A Case Series of Pulsed Radiofrequency Treatment of Myofascial Trigger Points and Scar Neuromas

A Case Series of Pulsed Radiofrequency Treatment of Myofascial Trigger Points and Scar Neuromas

Mazin Al Tamimi, MD, FIPP¹, Michael H. McCeney¹, Alan Brewer¹, Jason Krutsch¹, and Alexander Yakovlev, MD². (1) University of Colorado Health Sciences Center, Denver, CO, USA, (2) Marshfield Clinic, Marshfield, WI, USA

INTRODUCTION: Pulsed radiofrequency (PRF) field applied to nerve tissue to treat intractable pain has recently been proposed as a non-destructive alternative to continuous radiofrequency lesioning (1). Clinical reports using PRF have shown promise in the treatment of a variety of focal, neuropathic conditions (2),(3). To our knowledge, this is the first published report of the use of PRF to treat myofacial and neuromatous pain.

METHODS: All cases in which PRF was used to treat myofascial (trigger point) and neuromatous pain within our practice were evaluated retrospectively for technique, efficacy and complications. Trigger points were defined as localized, extremely tender areas in skeletal muscle that contained palpable, taut bands of muscle.

RESULTS: Nine patients were treated over an 18 month period. Ages ranged from 20-71 (average 47) and 2/3 of the patients were female. All patients had longstanding myofascial or neuromatous pain which was refractory to previous medical management, physical therapy, and trigger point injections. Eight out of 9 patients experienced 75 to 100 % reduction in their pain following PRF treatment at initial evaluation 4 weeks following treatment. Six out of 9 patients had long-term follow-up and, of these, 83% obtained 6 months to greater than 1 year of benefit. One patient experienced no better relief in terms of degree of pain reduction or duration of benefit when compared to previous trigger point injections. No complications were noted.

DISCUSSION: Myofascial trigger points and painful neuromas are common and often very difficult to effectively treat (4). Our review suggests that RPF could be an effective, simple, and non-destructive treatment modality for these painful conditions. Notwithstanding the shortcomings of this small retrospective series, the positive response demonstrated through this review suggests that further systematic evaluation of this treatment approach is warranted.

References:

(1) Sluijter ME, et al. The effects of pulsed radiofrequency field applied to dorsal root ganglion: a preliminary report. Pain Clinic 1998; 11:109-17.

(2) Cohen, S.P., et al. Pulsed radiofrequency of the dorsal root ganglia is superior to pharmacotherapy or pulsed radiofrequency of the intercostal nerves in the treatment of postsurgical thoracic pain. Pain Physician. 2006.

(3) Balogh, S. Transcutaneous application of pulsed radiofrequency: four case reports. Pain Practice. Vol 4, Issue 4, 2004 310-313