Pulsed Radiofrequency of the Dorsal Root Ganglia is Superior to Pharmacotherapy or Pulsed Radiofrequency of the Intercostal Nerves in the Treatment of Chronic Postsurgical Thoracic Pain

Background: Chronic postsurgical thoracic pain (CPTP) represents a major therapeutic challenge characterized by an absence of clinical studies to guide treatment. Recently, the implementation of pulsed radiofrequency (RF) has generated intense interest in the medical community as a safe and potentially effective treatment for neuropathic pain. To date, there are no studies comparing pulsed RF to more conventional therapeutic modalities for any pain condition.

Objectives: To compare treatment outcomes between pharmacotherapy, pulsed RF of the intercostal nerves (ICN) and pulsed RF of the dorsal root ganglia (DRG) in CPTP.

Methods: Retrospective data analysis involving 49 patients.

Results: At 6-week follow-up, 61.5% of the pulsed RF DRG group reported > or =50% pain relief vs. 27.3% in the medical management (MM) group and 21.4% in the IC group (P = 0.12). At 3-month follow-up, 53.8% in the DRG group continued to report > or = 50% pain relief vs. 19.9% in the MM and 6.7% in the ICN groups, respectively (P = 0.02). Among the pulsed RF patients who did report a successful outcome, the mean duration of pain relief was 2.87 months in the ICN group and 4.74 months in the DRG group (P = 0.01).

Conclusions: Pulsed RF of the DRG was a superior treatment to pharmacotherapy and pulsed RF of the ICN in patients with CPTP. Prospective studies are needed to confirm these results and identify the best candidates for this treatment.