Conventional Radiofrequency Thermocoagulation vs Pulsed Radiofrequency Neuromodulation of Ganglion Impar in Chronic Perineal Pain of Nononcological Origin

• Published in: Pain medicine (Malden, Mass.) Vol. 19; no. 12; pp. 2348 - 2356
• Main Authors: Usmani, Hammad, Dureja, G P, Andleeb, Roshan, Tauheed, Nazia, Asif, Naiyer
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.12.2018
• Subjects: Ablation; Adolescent; Adult; Aged; Catheters; Chronic pain; Chronic Pain - therapy; Electric stimulation therapy; Electrocoagulation - methods; Female; Fluoroscopy; Humans; Male; Middle Aged; Nerve Block - methods; Neuromodulation; Pain; Pain management; Pain Management - methods; Pain Measurement - methods; Patient satisfaction; Pelvic Pain - therapy; Prospective Studies; Pulsed Radiofrequency Treatment - methods; Questionnaires; Radio Waves - therapeutic use; Skin; Treatment Outcome; Young Adult; Conventional Radiofrequency; Pulsed Radiofrequency; Chronic Nononcological Perineal Pain; First Intracoccygeal Approach; Ganglion Impar Block; Neuromodulation; Thermocoagulation
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pnx244

Abstract Background Chronic nononcological perineal pain has been effectively managed by ganglion Impar block. Chemical neurolysis, cryoablation, and radiofrequency ablation have been the accepted methods of blockade. Recently, pulsed radiofrequency, a novel variant of conventional radiofrequency, has been used for this purpose. Study Design This was a prospective, randomized, double-blind study. Setting Two different interventional pain management centers in India. Objective To compare the efficacy of conventional radiofrequency and pulsed radiofrequency for gangliom Impar block. Methods The patients were randomly allocated to one of two groups. In the conventional radiofrequency (CRF) group (N = 34), conventional radiofrequency ablation was done, and in the PRF pulsed radiofrequency (PRF) group (N = 31), pulsed radiofrequency ablation was done. After informed and written consent, fluoroscopy-guided ganglion Impar block was performed through the first intracoccygeal approach. The extent of pain relief was assessed by visual analog scale (VAS) at 24 hours, and at the first, third, and sixth weeks following the intervention. A questionnaire to evaluate subjective patient satisfaction was also used at each follow-up visit. Results In the CRF group, the mean VAS score decreased significantly from the baseline value at each follow-up visit. But in the PRF group, this decrease was insignificant except at 24-hour follow-up. Intergroup comparison also showed significantly better pain relief in the CRF group as compared with the PRF group. At the end of follow-up, 28 patients (82%) in the CRF group and four patients (13%) in the PRF group had excellent results, as assessed by the subjective patient satisfaction questionnaire. There was no complication in any patient of either study group, except for short-lived infection at the site of skin puncture in a few. Conclusion Ganglion Impar block by conventional radiofrequency provided a significantly better quality of pain relief with no major side effects in patients with chronic nononcological perineal pain as compared with pulsed radiofrequency. Limitations The short-term follow-up period of only six weeks was a major drawback associated with this study.