Radiofrequency treatment effective for refractory chronic joint pain

Radiofrequency treatment is an effective option for treating refractory chronic knee, hip, and shoulder joint pain.
Radiofrequency treatment is an effective option for treating refractory chronic knee, hip, and shoulder joint pain.

ORLANDO — Radiofrequency treatment (RFT) is an effective option for treating refractory chronic knee, hip, and shoulder joint pain. Michael Jacobs, MD, MPH, from the Walter Reed National Military Medical Center, discussed the techniques and evidence for RFT for chronic extremity joint pain at the American Academy of Pain Medicine (AAPM) 33rd Annual Meeting in Orlando, Florida.1

Symptomatic knee osteoarthritis (OA) is one of the top 5 leading causes of disability, affecting 5% to 12% of adults in the United States.1,2 The prevalence of hip OA is as high as 9% in adults aged 45 years and older.2 Chronic shoulder pain, which accounts for 16% of all musculoskeletal pain, is the third most common site of musculoskeletal pain.

RFT disrupts pain signal transmission by destroying nerves through thermal ablation and has been used for trigeminal neuralgia, spinal pain, and cancer pain.3 Evidence from numerous small, randomized controlled trials supports the use of RFT in treating extremity joint pain.

RFT is indicated for chronic intra-articular joint pain due to causes such as OA and vascular necrosis, but not for isolated extra-articular etiologies such as tendinitis or iliotibial band syndrome. In addition, RFT should only be considered in patients whose pain is not satisfactorily controlled with conservative therapy, which includes risk factor modification, physical therapy, medications, and injections. Patients must also be ineligible for surgical intervention and pass a nerve block test that suggests a higher likelihood of responding to RFT.

Dr Jacobs discussed the relevant anatomy and RFT techniques for treating the knee, hip, and shoulder joints. Due to the proximity of arteries to the nerves targeted by RFT, arterial injury is a potential adverse event for RFT, but no cases have been reported to date for RFT treatment of knee joint pain. A case series of 17 patients undergoing RFT for hip joint pain exhibited improvement in pain and function at 6 months despite the occurrence of 3 hematomas.4

Water-cooled RFT is similar to RFT but is able to create a larger neural lesion at lower temperatures to increase the likelihood of producing denervation.4 Support for cooled RFT for knee joint pain consists of case study data, although a randomized clinical trial has been submitted for publication.4

RFT is also being considered in patients treated with joint replacement surgery, a sizeable proportion of whom go on to develop chronic pain. Limited data support the use of RFT and cooled RFT in this population.

Several aspects of RFT require further study, including evaluation of adverse events related to RFT and the efficacy of RFT after total joint replacement. Comparing RFT techniques — such as conventional, pulsed, and cooled — and determining whether RFT is effective for treating pain in other joints are additional directions for future investigation.

References

  1. Jacobs M. Radiofrequency denervation for joint pain: what is the evidence? Presented at: the American Academy of Pain Medicine 33rd Annual Meeting; March 16-19, 2017; Orlando, Florida.
  2. Lawrence RC, Felson DT, Helmick CG, et al; National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58(1):26-35. doi: 10.1002/art.23176
  3. Ikeuchi M, Ushida T, Izumi M, Tani T. Percutaneous radiofrequency treatment for refractory anteromedial pain of osteoarthritic knees. Pain Med. 2011;12(4):546-551. doi: 10.1111/j.1526-4637.2011.01086.x
  4. Rivera F, Mariconda C, Annaratone G. Percutaneous radiofrequency denervation in patients with contraindications for total hip arthroplasty. Orthopedics. 2012;35(3):e302-e305. doi: 10.3928/01477447-20120222-19
  5. Rojhani S, Qureshi Z, Chhatre A. Water-cooled radiofrequency provides pain relief, decreases disability, and improves quality of life in chronic knee osteoarthritis. Am J Phys Med Rehabil. 2017;96(1):e5-e8. Doi: 10.1097/PHM.0000000000000549
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