Radiofrequency for chronic lumbosacral and cervical pain: Results of a consensus study using the RAND/UCLA appropriateness method.

Autor: de Andrés Ares J; Department of Anesthesiology-Pain Unit, Hospital Universitario La Paz, Madrid, Spain., Eldabe S; Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK., Helsen N; Centre for Decision Analysis and Support, Ismar Healthcare, Lier, Belgium., Baranidharan G; Leeds Pain and Neuromodulation Centre, Leeds Teaching Hospitals, Leeds, UK., Barat JL; Service de Neurochirurgie, Hôpital privé Clairval - Ramsay santé, Marseille, France., Bhaskar A; Pain Management Centre, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK., Cassini F; SS. Antonio e Biagio e C. Arrigo Hospital, Allesandria, Piedmont, Italy., Gillner S; Department of Neurosurgery, University Hospital of Düsseldorf, Düsseldorf, Germany., Kallewaard JW; Department of Anaesthesiology and Pain Management, Rijnstate Hospital, Velp, The Netherlands.; Department of Anaesthesiology and Pain Treatment, Amsterdam University Medical Center, Amsterdam, The Netherlands., Klessinger S; Department of Neurosurgery, Neurochirurgie Biberach, Biberach, Germany., Mavrocordatos P; Swiss Pain Institute, Lausanne and Basel, Switzerland., Occhigrossi F; Pain Therapy Unit, San Giovanni-Addolorata Hospital, Rome, Italy., Van Zundert J; Department of Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium.; Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands., Huygen F; Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands., Stoevelaar H; Centre for Decision Analysis and Support, Ismar Healthcare, Lier, Belgium.
Jazyk: angličtina
Zdroj: Pain practice : the official journal of World Institute of Pain [Pain Pract] 2024 Sep; Vol. 24 (7), pp. 904-918. Date of Electronic Publication: 2024 Apr 10.
DOI: 10.1111/papr.13378
Abstrakt: Background: Despite the routine use of radiofrequency (RF) for the treatment of chronic pain in the lumbosacral and cervical region, there remains uncertainty on the most appropriate patient selection criteria. This study aimed to develop appropriateness criteria for RF in relation to relevant patient characteristics, considering RF ablation (RFA) for the treatment of chronic axial pain and pulsed RF (PRF) for the treatment of chronic radicular pain.
Methods: The RAND/UCLA Appropriateness Method (RUAM) was used to explore the opinions of a multidisciplinary European panel on the appropriateness of RFA and PRF for a variety of clinical scenarios. Depending on the type of pain (axial or radicular), the expert panel rated the appropriateness of RFA and PRF for a total of 219 clinical scenarios.
Results: For axial pain in the lumbosacral or cervical region, appropriateness of RFA was determined by the dominant pain trigger and location of tenderness on palpation with higher appropriateness scores if these variables were suggestive of the diagnosis of facet or sacroiliac joint pain. Although the opinions on the appropriateness of PRF for lumbosacral and cervical radicular pain were fairly dispersed, there was agreement that PRF is an appropriate option for well-selected patients with radicular pain due to herniated disc or foraminal stenosis, particularly in the absence of motor deficits. The panel outcomes were embedded in an educational e-health tool that also covers the psychosocial aspects of chronic pain, providing integrated recommendations on the appropriate use of (P)RF interventions for the treatment of chronic axial and radicular pain in the lumbosacral and cervical region.
Conclusions: A multidisciplinary European expert panel established patient-specific recommendations that may support the (pre)selection of patients with chronic axial and radicular pain in the lumbosacral and cervical region for either RFA or PRF (accessible via https://rftool.org). Future studies should validate these recommendations by determining their predictive value for the outcomes of (P)RF interventions.
(© 2024 The Authors. Pain Practice published by Wiley Periodicals LLC on behalf of World Institute of Pain.)
Databáze: MEDLINE
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