Effect of percutaneous radiofrequency thermocoagulation on different neuropathic pains

摘要

BACKGROUND: The clinical treatment of neuropathic pain is very troublesome ,and the physical method of radiofrequency thermocoagulation is a good choice for its treatment.OBJECTIVE: To observe the curative effact of percutaneous radiofrequency thermocoagulation on neuropathic neuralgia.DESIGN:A case follow-up analysis.SETTING: Minimally Invasive Surgery Room,Department of Neurosurgery,Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA.PARTICIPANTS: Totally 131 patients were selected from the Department of Neurosurgery,Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA from December 2000 to June 2006,including 73 males and 58 females,aging 37-72 years old,AND the disease course was 2-15 years.①Drug treatment failed to alleviate the pain or induced obvious side the pain or induced obvious side effects; ②With the same pathological changes as pain and effective in the nerve block test; Had signed the informed consents before treatment.Distribution of the neuropathic pain:①Trigeminal neuralgia,which were lighting attack,located at V2 in 28 cases,V3 in 46 cases,V1+V2 in 3 cases,V2+V3 in 28 cases,and V1+V2+V3 in 1 cases;②Migraine located at(except the frontal branch of trigeminal nerve)greater and lesser occipital nerves in 6 cases,auriculotemporal nerve in 3 cases,temporal and zygomatic nerves in 3 cases;③Unilateral neuralgia of C2 and C3 following herpes zoster in 1 case,and chest intercostals neuralgia in 2 cases;④Lasting burning pain in the operative area after thoracotomy was in 1 case of lung cancer.METHODS: ①All the enrolled patients were treated with percutaneous puncture at trigeminal ganglion or peripheral nerve,then nerve block was performed firstly for anesthesia,and the pain disappeared immediately at this moment,there was hypoesthesia or numbness in the area of innervation,which manifested the puncture apposition was correct.then electrostimulation of 50 Hz with the current of 0.1-0.5 V was given for further functional localization.②The RFG-3C radiofrequency therapeutic instrument(Radionics,USA)was used,the tip of the radiofrequency electrode was exposed for 5 mm,the temperature was kept at 80-85℃,30-60 for each time, and treated for 3 or 4 times.The neuralgia following herpes zoster could also be treated by thermocoagulation at several points.③Evaluation standards for the therapeutic efficacy:Excellent meant the pain disappeared completely without taking any anodyne. Good referred to the pain was alleviated as compared with the preoperative one, and it could be effectively controlled by anodyne at relapse, but radiofrequency therapy was unnecessary.MAIN OUTCOME MEASURES:Therapeutic efficacy of neuropathic neuralgia of different types after treatment of percutaneous radiofrequency thermocoagulation.RESULTS:All the 131 patients were involved in the final analysis of results,no one missed.④Therapeutic efficacy:In the 24-month follow-up,the therapeutic efficacy was excellent in 106 cases(80,9%),good in 21 cases(16.0%)and had no change in 4 cases(3.1%).For 13 of the patients with trigeminal neuralgia,the pain relapsed after the lesion of peripheral branches,and it disappeared after the second treatment.The treatment was invalid for 1 patient with lung cancer suffering from pain in the operative area after thoracotomy,and the pain was alleviated by spinal cord stimulation.The pain disappeared after treated for 3 times in the patients with cervical neuralgia following herpes zoster.②The pain relapsed in 28 cases(21.4%)at 12 months of the follow-up.③Adverse events and side effects:Except the hypoesthesia of different severity at the site of pain,there was no other complication after treatment.CONCLUSION:The follow-up results showed that percutaneous radiofrequency thermocoagulation is one of the effective methods for treating neuropathic neuralgias of various types.