PULSED RADIOFREQUENCY
TREATMENT IN CHRONIC PAIN
SYNDROMES
WHAT IS THE EVIDENCE?
Introdução à Medicina I | Teacher José Gustavo Martins |
Class 14
Summary
1. Introduction
1.1 Background and justification
• Motivation of the research
• What is pain?
• Pain problems (in the world and in Portugal)
• Chronic pain
• Different treatments for chronic pain
• Pulsed Radiofrequency treatment
1.2 Research question and aims
2. Methods
3. Expected Results
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
1.Introduction
1.1 Background and justification
Wide use of
the treatment
in various
types of
chronic pain
diseases
Controversity
on the theme
among the
scientific
comunity
Innovation and
interest
inherent to the
procedure
Motivation of the research
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
1.Introduction
1.1 Background and justification
What is pain?
PAIN
Acute
The International Association for the
Study of Pain defines pain as "an
unpleasant sensory and emotional
experience associated with actual or
potential tissue damage, or described in
terms of such damage.“ (5)
Chronic
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
1.Introduction
1.1 Background and justification
Pain problem in Portugal and in the world
 Pain is the second leading cause of hospitalization
 Early treatment of chronic pain enhances its control
 In Portugal, a large proportion of cases are not addressed as early as
recommended
 A high percentage of people have experienced back pain
 Plano Nacional de Controlo da Dor seeks to improve the treatment of patients
with pain syndromes. (7)
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
1.Introduction
1.1 Background and justification
Chronic pain
 Chronic pain has been defined as
pain that persists longer than the
temporal course of natural healing and
it is associated with a particular type of
injury or disease process. (8)
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
1.Introduction
1.1 Background and justification
Different treatments for chronic pain
Relaxation
Techniques
Helps reduce stress levels
Physical
Therapy
Relieves pain and
improves movement
and function
Electrical
Stimulation
Therapies
Alters pain signals as
they travel to the
brain
 Of the most importance is to build a clear treatment plan for chronic pain, and part of it should be
identifying ways for patients to manage their pain.
 There is also medicines which can be administrated to relieve pain and inflammation, such as
corticosteroids, acetaminophen, cooling sprays, opioid analgesics, or a therapy called nerve block
therapy which is an anesthetic that is injected into the affected nerve to relieve pain. (9)
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
1.Introduction
1.1 Background and justification
Radiofrequency treatment

A development of heat based radiofrequency denervation

To treat especially chronic pain

Minimally invasive target selective technique

Uses brief pulses of high voltage (Rf range – 300kHz) to produce controlled tissue
destruction

Heat dissipates between pulses, avoiding thermocoagulation

Reduces pain by modullating pain transmission

Produces transient inibition of evoked synaptic activity
(10) (11)
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
1.Introduction
1.2 Research question and aims
What is the evidence of published evidence about pulsed
radiofrequency treatment in chronic pain syndromes?
Aims
To do a critical approach about published articles about the evidence of pulsed
radiofrequency treatment in chronic pain syndromes
1.To know more about different types of chronic pain syndromes;
2.To know more about Pulsed radiofrequency treatment;
3.To understand why there is controversy about this subject.
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
2. Methods

Type of study
Systematic Review

Units of analysis
Articles found in databases

Data Search
PubMed
ISI Web of Knowledge
Scopus
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
2. Methods

Key-words
Pain
Chronic
Pulsed
Radiofrequency


MeSH Term:
Pain
Query
pulsed[All Fields] AND radiofrequency[All Fields] AND (("pain"[MeSH Terms] OR "pain"[All
Fields]) AND chronic[All Fields])
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
2. Methods
PULSED
RADIOFREQUENCY
CHRONIC
PAIN
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
2. Methods

Research Limits
Exclusion Criteria
- Other types of articles, such as reviews, letters to editor or comments
- Articles contemplating pulsed radiofrequency used not as a treatment
chronic pain syndromes
- Articles which don’t mention the methods used or the results
for
Inclusion Criteria
- Language: English
- No date of publication limits
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
Start
2. Methods
Read
abstract
Review, letter to
editor or coments
Yes
No
English
No
Yes
Radiofrequency used as a
treatment to chronic pain
syndromes
No
Yes
No
FLOW CHART
Articles mentioning the
methods used and the
results
End
Yes
Read the articles
Analyse the selected
articles
Discussion of the
results
Review article’s
writing
Website’s
building
yes
2. Methods
Work Fases
1. Formulation of a clear question: “Pulsed radiofrequency treatment in pain syndromes What is the evidence?”
2. Definition of aims
3. Definition of methods
4. Databases’ research
5. Abstracts’ reading
6. Articles selection, by application of inclusion an exclusion criteria (each article should be
read by two people. Divergences should be solved by consensus)
7. Analysis of the selected articles
8. Discussion of the results
9. Review article’s writing
10. Website’s building
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
2. Methods
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Formulation of the question
Definition of selection’s criteria
Databases’ research
Abstracts’ reading
Articles selection
Analysis
of
the
selected
articles
Discussion of the results
Review article’s writing
Website’s building
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
3. Expected Results


To reassure the knowledge previously acquired mainly in subjects regarding scientific
research tools and information selection.
To improve the quality of our research both in terms of knowledge and information, and
also time.

To have a solid review about this subject.

To understand the different points of view about this subject.

Manage to present it correctly to the public.
Introdução à Medicina I | Teacher José Gustavo Martins | Class 14
Class 14

ANA LUIS FARIA

INES PINTO

JORGE PINTO

JORGE SOARES

JOSE BARRETO

JOSE VICENTE FORMOSO

LUÍS OLIVEIRA

MAFALDA PINTO

MAFALDA PAIS CARRINGTON

MARIA TERESA SILVERIO

MARIA LEONOR GODINHO

MIGUEL VALENTE

PAULA TEIXEIRA

PEDRO MONTEIRO
References

1. van Boxem K, van Eerd M, Brinkhuize T, Patijn J, van Kleef M, van Zundert J. Radiofrequency and pulsed radiofrequency treatment of
chronic pain syndromes: the available evidence. 2008 Sep-Oct

2. Racz, G.B, Ruiz-Lopez, R. Radiofrequency Procedures: Review Article, Pain Practice, 2006; p.46-50

3. Misra S, Ward S, Coker C.Pain. Pulsed radiofrequency for chronic testicular pain-a preliminary report, 19/03/2009, p.673-8

4. Byrd D, Mackey S. Curr Pain Headache Rep. Pulsed radiofrequency for chronic pain. 2008 Jan, p.37-41.



5. Merskey, H; Bogduk N. Part III: Pain Terms, A Current List with Definitions and Notes on Usage, 1994, p 209
6. Glossary of terms. Consultado em 23 de Dezembro de 2009, em Medicine Net:
http://www.medicinenet.com/emotional_eating/glossary.htm
7. Portal da Saúde. Consultado em 20 de Dezembro de 2009, em Ministério da Saúde:
http://www.minsaude.pt/portal/conteudos/a+saude+em+portugal/noticias/arquivo/2008/6/controlo+dor.htm)
8. Chronic pain. Consultado em 25 de Outubro de 2009, em emedicine health:
http://www.emedicinehealth.com/chronic_pain/page2_em.htm

9. Flannery, Jeanne. Rehabilitation nursing secrets, p.330 e 307

10. Pulsed radiofrequency treatment of the Gasserian ganglion in patients with idiopathic trigeminal neuralgia Pain, Volume 104, Issue 3, Page 449

11. Pulsed radiofrequency for chronic back pain. Consultado em 29 de Outubro de 2009 em The medical news: http://www.newsmedical.net/news/2007/05/22/25417.aspx