Background & Aims
Chronic lumbosacral radicular pain (CLR) is a major public health issue worldwide and has the prevalence of 9.9% to 25%. Traditionally inter laminar epidural steroid is given for management of CLR. Transforaminal epidural steroid injection (TFESI) is given under fluoroscopy guidance by pain physicians. Pulsed radio frequency neuromodulation of dorsal root ganglion (PRF of DRG) has been a less explored therapeutic technique. The objective of this study was to look at the feasibility of assessing the safety and efficacy of PRF of DRG added to TEFSI as compared with TEFSI alone in reducing CLR pain.
Primary Objective was to measure the intensity of pain using NRS score.
Secondary Objectives were
1. To assess functional status as measured by the Modified Oswestry Disability Index (MODI).
2. To assess patient satisfaction through Global Perceived Index .
3. To assess the incidence of surgery for CLR during follow up & observe the complication associated with the procedure.
Methods
This is a randomized comparative study. 20 patients visiting the Pain clinic of JSS Medical College Hospital, Mysuru, India diagnosed with CLR pain were selected based on inclusion and exclusion criteria after taking written informed consent. Patients were randomized into 2 groups namely Group T and Group TR with 10 patients in each group depending on the type of intervention performed under fluoroscopy & dye guidance in operation theater.
Patients in GROUP T underwent TFESI and in GROUP TR underwent DRG PRF + TFESI.
The following parameters were assessed in both the groups at pre-procedure, immediate post procedure and at 2, 4, 12 weeks. Numerical Rating Scale (NRS) determined the intensity of pain. Modified Oswestry Disability Index (MODI Score) assessed degree of disability and pain. Global Perceived Index assessed the patient satisfaction. Any complication associated with the procedure and incidence of surgery for CLR during follow up was noted.
Results
The demographic variables were comparable between the two groups. All base line variables were compared between two groups. The reduction in NRS scoring was seen more in Group TR compared to Group T at all time intervals and it was statistically significant at 12 weeks (p <0.05). The reduction in ODI was seen more in Group TR compared to Group T at all time intervals though it was statistically insignificant (p>0.05). Group TR showed higher values compared to Group T in GPI index in all intervals and it was statistically significant at 4 and 12 weeks ( p <.005). There was no incidence of surgery or any complications noted during follow up period.
Conclusions
Pulsed radio frequency neuromodulation of dorsal root ganglion combined with transforaminal epidural steroid could effectively and rapidly relieve radicular pain and achieve long-term remission. It is safe and effective technique in the management of CLR with good outcome. Although the method is widely applicable, the precise selection of patients is imperative.
References
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Presenting Author
Pratibha Matche
Poster Authors
Pratibha Matche
MD
JSS Medical College, JSSAHER, Mysore
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Low Back Pain