1. 2016;19;429-444Treatment of Neuropathic Pain Using Pulsed Radiofrequency: A Meta-analysis
   Systematic Review
   Yu Shi, MD, and Wen Wu, MD.

BACKGROUND: Neuropathic pain (NP) is a major public health problem worldwide. Because of the unclear mechanism of NP, its treatment is one of the most difficult medical problems. As a targeted, noninvasive, safe therapy, pulsed radiofrequency (PRF) provides a new method for the treatment of NP; however, its effect on this treatment still lacks support from evidence-based medicine.

OBJECTIVE: To conduct a meta-analysis of available randomized controlled trials and to evaluate the effectiveness and clinical utility of PRF for the treatment of NP.

STUDY DESIGN: Meta-analysis.

SETTING: All selected studies were randomized controlled trials.

Method: A systematic and comprehensive database search was performed of the PubMed, CENTRAL, EMBASE.com, Cochrane Library, Chinese Biomedical Literature, and Wanfang databases for literature published from the establishment of the databases to December 19, 2015. According to inclusion and exclusion criteria, the results of randomized controlled trials supporting PRF for NP treatment were collected. The risk of bias tool described in the Cochrane Handbook version 5.1.0 was used to assess the quality of each trial. Meta-analysis was performed using RevMan 5.3 software.

RESULTS: A total of 12 randomized controlled trials involving 592 patients met the inclusion criteria. Overall, the results of the meta-analysis showed that, compared with the control group, PRF had a better effect on postherpetic neuralgia (PHN) in terms of pain score (one week, one month, and 3 months), excellent and good rate (one day, one month), and efficiency rate (one day). But PRF did not have a better effect on radicular pain in pain score (3 months). Side effects were less frequently found with the PRF treatment.

LIMITATIONS: Although we repeatedly tested the key words and used a manual method to prevent the loss of studies, due to the limitation of the included studies, some of the data were insufficient to complete the meta-analysis, and we were unable to obtain the original data from some studies. Some studies did not report the blind design, which decreased the quality of the current study.

CONCLUSION: PRF did not have a better effect on radicular pain, and PRF is an effective and safe therapeutic alternative for the analgesia of PHN. However, for a high recurrence rate over a long period, repeated PRF treatment has limitations.

Key words: Neuropathic pain, pulsed radiofrequency, analgesia, meta-analysis