Stimpod NMS 460

1. Radiofrequency Ablation vs PRF:
   • During RF, a doctor inserts a thin needle under the skin and uses a fluoroscope to guide it to the target nerve. The doctor then sends radio waves through the needle to create a small burn, or lesion, in the nerve
   • PFA uses high voltage, ultra-short electrical pulses to create irreversible pores in cell membranes, causing cell death
   • PFA is considered safer than RFA because it’s a non-thermal procedure. PFA lesions are also wider, larger, and more symmetrical than RFA lesions
   • PFA is highly efficient for redo ablation following prior RFA
2. Microscopic Changes/Mechanism of Effectiveness
   • Destruction of myelin of pain fibers
   • Destruction of mitochondria and vacuolization
   • induced interstitial changes in the number and size of collagen fibers, mainly in the endoneurium and perineurium regions
   • PRF appeared to interrupt signals only in unmyelinated C fibers while leaving myelinated delta fibers functional to transmit pain signals
   • It induces an electric field in the regions of the dorsal root ganglion and influences local neuronal function
3. Results of Research
   • Post-Herpetic Neuralgia (Shingles)
     • The results of pain scores and excellent and good rate/efficiency rate suggested that PRF appeared to have beneficial effects on PHN relief after one week, one month, and 3 months
   • Radicular pain
     • The results of pain scores showed no statistically significant differences between the PRF and control groups in subgroup analysis (3 months) (P > 0.05). The results suggested that PRF was not associated with significantly better therapeutic effects on radicular pain, and that PRF was associated with effects similar to those of traditional treatments.
     • But it may be beneficial to switch to PRF to avoid harmful side effects of long term drug use
   • from 3 to 12 months, control group tended to demonstrate better pain relief. The aforementioned results indicated that PRF may not have a significant treatment effect on NP in the long term, suggesting that PRF has a limited duration of efficacy. In other words, for a high recurrence rate over a long period, repeated PRF treatment has limitations.
4. Diabetic neuropathy
   • Intl Journal of Med Sci 2016 Huang; study on rats
   • It may be concluded that PRF has an analgesic effect on neuropathic pain by suppressing the nociception-induced release of excitatory neurotransmitters. PRF may provide a novel promising therapeutic approach for managing diabetic neuropathic pain
   • This study was done with PRF stimulation using needles applied directly into spinal nerve roots.
   • 2 Other trials underway examining treatment at site of tibial nerve
5. Incontinence
6. Fibromyalgia
   • Found one study that focused on low-frequency pulsed electromagnetic field (PEMF), but none that studied PRF used to treat Fibromyalgia.
   • There are other pain clinics that are advertising the use of PRF to treat Fibromyalgia