Efficacy of Pulsed Radiofrequency Stimulation in Patients with Peripheral Neuropathic Pain: A Narrative Review.

BACKGROUND: Recently, clinicians have been applying pulsed radiofrequency (PRF) stimulation on various peripheral nerves to manage patients' peripheral neuropathic pain. OBJECTIVES: To review the literature on the use and efficacy of PRF for controlling peripheral neuropathic pain. STUDY DESIGN: This is a narrative review of relevant articles on the effectiveness of PRF for peripheral neuropathic pain. METHODS: A PubMed search was conducted for papers published from January 1, 1980 to August 31, 2017 that used PRF to treat peripheral neuropathic pain. The key search phrase for identifying potentially relevant articles was [PRF AND pain]. The following inclusion criteria were applied for the selection of articles: 1) patients' pain was caused by peripheral nervous system disorders; 2) PRF stimulation was applied on the peripheral nerve; and 3) after PRF stimulation, follow-up evaluation was performed to assess the reduction in pain. Review articles were excluded. RESULTS: A total of 468 articles were found to be potentially relevant. After reading the titles and abstracts of the papers and assessing them for eligibility based on the full-text articles, 63 publications were finally included in this review. For radicular pain from spinal diseases, the evidence supports that PRF is an effective treatment. Similarly, PRF appears to be effective for postherpetic neuralgia and occipital neuralgia. On the other hand, for trigeminal neuralgia, the results of previous studies indicate that PRF is not appropriate for managing trigeminal neuralgia and less effective than conventional RF. However, data on the use of PRF for pudendal neuralgia, meralgia paresthetica, carpal tunnel syndrome, tarsal tunnel syndrome, and Morton's neuroma, is lacking and thus the efficacy of PRF in these peripheral nerve disorders cannot be determined at this time. LIMITATIONS: This review did not include studies indexed in databases other than PubMed. CONCLUSIONS: This review will help guide clinicians in making informed decisions regarding whether PRF is the appropriate option for managing the various peripheral neuropathic pain conditions in their patients. KEY WORDS: Pulsed radiofrequency, peripheral neuropathic pain, radicular pain, postherpetic neuralgia, trigeminal neuralgia, occipital neuralgia, pudendal neuralgia, meralgia, carpal tunnel syndrome, review.