Pulsed radiofrequency treatment (pRF): A modern option for the treatment of chronic pain
Pulsed radiofrequency treatment (pRF) is a minimally invasive, non-destructive method for the treatment of chronic pain. In contrast to thermal radiofrequency ablation, which uses heat to ablate nerves and interrupt their function, pRF aims to modulate pain transmission through electrical fields without causing permanent tissue damage.
Mechanism of action
In pRF, a probe is placed near the affected nerve under imaging guidance, such as ultrasound or X-ray. High-frequency electrical impulses, typically 400–500 kHz, are delivered through this probe in short pulses, heating the tissue to a maximum of 42 °C. This temperature is sufficient to influence the electrical activity of nerve cells without destroying them.
The exact mechanism of action has not yet been fully clarified. However, studies suggest that pRF reduces the activity of microglia in the spinal cord and inhibits pro-inflammatory cytokines such as interleukin-6 and TNF-α, which contributes to pain relief. Ultimately, this influences the immune system and reduces the oxidative stress to which nerve cells are exposed.
pRF is primarily used for neuropathic pain, particularly when it can be attributed to specific nerves or nerve roots. Typical areas of application include:
- Radiculopathies
- Peripheral neuropathic pain caused by nerve lesions, including postherpetic neuralgia
- Trigeminal neuralgia (*not performed at ISSZ)
Before pRF is performed, diagnostic blocks of the nerve structures are carried out using local anesthetics in order to identify the source of pain and assess the chances of success of the treatment.
The treatment is performed on an outpatient basis under local anesthesia. After the probe has been positioned, the target nerve is electrically stimulated to confirm the correct placement; this is known as sensory testing. The pRF is then applied for a specific duration, usually a few minutes.
Patients generally experience the procedure as only mildly painful or pain-free. In most cases, two treatments are performed at an interval of 2–3 weeks in order to enhance the effect.
Pain relief after pRF can vary from person to person. Many patients report an improvement in symptoms for several months, on average about 3 to 6 months. In some cases, the effect may last longer. If the pain returns, the treatment can be repeated.
- Minimally invasive and can be performed on an outpatient basis
- No permanent nerve damage
- Suitable for patients who cannot or do not wish to receive corticosteroids
- Low risk of side effects
The goal of the treatment remains the resumption of movement during the period of reduced or absent pain, along with the associated improvement in physical and, in particular, psychological well-being.
Pulsed radiofrequency treatment offers an effective and gentle alternative for the treatment of chronic neuropathic pain syndromes. Due to its non-destructive mode of action and the possibility of repeating the treatment, it represents a valuable addition to the therapeutic spectrum.