Radiofrequency neuroablation as a treatment method for pain syndrome in conservative treatment of knee osteoarthritis
DOI:
https://doi.org/10.15674/0030-59872019335-42Keywords:
pain syndrome, knee osteoarthritis, radiofrequency neuroablationAbstract
Pain syndrome is one of the most frequent reasons for visiting a doctor of elderly patients with knee osteoarthritis. Pain caused by knee osteoarthritis is nociceptive; therefore, in the treatment of the knee osteoarthritis, it is rational to provide a targeted impact on the structures that produce the pain. Radiofrequency neuroablation (RFNA) allows induce the nociceptive mechanism in the structures conducting pain impulses.
Objective: to evaluate the effectiveness of radiofrequency neuroablation in the treatment of pain syndrome in patients with knee osteoarthritis.
Methods: the open controlled randomized study included treatment results analysis of 44 patients with knee osteoarthritis of the third stage with predominance of pain in one of the knee joints. Patients were divided into two groups: the study group (n = 22) and the comparison group (n = 22). Patients of both groups for the treatment of knee joint pain received osteoarthritis basis therapy. Patients in the study group additionally had RFNA of the genicular nerves. The intensity of the pain syndrome was measured with visual analog scale (VAS) and the functional status and quality of life of patients was analyzed using the WOMAC questionnaire in terms of 2 weeks, 1 and 3 months after the beginning of the treatment.
Results: this study revealed that the functional activity of the patients of both groups was decreased in affected with intensive pain syndrome — the total WOMAC index was 87.0 points in middle range. Positive changes were revealed in both groups of patients. More pronounced and lasting effect of the treatment was obtained in a group of patients undergoing RFNA procedure in combination with basis conservative treatment: decreasing values regard to the VAS to 4.0 points and the total WOMAC index to 33.0 points). In comparison group was admitted the scores reduction of the VAS to 5.5 points and the total WOMAC index to 61.0 points.
Conclusion: RFNA of the genicular nerves, as an additional method of pain treatment, along with conservative therapy in patients with knee osteoarthritis is an effective way of the pain syndrome reducing which improves functional activity and quality of life.
References
- Neogi, T. (2013). The epidemiology and impact of pain in osteoarthritis. Osteoarthritis and Cartilage, 21 (9), 1145–1153. doi:10.1016/j.joca.2013.03.018
- Bakalyuk, T.G., Misula, I.R., Sirant, H.O., Zawidniuk, Y.V. & Zyatkovskaya, O.Y. (2018). Joint pain in primary gonarthrosis in the elderly: ways to improve rehabilitation efficiency. Achievements of clinical and experimental medicine, 2, 29–33. (in Ukrainian)
- Srikanth, V. K., Fryer, J. L., Zhai, G., Winzenberg, T. M., Hosmer, D., & Jones, G. (2005). A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis. Osteoarthritis and Cartilage, 13 (9), 769–781. doi:10.1016/j.joca.2005.04.014
- Gwilym, S. E., Keltner, J. R., Warnaby, C. E., Carr, A. J., Chizh, B., Chessell, I., & Tracey, I. (2009). Psychophysical and functional imaging evidence supporting the presence of central sensitization in a cohort of osteoarthritis patients. Arthritis & Rheumatism, 61 (9), 1226–1234. doi:10.1002/art.24837
- Slobodin, T. M., & Maslova, I. H. (2018). Pathogenesis and the modern comprehensive approach to the treatment of pain syndromes in neurology. International Neurological Journal, 6 (100), 17–22. doi: 10.22141/2224-0713.6.100.2018.146453. (in Russian)
- Podhajsky, R. J., Sekiguchi, Y., Kikuchi, S., & Myers, R. R. (2005). The histologic effects of pulsed and continuous radiofrequency lesions at 42°C to rat dorsal root ganglion and sciatic nerve. Spine, 30 (9), 1008–1013. doi:10.1097/01.brs.0000161005.31398.58
- Howes, L. G. (2007). Selective COX-2 inhibitors, NSAIDs and cardiovascular events — is celecoxib the safest choice? Therapeutics and clinical risk management, 3 (5), 831–845.
- Franco, C. D., Buvanendran, A., Petersohn, J. D., Menzies, R. D., & Menzies, L. P. (2015). Innervation of the anterior capsule of the human knee. Regional Anesthesia and Pain Medicine, 40 (4), 363–368. doi:10.1097/aap.0000000000000269
- Rojhani, S., Qureshi, Z., & Chhatre, A. (2017). Water-cooled radiofrequency provides pain relief, decreases disability, and improves quality of life in chronic knee osteoarthritis. American Journal of Physical Medicine & Rehabilitation, 96 (1), e5–e8. doi:10.1097/phm.0000000000000549
- Kesikburun, S., Yaşar, E., Uran, A., Adigüzel, E., & Yilmaz, B. (2016). Ultrasound-guided genicular nerve pulsed radiofrequency Treatment for painful knee osteoarthritis: A preliminary report. Pain Physician, 19 (5), E751–E759.
- Ahmed, A., & Arora, D. (2018). Ultrasound-guided radiofrequency ablation of genicular nerves of knee for relief of intractable pain from knee osteoarthritis: a case series. British Journal of Pain, 12 (3), 145–154. doi:10.1177/2049463717730433
- Roy, I. V., Fishchenko, Ya. V., & Kudrin, A. P. (2017). Radiofrequency ablation of the sacroiliac joint in the pain treatment. Trauma, 18, 2, 95–99. doi: 10.22141/1608-1706.2.18.2017.102565. (in Russian)
- Povoroznyuk, V., Pryimych, U., & Chebotarev, D. (2016). Identification of neuropathic pain component in patients OF various age with knee osteoarthritis. Osteoarthritis and Cartilage, 24, Suppl. 1, S450–S451. doi: 10.1016/j.joca.2016.01.820.
- Masala, S., Fiori, R., Raguso, M., Morini, M., Calabria, E., & Simonetti, G. (2014). Pulse-dose radiofrequency for knee osteoartrithis. CardioVascular and Interventional Radiology, 37 (2), 482–487. doi:10.1007/s00270-013-0694-z
- Choi, W., Hwang, S., Song, J., Leem, J., Kang, Y., Park, P., & Shin, J. (2011). Radiofrequency treatment relieves chronic knee osteoarthritis pain: A double-blind randomized controlled trial. Pain, 152 (3), 481–487. doi:10.1016/j.pain.2010.09.029
Downloads
How to Cite
Issue
Section
License
Copyright (c) 2019 Maksim Golovakha, Yevhen Bilykh
This work is licensed under a Creative Commons Attribution 4.0 International License.
The authors retain the right of authorship of their manuscript and pass the journal the right of the first publication of this article, which automatically become available from the date of publication under the terms of Creative Commons Attribution License, which allows others to freely distribute the published manuscript with mandatory linking to authors of the original research and the first publication of this one in this journal.
Authors have the right to enter into a separate supplemental agreement on the additional non-exclusive distribution of manuscript in the form in which it was published by the journal (i.e. to put work in electronic storage of an institution or publish as a part of the book) while maintaining the reference to the first publication of the manuscript in this journal.
The editorial policy of the journal allows authors and encourages manuscript accommodation online (i.e. in storage of an institution or on the personal websites) as before submission of the manuscript to the editorial office, and during its editorial processing because it contributes to productive scientific discussion and positively affects the efficiency and dynamics of the published manuscript citation (see The Effect of Open Access).