Transforaminal Steroid Injection After Dorsal Root Ganglion Pulsed Radiofrequency (DRG-PRF): Impact on Pain Intensity and Disability

IF 4.1 2区医学 Q1 CLINICAL NEUROLOGY Pain and Therapy Pub Date : 2024-07-28 DOI:10.1007/s40122-024-00639-w

Matteo Luigi Giuseppe Leoni, Fabrizio Micheli, David Michael Abbott, Marco Cascella, Giustino Varrassi, Pasquale Sansone, Roberto Gazzeri, Monica Rocco, Marco Mercieri

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Abstract

Introduction

Dorsal root ganglion pulsed radiofrequency (DRG-PRF) is frequently used for the treatment of chronic lumbar radicular pain with good outcomes in terms of pain management. Transforaminal epidural steroid injection (TFESI) is often administered immediately after DRG-PRF to increase the anti-inflammatory effects, but support for the synergic mechanism is lacking in the literature. The aim of this study was to investigate the potential role of TFESI immediately after DRG-PRF and its possible role on pain intensity and patient disability.

Methods

A database of patients who underwent DRG-PRF with or without TFESI immediately after DRG-PRF was retrospectively analysed; propensity score matching was applied to the analysis to reduce possible bias. Pain intensity (numerical rating scale [NRS]) and Oswestry disability index (ODI) were recorded pre-operatively and at the 1- and 3-month follow-up in the two groups of patients.

Results

A total of 252 patients were included in this retrospective analysis, 126 patients in the DRG-PRF + TFESI group and 126 patients in the DRG-PRF group after propensity score matching. Both groups displayed a significant reduction in pain intensity (NRS score reduction; p < 0.0001) and improvement in the ODI (p < 0.0001) from baseline at the 3-month follow-up. Interestingly, the use of TFESI after DRG-PRF was not associated with any clinical benefit as no difference in NRS and ODI was found between the two groups at the 1- and 3-month follow-ups.

Conclusions

Our study revealed a significant pain reduction and disability improvement after DRG-PRF in patients with lumbar radicular pain. Interestingly, no positive role of TFESI immediately after DRG-PRF was observed. These findings suggest that DRG-PRF provides substantial pain relief, and no added benefit is obtained with subsequent steroid injection. Future prospective studies with expanded follow-up periods are needed to confirm these findings.

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背根神经节脉冲射频（DRG-PRF）后经椎管注射类固醇：对疼痛强度和残疾的影响

导言背根神经节脉冲射频（DRG-PRF）常用于治疗慢性腰椎根性疼痛，在疼痛控制方面效果良好。经椎间孔硬膜外注射类固醇（TFESI）通常会在 DRG-PRF 治疗后立即进行，以增强抗炎效果，但文献中缺乏对协同机制的支持。本研究旨在探讨 DRG-PRF 术后立即注射 TFESI 的潜在作用及其对疼痛强度和患者残疾的可能影响。方法回顾性分析了接受 DRG-PRF 术后立即注射或未注射 TFESI 的患者数据库；为减少可能的偏差，分析中采用了倾向评分匹配法。两组患者的疼痛强度（数字评分量表 [NRS]）和 Oswestry 残疾指数（ODI）在术前、1 个月和 3 个月随访时均有记录。在 3 个月的随访中，两组患者的疼痛强度（NRS 评分降低；p < 0.0001）和 ODI（p < 0.0001）均较基线有明显降低。有趣的是，DRG-PRF 后使用 TFESI 与任何临床益处无关，因为在 1 个月和 3 个月的随访中，两组患者的 NRS 和 ODI 均无差异。有趣的是，在 DRG-PRF 术后，TFESI 并没有发挥积极作用。这些研究结果表明，DRG-PRF 能显著缓解疼痛，但随后的类固醇注射并不能带来额外的益处。未来还需要进行更多的前瞻性研究来证实这些发现。

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来源期刊

Pain and Therapy CLINICAL NEUROLOGY-

CiteScore

6.60

自引率

5.00%

发文量

110

审稿时长

6 weeks

期刊介绍： Pain and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of pain therapies and pain-related devices. Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to, acute pain, cancer pain, chronic pain, headache and migraine, neuropathic pain, opioids, palliative care and pain ethics, peri- and post-operative pain as well as rheumatic pain and fibromyalgia. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports, trial protocols, short communications such as commentaries and editorials, and letters. The journal is read by a global audience and receives submissions from around the world. Pain and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.