Radiofrequncy Ablation in Chronic Pain Management射频消融治疗慢性疼痛的管理.pptVIP

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Radiofrequncy Ablation in Chronic Pain Management射频消融治疗慢性疼痛的管理.ppt

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Radiofrequncy Ablation in Chronic Pain Management射频消融治疗慢性疼痛的管理

Radiofrequncy Ablation in Chronic Pain Management Joel Chang MD CASE 67 y/o M Lumbago, facet arthropathy, lumbar spondylolithesis, post-laminectomy Attempted Tx: TENS, PT/ aqua, lidoderm, oxycontin, epidural 2 Lumbar MBBs of L3-S1 with about 1 hour relief each time Presented for pulsed radiofrequency ablation of L3-S1 of right MBs Overview RFA is indicated for pain with constant and limited distribution Interrupts nociceptive pathways in the treatment of chronic pain Useful for nociceptive pain and some neuropathic pain Diagnosis confirmed with diagnostic blocks first Tendency for recurrence 1-2 years but can be repeated Non-indications Centralized pain Pathology in the spinal cord Serious Psychopathology Diagnosis Diagnostic blocks are usually done before RFA Done only if blocks are expected to provide information (ex: herniated disc) Diagnostic block utility include trigeminal neuralgia, and lumbar and cervical facet joint pain Diagnostic Injections Studies showed that single diagnostic lumbar z joint blocks are false positive 38% of the time. Blocks are usually repeated as a result The International Association for the Study of Pain specifies that diagnosis requires radiographically guided blocks provide complete relief and are validated by a appropriate control test that exclude false-positive responses RFA Sites Medial Branch of Posterior Ramus: innervates the facet joints Dorsal Root Ganglion (herniated discs or regional pain syndromes) Intradiscal RF Sympathetic chain Splanchnic nerve Gasserian ganglion for trigeminal neuralgia RF Machine Includes temperature display, impedance monitor, stimulator, and lesion generator. Impedance Monitor: Useful for detecting entry into various mediums ( a large increase for example might suggest movement from fluid to tissue) Electrical Stimulation: Sensory stimulation confirms proximity to the target. Motor stimulation confirms a safe distance to motor fibers in case a heat lesion is made Lesioning Module: conti