What is Pulsed Radiofrequency Therapy

In the 1950s, the first radiofrequency instrument was used in neurosurgery to ablate and destroy the trigeminal nerve. Radiofrequency destruction of the posterior branch of the spinal nerve and the posterior root ganglion of the spinal nerve can effectively relieve limb pain and posterior trunk pain. However, nerve destruction can cause numbness of the skin, ankle biting or burning pain, and even movement disorders, and the regeneration of the destroyed nerve will bring back the pain, which brings a lot of troubles to both doctors and patients. Therefore, except for radiofrequency destruction of lumbar sympathetic ganglion or stellate ganglion, which can effectively eliminate the burning pain, hypersensitivity pain and ischemic pain characteristic of pathological neuralgia and improve the blood supply to the focal area, radiofrequency nerve ablation is only a helpless method to treat the symptoms of severe pain, and both doctors and patients are reluctant to activate it easily, resulting in The low turn-on rate of RF instruments and high medical costs. In 1997, Sluijter reported on pulsed radiofrequency technology for the treatment of neuropathic pain, which was of great interest because the pulsed ultra-high frequency current at temperatures below 42°C did not destroy the nerves. It was found that pulsed radiofrequency was effective in suppressing pain in a rabbit formalin-induced pain model, increasing analgesic substances such as spinal cord posterior horn and posterior root ganglion SP and brain tissue β-endorphin, and inhibiting the long-range response of C-fiber evoked potentials in the rat spinal cord dorsal horn. It is suggested that this technique is likely to exert analgesic effects by altering central analgesic substances or transmission structures in the nerve myelin sheath. Pulsed radiofrequency has been used as the analgesic of choice for superficial neuralgia in the trigeminal nerve, posterior cervical and lumbar spinal nerves, spinal nerve, greater occipital nerve, glossopharyngeal nerve, and stellate ganglion, with an excellent rate of 60-80% and a maintenance time of 1 month to 1 year, with the longest maintenance time having exceeded 1.5 years. Although the analgesic effect of pulsed radiofrequency, which is called “nerve stem acupuncture” by patients, is not as effective as heat-damaged nerves, it avoids the disadvantage of nerve destruction, and the latter also has the problem of nerve regeneration and pain recurrence. Pulsed radiofrequency does not cause new skin numbness or sensation, during the analgesic period the patient can be further treated by other rehabilitation methods, and once the pain returns the nerve can be pulsed radiofrequency again or changed to destructive radiofrequency if necessary. In the 21st century, RF ablation has made a breakthrough in non-neurodestructive treatment. Radiofrequency ablation reduces the tumor volume in cancer patients and can achieve both tumor reduction and analgesia. The advent of a variety of intradiscal radiofrequency electrodes and techniques has opened up the field of discogenic pain treatment and is becoming increasingly popular with patients who do not wish to undergo open surgical treatment. For example, bendable fiber ring radiofrequency electrodes and cold water circulation bipolar radiofrequency technology specifically for ablation and shaping of disc fissures, and plasma radiofrequency electrodes for low-temperature ablation and vaporization to rapidly reduce intra-disc pressure. Our pain physicians play the advantage of the radiofrequency sleeve needle only has 0.7mm diameter and the instrument can identify the distance between the needle tip and the nerve, put the radiofrequency sleeve needle tip into the disc herniation with local heating, directly thermal coagulation to reduce the lesion of the nerve compression nucleus pulposus herniation and close the fibrous annulus fissure. The advantage of quickly relieving the pain of the herniated nerve root while maximizing the protection of the disc height and physiological role reduces the degree of postoperative narrowing of the intervertebral space and the series of complications it causes, and saves the cost of expensive special intra-disc electrodes.