful and non-painful limbs. In the hypoesthetic NP group, a lower somatosensory cortex activity was found in non-painful limbs compared with the healthy volunteers (p < 0.05). In the unilateral hyperalgesic NP group, a lower somatosensory cortex activity was found on the painful side, and if the hyperalgesia was widespread, lower blood oxygen-level-dependent activity was also found in the operculum and insular cortex (p < 0.05). The patients with different phenotypes of NP had different activities in the areas related to the processing of pain, and were more prominent in patients with widespread hyperalgesia. Studies with larger numbers of patients are required for a definite statement.

The effects of preadministration of local anesthetic on pulsed radiofrequency

Background/aim: Pulsed radiofrequency (PRF) has been reported to be a safe and reliable method for the management of a variety of chronic pain syndromes. It is not known whether the preadministration of local anesthetic increases the size of the electrical field. We revealed the effects of administering local anesthetic on PRF and investigated whether they were related to local anesthetic or fluid effects. Materials and methods: Group 1 (n = 18) received PRF to the suprascapular nerve with 1 mL of bupivacaine, group 2 (n = 20) received PRF with 1 mL of physiological saline solution, and group 3 (n = 18) received PRF only. Results: There were significant improvements in visual analog scale (VAS) scores at 30 min, 1 month, and 3 months after treatment in group 1 (P < 0.05) and at 1 month and 3 months in groups 2 and 3 (P < 0.05). There was a significant improvement in VAS scores in group 1 compared with groups 2 and 3 at 30 min after treatment. Conclusion: PRF applied to the nerve along with local anesthetic may increase pain relief, especially in the early posttreatment period. The favorable effects may depend on the pharmacodynamic features of the local anesthetic .