Clin Pain.  2024 Dec;23(2):79-83. 10.35827/cp.2024.23.2.79.

Pulsed Radiofrequency Stimulation for Radicular Pain

• Lee DG

• KMID: 2563773
• DOI: http://doi.org/10.35827/cp.2024.23.2.79

Abstract

Radicular pain due to spinal degeneration is commonly managed with transforaminal epidural steroid injections (TFESI) to reduce inflammation. However, in cases where pain persists due to central sensitization, pulsed radiofrequency (PRF) stimulation presents a promising adjunctive therapy. PRF avoids the high temperatures of continuous radiofrequency (CRF) stimulation, using a controlled electrical field that reduces the risk of nerve damage while modulating central sensitization pathways. Studies suggest that PRF can provide effective, prolonged pain relief, especially in patients with refractory radicular pain unresponsive to repeated TFESI. PRF’s mechanism involves subthreshold stimulation that induces long-term depression through α-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) and N-Methyl-D-Aspartate (AMPA) and N-Methyl-D-Aspartate (NMDA) receptor modulation, decreasing pain sensitivity without significant heat generation. Additionally, PRF’s combination with local anesthetics has shown enhanced pain control up to six months. Given the complex interplay between inflammation and central sensitization in chronic radicular pain, PRF may serve as a clinically valuable option, potentially delaying or reducing the need for surgery. Further research is needed to refine PRF protocols and optimize its use in conjunction with conventional therapies.

Keyword

Radiating pain; Chronic pain; Radiofrequency therapy; Neuromodulation therapy; Long-term synaptic depression