Year 2021 / Volume 28 / Number 4


Dorsal root ganlion pulsed radiofrequency for lumbosacral radicular pain: a narrative review

Rev. Soc. Esp. Dolor. 2021; 28(4): 219-231 / DOI: 10.20986/resed.2021.3882/2021

Pablo Jorge Castromán, Marta Surbano


Objective: Pulsed radiofrequency can be a nondestructive option compared with the thermical lesion produced by continuous radiofrequency. The application of PRF of the dorsal root ganglion is a therapeutic tool in patients with Lumbosacral Radicular Syndrome refractory to epidural steroids injections. The mechanisms of action are not clear yet and a neuromodulation process is proposed. The evidence of the efficacy of this intervention is of low quality, due to several factors. Our objective is to present a review of the evidence of the efficacy and safety profile of the DRG RFP. The clinical aspects related to the technique and its possible mechanisms of action are also reviewed.
Material and methods: A bibliographic review was performed in MEDLINE (Pubmed), Google Scholar, Scopus, CINAHL, Embase, Cochrane and Fisterra (clinical guidelines) of articles in English and Spanish, during the available years with the terms: “Dorsal Root Ganglion pulsed radiofrequency” and “lumbar” or “lumbosacral radicular pain” in English and Spanish. Bibliographic review was carried out by the 2 authors independently.
Results: We present the analysis of eight prospective, randomized studies and nine cohort studies, with a before and after type of design, in which the study of efficacy and safety was proposed as the main objective.
Conclusions: This review suggested that PRF of the DRG can be a good therapeutic option in patients with refractory LRS. Larger, blinded, prospective and randomized controlled trials are needed to support this statement.


Objetivo: La radiofrecuencia pulsada constituye la variante no destructiva de la termolesión por radiofrecuencia. Una opción terapéutica en pacientes con síndrome radicular lumbosacro refractario a esteroides epidurales es la aplicación de RFP en el ganglio de la raíz dorsal. Si bien el mecanismo íntimo de acción de la misma no está del todo esclarecido, se plantea como una técnica de neuromodulación. La evidencia de la eficacia de esta intervención es débil por diversos factores: insuficientes estudios clínicos randomizados, el bajo tamaño muestral utilizado en los mismos, las controversias sobre algunos aspectos técnicos en la aplicación de la RFP, la selección incorrecta de pacientes, la presencia o no de dolor neuropático, etc. Nuestro objetivo es presentar una revisión de la evidencia de la eficacia y el perfil de seguridad de la RFP del GRD en pacientes con SRLS refractario. Los aspectos clínicos relacionados con la técnica y sus posibles mecanismos de acción son también reseñados.
Material y métodos: Realizamos una búsqueda bibliográfica en MEDLINE (Pubmed), Google Scholar, Scopus, CINAHL, Embase, Cochrane y Fisterra (guías clínicas) en inglés y español para todos los años disponibles con los términos “Dorsal Root Ganglion pulsed radiofrequency” y “lumbar” o “lumbosacral radicular pain” en idioma inglés y español. La evaluación fue realizada por los dos autores de manera independiente.
Resultados: Presentamos el análisis de ocho estudios prospectivos randomizados y nueve de cohorte única de tipo antes y después, de pacientes con dolor radicular lumbosacro refractario cuyos objetivos fueron la evaluación de la eficacia y seguridad de la técnica.
Conclusiones: La RFP del GRD podría ser una opción terapéutica útil en el SRLS refractario, pudiendo considerarse sus resultados como preliminares, y deberán ser confirmados por estudios prospectivos randomizados con criterios de selección homogéneos y mayor número de pacientes.

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1. Sluijter ME, Cosman E, Rittman W, van Kleef M. The effect of pulsed radiofrequency fields applied to the dorsal root ganglion: A preliminary report. Pain Clin. 1998;11:109-17.
2. Vuka I, Došenović S, Marciuš T, Ferhatović Hamzić L, Vučić K, Sapunar D, et al. Efficacy and safety of pulsed radiofrequency as a method of dorsal root ganglia stimulation for treatment of nonneuropathic pain: a systematic review. BMC Anesthesiology. 2020;20:105
3. Vuka I, Marciuš T, Došenović S, Ferhatović Hamzić L, Vučić K, Sapunar D, et al. Efficacy and Safety of Pulsed Radiofrequency as a Method of Dorsal Root Ganglia Stimulation in Patients with Neuropathic Pain: A Systematic Review. Pain Med. 2020;21(12): 3320-43.
4. Abejón D, Parodi E, Blanco T, Cavero V, Perez J, Perez Cajaraville J. Radiofrecuencia pulsada del ganglio de las raíces lumbares. Rev Soc Esp Dolor. 2011;18(2):135-40.
5. Van Boxem K, Cheng J, Patjin J, van Kleef M, Lataster A, Mekhail N, et al. Lumbosacral Radicular Pain. Pain Practice. 2010;10(4):339-58.
6. Manchikanti L, Abdi S, Alturi S, Benyamin RM, Boswell MV, Buenaventura RM, et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician. 2013;16(Supl. 2):S49-S283.
7. Van Boxem K, Huntoon M, Van Zundert J, Patijn J, van Kleef M, Joosten EA. Pulsed radiofrequency: a review of the basic science as applied to the pathophysiology of radicular pain: a call for clinical translation. Reg Anesth Pain Med. 2014;39(2):149-59.
8. Snidvongs S, Mehta V. Pulsed radio frequency: a non-neurodestructive therapy in pain management. Curr Opin Support Palliat Care. 2010;4(2):107-10.
9. Abejón D, Reig E. Is pulsed radiofrequency a neuromodulation technique? Neuromodulation. 2003;6(1):1-3.
10. Chua NHL , Vissers KC, Sluijter ME. Pulsed radiofrequency treatment in interventional pain management: mechanisms and potential indications—a review. Acta Neurochir. 2011;153(4):763-71.
11. Van Boxem K, Huntoon M, Van Zundert J, Patijn J, van Kleef M, Joosten EA. Pulsed radiofrequency: a review of the basic science as applied to the pathophysiology of radicular pain: a call for clinical translation. Reg Anesth Pain Med. 2014;39(2):149-59.
12. Moore D, Galvin D, Conroy MJ, Das B, Dunne M, Lysagh J, et al. Characterisation of the effects of pulsed radio frequency treatment of the dorsal root ganglion on cerebrospinal fluid cellular and peptide constituents in patients with chronic radicular pain: A randomised, triple-blinded, controlled trial. J Neuroimmunol. 2020;343:577219.
13. Higuchi Y, Nashold BS Jr, Sluijter M. Exposure of the dorsal root ganglion in rats to pulsed radiofrequency currents activates dorsal horn lamina I and II neurons. Neurosurgery. 2002;50(4):850-5.
14. Van Zundert J, de Louw AJ, Joosten EA. Pulsed and continuous radiofrequency current adjacent to the cervical dorsal root ganglion of the rat induces late cellular activity in the dorsal horn. Anesthesiology. 2005;102(1):125-31.
15. Park HW, Ahn SH, Kim SJ, Seo JM, Cho YW, Jang SH, et al. Changes in spinal cord expression of fractalkine and its receptor in a rat model of disc herniation by autologous nucleus pulposus. Spine. 2011;36(12):753-60.
16. Kim SJ, Kim WR, Kim HS, Park HW, Cho YW, Jang SH, et al. Abnormal spontaneous activities on needle electromyography and their relation with pain behavior and nerve fiber pathology in a rat model of lumbar disc herniation. Spine. 2011;36(24):1562-7.
17. Erdine S, Bilir A, Cosman ER, Cosman ER Jr. Ultrastructural changes in axons following exposure to pulsed radiofrequency fields. Pain Pract. 2009;9(6):407-17.
18. Hamann W, Abou-Sherif S, Thompson S, Hall S. Pulsed radiofrequency applied to dorsal root ganglia causes a selective increase in ATF3 in small neurons. Eur J Pain. 2006;10(2):171-6.
19. Hagiwara S, Iwasaka H, Takeshima N. Mechanisms of analgesic action of pulsed radiofrequency on adjuvant-induced pain in the rat: Roles of descending adrenergic and serotonergic systems. Eur J Pain. 2009;13(3):249-52.
20. Hamann W, Abou-Sherif S, Thompson S, Hall S. Pulsed radio frequency applied to dorsal root ganglia causes a selective increase in ATF3 in small neurons. Eur J Pain. 2006;10(2):171-6.
21. Erdine S, Yucel A, Cimen A, Aydin S, Sav A, Bilir A. Effects of pulsed versus conventional radiofrequency current on rabbit dorsal root ganglion morphology. Eur J Pain. 2005;9(3):251-6.
22. Fernandes CR, Fonseca MN, Rosa DM, Simoes CM, Duarte NMC. Recomendaciones de la Sociedad Brasileña de Anestesiología para la seguridad en anestesia regional. Rev Bras Anestesiol 2011;61(5):366-81.
23. Vigneri S, Sindaco G, La Grua M, Zanella M, Paci M, Vinci F, et al. Long-term Inhibition of Soleus H-reflex with Epidural Adhesiolysis and Pulsed Radiofrequency in Lumbosacral Neuropathic Pain. Pain Pract. 2021;21(3):277-84.
24. Manchikanti L, Falco FJE, Benjamin RM, Caraway DL, Helm II S, Wargo BW, et al. Assessment of infection control practices for interventional techniques: a best evidence synthesis of safe injections practices and use of single-dose medication vials. Pain Physician. 2012;15(5):E573-E614.
25. Hofmeister M, Dowsett LE, Lorenzetti DL, Clement F. Ultrasound- versus fluoroscopy-guided injections in the lower back for the management of pain: a systematic review. Eur Radiol. 2019;29(7):3401-9.
26. Lee DG, Ahn SH, Lee J. Comparative effectivenesses of pulsed radiofrequency and transforaminal steroid injection for radicular pain due to disc herniation: A prospective randomized trial. J Korean Med Sci. 2016;31(8):1324-30.
27. Arons M, Strīķe E, Pilmane M, Vasiļevskis E, Evansa I, Paņihins I, et al. Chronic Lumbosacral Painful Unilateral Radiculopathy: Dorsal Root Ganglion Pulsed Radiofrequency vs. Transforaminal Epidural Steroid Injection: A Prospective Randomized Study. Clin Surg. 2020;5:2759.
28. Koh W, Choi SS, Karm MH, Suh JH, Leem JG, Lee JD, et al. Treatment of chronic lumbosacral radicular pain using adjuvant pulsed radiofrequency: A randomized controlled study. Pain Med 2015;16(3):432-41.
29. De M, Mohan VK, Bhoi D, Talawar P, Kumar A, Garg B, et al. Transforaminal Epidural Injection of Local Anesthetic and Dorsal Root Ganglion Pulsed Radiofrequency Treatment in Lumbar Radicular Pain: A Randomized, Triple-Blind, Active-Control Trial. Pain Pract. 2020;20(2):154-67.
30. Shanthanna H, Chan P, McChesney J, Thabane L, Paul J. Pulsed radiofrequency treatment of the lumbar dorsal root ganglion in patients with chronic lumbar radicular pain: A randomized, placebo-controlled pilot study. J Pain Res. 2014;7:47-55.
31. Chang MC, Cho YW, Ahn SH. Comparison between bipolar pulsed radiofrequency and monopolar pulsed radiofrequency in chronic lumbosacral radicular pain: A randomized control trial. Medicine (Baltimore). 2017;96(9):e6236.
32. Simopoulos TT, Kraemer J, Nagda JV, Aner M, Bajwa ZH. Response to pulsed and continuous radiofrequency lesioning of the dorsal root ganglion and segmental nerves in patients with chronic lumbar radicular pain. Pain Physician. 2008;11(2):137-44.
33. Tortora F, Negro A, Russo C, Cirillo S, Caranci F. Chronic intractable lumbosacral radicular pain, is there a remedy? Pulsed radiofrequency treatment and volumetric modifications of the lumbar dorsal root ganglia. Radiol Med. 2021;126(1):124-32.
34. Das B, Conroy M, Moore D, Lysaght J, McCrory C. Human dorsal root ganglion pulsed radiofrequency treatment modulates cerebrospinal fluid lymphocytes and neuroinflammatory markers in chronic radicular pain. Brain Behav Immun 2018;70:157-65.
35. Gabrhelik T, Michalek P, Berta E, Adamus M, Pieran M, Dolecek L. Pulsed radiofrequency of radicular pain. Ceska Slov Neurol. Neurochirurg. 2007;70:533-7.
36. Lee DG, Cho YW, Ahn SH, Chang MC. The effect of bipolar pulsed radiofrequency treatment on chronic lumbosacral radicular pain refractory to monopolar pulsed radiofrequency treatment. Pain Physician. 2018;21(2):E97-103.
37. Mehta V, Snidvongs S, Ghai B, Langford R, Wodehouse T. Characterization of peripheral and central sensitization afterdorsal root ganglion intervention in patients with unilateral lumbosacral radicular pain: A prospective pilot study. Br J Anaesth. 2017;118(6):924-31.
38. Van Boxem K, de Meij N, Kessels A, Van Kleef M, Van Zundert J. Pulsed radiofrequency for chronic intractable lumbosacral radicular pain: A six-month cohort study. Pain Med. 2015;16(6):1155-62.
39. Van Boxem K, van Bilsen J, de Meij N, Herrler A, Kessels F, Van Zundert J, et al. Pulsed radiofrequency treatment adjacent to the lumbar dorsal root ganglion for the management of lumbosacral radicular syndrome: A clinical audit. Pain Med. 2011;12(9):1322-30.
40. Castromán P, Cristiani F, Surbano M, Ayala S, Schwartzmann A, Varaldi G. Radiofrecuencia pulsada del Ganglio de la Raíz Dorsal en el Sindrome Radicular Lumbosacro Crónico Refractario a los Esteroides Epidurales. Rev Esp Dolor. 2019;26(3):162-70. 10.20986/resed.2019.3702/2018.
41. Marliana A, Yudianta S, Subagya DW, Setyopranoto I, Setyaningsih I, Tursina Srie C, Setyawan R, Rhatomy S. The efficacy of pulsed radiofrequency intervention of the lumbar dorsal root ganglion in patients with chronic lumbar radicular pain. Med J Malaysia. 2020;75(2):124-9.
42. Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain. 2008;9(2):105-21.
43. Van Boxem K, de Meij N, Patijn J, Wilmink J, van Kleef M, Van Zundert J, et al. Predictive Factors for Successful Outcome of Pulsed Radiofrequency Treatment in Patients with Intractable Lumbosacral Radicular Pain. Pain Med. 2016;17(7):1233-40.
44. Trinidad JM, Carnota AI, Failde I, Torres LM. Clinical Study Radiofrequency for the Treatment of Lumbar Radicular Pain: Impact on Surgical Indications. Pain Res Treat. 2015;2015:392856.
45. Abejon D, Garcia-del-Valle S, Fuentes ML, Gomez-Arnau JI, Reig E, van Zundert J. Pulsed radiofrequency in lumbar radicular pain: Clinical effects in various etiological groups. Pain Pract. 2007;7(1):21-6.
46. Hong LW, Chen KT. A real-world evidence of a consecutive treatment of 42 spine-related pain using dorsal root ganglion-pulsed radiofrequency. Clin Neurol Neurosurg. 2020;197:106186.
47. Kim SJ, Park SJ, Yoon DM, Yoon KB, Kim SH. Predictors of the analgesic efficacy of pulsed radiofrequency treatment in patient with chronic lumbosacral radicular pain: A retrospective observational study. J Pain Res. 2018;11:1223-30.
48. Practice Advisory for the Prevention, Diagnosis, and Management of Infectious Complications Associated with Neuraxial Techniques: An Updated Report by the American Society of Anesthesiologists Task Force on Infectious Complications Associated with Neuraxial Techniques and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology. 2017;126(4):585-601.
49. Manchikanti L, Cash KA, Pampati V, Falco FJE. Transforaminal epidural injections in chronic lumbar disc herniation: a randomized, doble-blind, active controlled trial. Pain Physician. 2014;17:E489-E501.
50. Manchikanti L, Cash KA, Mc Manus C, Pampati V, Benyamin RM. A randomized double blind, active controlled trial of fluoroscopic lumbar interlaminar epidural injections in chronic axial or discogenic low back pain: results of two years follow-up. Pain Physician. 2013;16(5):E491-E504.
51. Surbano M, Antunez M, Coutinho I, Machado V, Castroman P. Uso del Brief Pain Inventory (BPI) para la evaluación de las técnicas intervencionistas en el tratamiento de la lumbalgia. Dolor. 2014;23(62):10-4.
52. Gatchel RJ, Mayer TG, Choi YH, Chou CR. Validation of a consensus-based minimal clinically important difference (MCID) threshold using an objective functional external anchor. Spinal J. 2013;13(8):889-93.

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Instrucciones para citar

Castromán P, Surbano M. Dorsal root ganlion pulsed radiofrequency for lumbosacral radicular pain: a narrative review. Rev Soc Esp Dolor 2021; 28(4): 219-231 / DOI: 1020986/resed20213882/2021

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Recibido: 02/01/2021

Aceptado: 18/09/2021

Prepublicado: 23/09/2021

Publicado: 15/10/2021

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