$45 Neuropathy Relief Package (reg. $450) > SCHEDULE NOW < Click Here to
$45 Neuropathy Relief Package (reg. $450) > SCHEDULE NOW < Click Here to
$45 Neuropathy Relief Package (reg. $450) > SCHEDULE NOW < Click Here to
$45 Neuropathy Relief Package (reg. $450) > SCHEDULE NOW < Click Here to
Study of the outcome of patients undergoing pulsed radiofrequency for the treatment of Trigeminal Neuralgia; an observational study.
Author
Neha Sharma
Published
2020-12-10
Abstract
Background
Trigeminal neuralgia is sudden unilateral severe, stabbing, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve. It is treated by pharmacological (antiepileptic drugs) and non-pharmacological (alcohol block of affected trigeminal division, radiofrequency ablation, balloon compression, glycerol rhizolysis, peripheral neurectomy and microvascular decompression) means. Pulsed radiofrequency stimulation (PRF) has been recently introduced to alleviate neural, joint pain, and muscle pain. We tried to use PRF for pain relief in trigeminal neuralgia.
Objective
The primary objective of our study was to observe the effectiveness and safety of pulsed radiofrequency in the patients of trigeminal neuralgia who are refractory to medical management.
The secondary objectives of our study was to study the effect of pulsed radiofrequency on the duration of pain relief in patients of trigeminal neuralgia who are refractory to medical management and who had not responded to mandibular, maxillary and gasserian nerve blocks.
Participant
In this observational study, we enrolled all fresh patients with trigeminal neuralgia attending our pain clinic for the first time and those who had not responded to conservative medical treatment or interventional nerve blocks. All the patients were diagnosed on the basis of signs, symptoms and MRI (CISS sequence). Anatomical landmarks of ophthalamic nerve, maxillary nerve, mandibular nerve were identified and nerve stimulation was done by placing the probe in the affected nerve division. For ophthalmic nerve division the radiofrequency probe placed at the supraorbital foramen. For patients with maxillary neuralgia, the probe was placed at the superior end of the zygomatic arch just anterior to the auricle (suprazygomatic approach). For mandibular nerve block the probe was placed between the coronoid and condylar processes of the ramus of the mandible. The mental nerve block was given in a line with the pupil on the mental process of the mandible, with regard to the inferior premolar tooth. Each point was stimulated with the radiofrequency probe kept for 10 minutes, giving a current of 5 to 10 milli-amperes with a set frequency of 2 Hertz. A total of 10 settings were given on alternate days. Assessment of pain relief, improvement, or deterioration was done using Barrow Neurological Institute Pain Intensity Score and Brief Pain Inventory facial scale scoring.
Results
There was a significant reduction in pain scores observed on Barrow neurological institute (BNI) and Brief Pain Inventory-(BPI) pain intensity score (p value of <0.05) before and after pulsed radiofrequency (PRF) application.The duration of pain relief after the application of PRF was up to 180 days in 15 patients, 181-300 days in 8 patients and 300 to 600 days in 7 patients. Only 2 patients had a prolonged pain relief lasting for 601-720 days. One patient had developed exposure keratitis after 4 sittings of pulsed radiofrequency application at the supraorbital foramen.
Conclusion
PRF offers short term relief in a majority of patients for a period of 18 months to 24 months. However, it was found that the long term effects of PRF may not be seen in patients with TN.
Implication
PRF may be used as a short term measure for alleviating severe pain of TN till neurolytic blocks or a definitive surgery is carried out.
Keywords:
PRF in TN