Radiofrequency of suprascapular nerve as an analgesic strategy for chronic pain management. Systematic review and meta-analysis.

J Sebastián Infante, N Blackburn, J Felipe Vargas
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Abstract

Introduction: Chronic shoulder pain is highly prevalent in the general population. Many different analgesic strategies have been described, including radiofrequency treatment to the suprascapular nerve (RFS); however, the effectiveness this approach remains unclear, and no strong recommendation can be made. The aim of this systematic review is to analyse the latest clinical trials evaluating the effectiveness of RFS techniques applied to the suprascapular nerve in terms of management of chronic shoulder pain, post-procedural functionality, and adverse effects.

Methods: We performed a systematic review of clinical trials retrieved from Medline, Embase and the CENTRAL databases. We included trials comparing RFS with other strategies, including placebo, that had as their primary outcome measures pain rated on a visual analogue scale, functionality rated on a shoulder pain and disability index (SPADI), and the incidence of adverse events. Risk of bias was analysed using the Cochrane RoB2 tool. Evidence was analysed using a random effects model and heterogeneity was quantified using the I2 test.

Results: We identified 3030 trials, of which 8 met the inclusion criteria (n = 408). Seven had a high risk of bias. Pain intensity at 1 and 3 months was lower in patients receiving RFS, with a standardised mean difference (SMD) of -0.9 (95% CI [-1.1, 0.33], p = 0.29; I2 88%, p < 0.001) and -1.17 (95% CI [-2.49, 0.14], p = 0.08; I2 97%, p < 0.001), respectively. Functional compromise at 1 and 3 months decreased in patients receiving RFS, with an SMD of -0.31 (95% CI [-0.91, 0.29], p = 0.31; I2 80%, p < 0.001) and -1.54 (95% CI [-3.26, 0.19], p = 0.08; I2 98%, p < 0.001), respectively. No RFS-related adverse events were described.

Conclusion: The evidence suggests that RFS reduces pain and improves functionality. However, the certainty of the evidence is low.

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肩胛上神经射频治疗作为慢性疼痛治疗的一种镇痛策略。
简介慢性肩痛在普通人群中非常普遍。目前已有许多不同的镇痛策略,包括肩胛上神经射频治疗(RFS);但是,这种方法的有效性仍不明确,也无法提出有力的建议。本系统性综述旨在分析最新的临床试验,评估应用于肩胛上神经的射频治疗技术在治疗慢性肩痛、术后功能和不良反应方面的有效性:我们对从 Medline、Embase 和 CENTRAL 数据库中检索到的临床试验进行了系统性回顾。我们纳入了将 RFS 与包括安慰剂在内的其他策略进行比较的试验,这些试验的主要结果指标包括视觉模拟量表评定的疼痛、肩痛与残疾指数 (SPADI) 评定的功能以及不良反应的发生率。使用 Cochrane RoB2 工具分析了偏倚风险。使用随机效应模型对证据进行分析,并使用 I2 检验对异质性进行量化:我们确定了 3030 项试验,其中 8 项符合纳入标准(n = 408)。其中 7 项存在高偏倚风险。接受RFS治疗的患者在1个月和3个月时的疼痛强度较低,标准化平均差异(SMD)为-0.9(95% CI [-1.1, 0.33],P = 0.29;I2 88%,P 2 80%,P 2 98%,P 结论:证据表明,RFS 可减轻疼痛并改善功能。然而,证据的确定性较低。
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