by Dennis Thompson
WEDNESDAY, March 29, 2023 (HealthDay News) — People with sciatica get lasting relief from a procedure that uses a fine needle to heat nerve roots near the spine, a new clinical trial finds. shows.
A minimally invasive procedure called pulsed radiofrequency (RF) provided improved pain relief and improvement in disability for up to one year for patients with sciatica, according to findings published March 28 in the journal Neurology. radiology,
The procedure could help people with sciatica avoid or delay surgery, said lead researcher Dr. Alessandro Napoli is an Associate Professor of Radiology at Policlinico Umberto I – Sapienza University of Rome in Italy.
“With this method pulsed radiofrequency can relieve pain in 10 minutes, without surgery, without hospitalization, and can lead to a faster recovery and return to daily activities. It’s an important card to play.” ,” Napoli said.
People with sciatica have a sharp pain that travels down one leg through their hips and buttocks. The condition is usually caused by a herniated disc or slipped intervertebral disc that puts pressure on the sciatic nerve, the largest nerve in the body.
The standard treatment is a steroid injection to calm the nerve, Dr. Jack Jennings, professor of radiology and orthopedic surgery at Washington University School of Medicine in St. Louis. Lewis.
“Steroids are basically guts to fool, to say nothing is wrong,” said Jennings, who wrote an editorial accompanying the new study.
The clinical trial added pulsed RF to standard steroid injections to see if it would provide better, longer-lasting pain relief.
In pulsed RF, doctors use a CT scan to push fine needles into the nerves that cause hip pain.
The needle is then heated using pulses of radio waves. The heat inhibits the nerve, preventing it from sending pain signals to the brain.
“It’s like resetting an operating system,” Napoli said.
The procedure takes about 10 minutes and is performed on an outpatient basis without general anesthesia, the researchers said in background notes.
Napoli said he thinks the two treatments, pulsed RF and steroids, work together, contributing to the anti-inflammatory activity of the steroids and the disruption of the nerve signal from the pulsed RF.
Nearly 350 people with sciatica were randomly assigned in a clinical trial to receive steroids alone or steroids in combination with pulsed RF. All were followed for a year to see how well the treatment worked.
By the end of the year, 96% of the pulsed RF group had experienced improvement in pain, compared with 69% given steroids alone, the results showed.
About 68% of the pulsed RF group experienced complete pain relief, compared to 13% of the steroid group.
On the other hand, twice as many people (25 versus 12) treated with steroids alone had intolerable pain requiring further treatment, including surgery.
The researchers said patients who received pulsed RF treatment also experienced less disability.
“For me, the most impressive part of this was the durability up to a year and the number of people who responded completely,” Jennings said of the results. “These numbers are great in our world of pain.”
The study replicates the results of a 2017 clinical trial that showed pulsed RF plus steroids could be used to treat pain caused by pinched nerves, Dr. Jianguo Cheng, director of the Cleveland Clinic’s Multidisciplinary Pain Medicine Fellowship Program.
“The results of the current study are consistent with what we reported earlier,” Cheng said. “An important strength of this study is that it has a large sample size and is a multicenter study, providing strong evidence in support of combination therapy.”
Pulsed RF is more often used to treat sciatica in Europe than in the United States, Jennings said, even though the procedure has long been approved by the U.S. Food and Drug Administration.
Jennings said steroid injections can damage the body and the effects wear off over time.
“They have an expiration date on the person. You can’t inject them every three or four months for a lifetime. They eventually stop working. So to me, if you can increase the durability and last a year or more can get relief from it [pulsed RF]It’s unbelievable,” Jennings said.
“I hope this study will lead to increased knowledge and wider acceptance of the procedure, and I think it will,” he said.
Jennings hopes that a follow-up study will test only pulsed RF against steroids to see if the treatment would work on its own.
The Cleveland Clinic has more information about sciatica and radiofrequency therapy.
SOURCES: Alessandro Napoli, MD, PhD, associate professor, radiology, Policlinico Umberto I – Sapienza University of Rome, Italy; Jack Jennings, MD, PhD, professor, radiology and orthopedic surgery, Washington University School of Medicine in St. Louis. Louis, Mallinckrodt Institute of Radiology; Jianguo Cheng, MD, PhD, director, Cleveland Clinic Multidisciplinary Pain Medicine Fellowship Program; radiologyMarch 28, 2023
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