Cooled RFA Effective for Treatment of Refractory Chronic Neck Pain

Cooled radiofrequency ablation (c-RFA) of cervical nerves appears to be an effective treatment for chronic neck pain, with a significant reduction in pain scores and a high percentage of patients reporting improvement, according to study results published in Pain Practice.

The technique of c-RFA is minimally invasive and uses thermal energy to disrupt pain transmission along nociceptive pathways, mainly via nerve tissue necrosis.

Between 2015 and 2022, researchers from the University of Wisconsin, Madison, performed a retrospective chart review of electronic medical health records of patients who received c-RFA for alleviation of chronic neck pain caused by cervical facet joint arthropathy. Their goal was to assess the efficacy of c-RFA of cervical nerves as an alternative treatment for chronic neck pain refractory to conventional treatments, in terms of degree, duration, and magnitude of pain score reduction. They analyzed 298 c-RFA procedures performed on 203 patients, 129 of whom were women. Mean (SD) patient age was 56.03 (12.76) years, and mean (SD) BMI was 28.76 (6.05).

Lesions were performed at the appropriate cervical levels for a given procedure, at 80°C for 2 minutes and 30 seconds.

After undergoing c-RFA, patients participated in follow-up appointments during which they were physically evaluated and discussed outcomes and side effects of their treatment. At follow-up appointments, postoperative pain scores were collected using the visual analogue scale (VAS); the researchers compared these with preoperative scores.

Following c-RFA there was a statistically significant reduction in pain scores. Preoperatively, the average (SD) pain score was 6.15 (1.55), whereas the average (SD) postoperative score was 3.64 (2.09). A 2-tailed paired T-test confirmed the significance of this improvement (P <.0001). Pain was reduced in 85.23% (n=263) of cases, with 6% (n=19) achieving complete remission. However, 8.72% (n=26) experienced no change and 3.02% (n=9) reported worsening symptoms. Among patients whose pain improved, the average reduction in pain was 48.04%±26.53%, with relief lasting an average of 6.67±4.84 months.

Among the 298 procedures, 74 adverse events (AEs) were reported; 1 patient was hospitalized due to heart palpitations, which resolved the same day. The most common AEs, all of which resolved spontaneously, were postoperative pain around the ablation site (66 cases) and pain radiating down the arm.

Limitations included an inability to implement strict postoperative patient follow-up protocols owing to the retrospective nature of this study, the fact that some post-operative VAS scores were not collected, and challenges in mitigating certain confounding variables. The researchers concluded, “This study supports the efficacy of cooled radiofrequency ablations as a minimally invasive treatment for chronic neck pain secondary to cervical facet arthropathy that is refractory to other treatments, providing significant relief for a substantial length of time.” They added, “In juxtaposition to other modalities of pain management, it is minimally invasive and has few severe side effects; thus, it serves as an effective and low-risk option for patients experiencing chronic refractory pain. … Cooled radiofrequency ablation procedures have several techniques including pulsed and thermal. As such, future research should be conducted to determine the efficacy and risk associated with these other subtypes of radiofrequency ablation for patients experiencing chronic pain.”

This article originally appeared on Clinical Pain Advisor