Percutaneous, computed tomography guided neurolysis using continuous radiofrequency for pain reduction in oncologic patients

Abstract

Aim: This study evaluates the efficacy and safety of percutaneous computed tomography (CT)-guided neurolysis using continuous radiofrequency for pain reduction in oncologic patients.

Methods: Over the course of 16 months, 22 patients underwent radiofrequency neurolysis as palliative therapy for pain reduction in celiac and splachnic plexus (n = 9), thoracic (n = 1), lumbar (n = 2) and superior hypogastric plexus (n = 5), as well as stellate ganglion (n = 5). Pain levels before treatment, one week after treatment, and at the last follow-up (average follow-up 6 months) were compared by means of a Numeric Visual Scale (NVS) questionnaire and a Brief Pain Inventory (Short Form) questionnaire.

Results: Median procedure time was 44 min. Median number of CT scans, performed to control correct positioning of the cannula and precise electrode placement, was 8. Pain scores of questionnaires prior to treatment (mean value 9.50 NVS units, range 8-10 NVS units) and post treatment (mean value 3.27 NVS units, range 2-6 NVS units) showed a mean decrease of 6.23 NVS units in terms of pain reduction and life quality improvement (P < 0.05). Overall mobility improved in 18/18 (100%) patients. No complication was observed.

Conclusion: This study concludes that CT-guided neurolysis by means of continuous radiofrequency ablation is a safe and efficient technique for pain palliation in oncologic patients.

Keywords

Pain / oncology / computed tomography / neurolysis / continuous radiofrequency

References

[1] Prommer EE.Pharmacological management of cancer-related pain..Cancer Control2015;22:412-25

[2] Coleman R,Aapro M,Herrstedt J.Bone health in cancer patients: ESMO Clinical Practice Guidelines..Ann Oncol2014;25 Suppl 3:iii124-37

[3] Ripamonti CI,Maranzano E,Roila F.Management of cancer pain: ESMO Clinical Practice Guidelines..Ann Oncol2012;23 Suppl 7:vii139-54

[4] World Health Organization. Cancer pain relief: with a guide to opioid availability. 2nd ed. 1996. Available from: http://apps.who.int/iris/bitstream/10665/37896/1/9241544821.pdf

[5] Vayne-Bossert P,Good P,Hardy J.Interventional options for the management of refractory cancer pain--what is the evidence?.Support Care Cancer2016;24:1429-38

[6] Martin BC,Edlund MJ,Braden JB.Long-term chronic opioid therapy discontinuation rates from the TROUP study..J Gen Intern Med2011;26:1450-7 PMCID:PMC3235603

[7] Ballantyne JC,Stannard C.WHO analgesic ladder: a good concept gone astray..BMJ2016;352:i20

[8] Vallejo R,Aliaga L.Radiofrequency vs. pulse radiofrequency: the end of the controversy..Tech Region Anesth Pain Manage2010;14:128-32

[9] de Louw AJ,Freling G,Arends JW.The morphological effects of a radio frequency lesion adjacent to the dorsal root ganglion (RF-DRG) -- an experimental study in the goat..Eur J Pain2001;5:169-74

[10] Kvarstein G.Pulsed radiofrequency -- time for a clinical pause and more science..Scand J Pain2012;3:124-6

[11] Cahara A,Macrea L,Sluijter M.Pulsed radiofrequency: current clinical and biological literature available..Pain Med2006;7:411-23

[12] Malik K,Walega D.Water-cooled radiofrequency: a neuroablative or a neuromodulatory modality with broader applications?.Case Rep Anesthesiol2011;2011:263101

[13] Locklin JK,Berger A.Palliation of soft tissue cancer pain with radiofrequency ablation..J Support Oncol2004;2:439-45

[14] Bhaskar AK.Interventional management of cancer pain..Curr Opin Support Palliat Care2012;6:1-9

[15] de Courcy JG.Interventional techniques for cancer pain management..Clin Oncol (R Coll Radiol)2011;23:407-17

[16] Uchida K.Radiofrequency treatment of the thoracic paravertebral nerve combined with glucocorticoid for refractory neuropathic pain following breast cancer surgery..Pain Physician2009;12:E277-83

[17] Papadopoulos D,Batistaki C.Bilateral thoracic splanchnic nerve radiofrequency thermocoagulation for the management of end-stage pancreatic abdominal cancer pain..Pain Physician2013;16:125-33

[18] Vissers KC,Wagemans M,Giezeman MJ,Mekhail N,van Kleef M.23. Pain in patients with cancer..Pain Pract2011;11:453-75

[19] Zhong W,Zeng JX,Yu T,Yuan YH.Celiac plexus block for treatment of pain associated with pancreatic cancer: a meta-analysis..Pain Pract2014;14:43-51

[20] Plancarte R,El-Helaly M,Lema MJ.Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer..Reg Anesth1997;22:562-8

[21] Arcidiacono PG,Carrara S,Testoni PA.Celiac plexus block for pancreatic cancer pain in adults..Cochrane Database Syst Rev2011;(3):CD007519

[22] Puli SR,Bechtold ML,Brugge WR.EUS-guided celiac plexus neurolysis for pain due to chronic pancreatitis or pancreatic cancer pain: a meta-analysis and systematic review..Dig Dis Sci2009;54:2330-7