Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness

被引：70

作者：

Cohen, Steven P. ^{[1
,2
,3
]}

Peterlin, B. Lee ^{[4
]}

Fulton, Larry ^{[5
]}

Neely, Edward T. ^{[6
]}

Kurihara, Connie ^{[7
,8
]}

Gupta, Anita ^{[9
]}

Mali, Jimmy ^{[10
]}

Fu, Diana C. ^{[11
]}

Jacobs, Michael B. ^{[12
]}

Plunkett, Anthony R. ^{[10
]}

Verdun, Aubrey J. ^{[13
]}

Stojanovic, Milan P. ^{[14
]}

Hanling, Steven ^{[15
]}

Constantinescu, Octav ^{[16
]}

White, Ronald L. ^{[16
]}

McLean, Brian C. ^{[17
]}

Pasquina, Paul F. ^{[18
,19
]}

Zhao, Zirong ^{[20
]}

机构：

[1] Johns Hopkins Sch Med, Dept Anesthesiol & Crit Care Med, Baltimore, MD USA

[2] Johns Hopkins Sch Med, Dept Phys Med & Rehabil, Baltimore, MD USA

[3] Uniformed Serv Univ Hlth Sci, Bethesda, MD 20814 USA

[4] Johns Hopkins Sch Med, Dept Neurol, Baltimore, MD USA

[5] Texas Tech Sch Med, Dept Hlth Org Management, Lubbock, TX USA

[6] Walter Reed Natl Mil Med Ctr, Dept Neurol, Bethesda, MD USA

[7] Walter Reed Natl Mil Med Ctr, Dept Surg, Bethesda, MD USA

[8] Walter Reed Natl Mil Med Ctr, Dept Nursing, Bethesda, MD USA

[9] Drexel Univ, Dept Anesthesiol, Philadelphia, PA 19104 USA

[10] Womack Army Med Ctr, Ft Bragg, NC USA

[11] Naval Med Ctr San Diego, Dept Neurol, San Diego, CA USA

[12] Walter Reed Natl Mil Med Ctr, Dept Phys Med & Rehabil, Bethesda, MD USA

[13] Walter Reed Natl Mil Med Ctr, Dept Anesthesiol, Bethesda, MD USA

[14] Boston VA Hosp, Dept Anesthesiol, Boston, MA USA

[15] Naval Med Ctr San Diego, Dept Anesthesiol, San Diego, CA USA

[16] Landstuhl Reg Med Ctr, Dept Surg, Landstuhl, Germany

[17] Tripler Army Med Ctr, Dept Surg, Honolulu, HI 96859 USA

[18] Uniformed Serv Univ Hlth Sci, Dept Phys Med & Rehabil, Bethesda, MD 20814 USA

[19] DC VA Hosp, Dept Internal Med, Washington, DC USA

[20] DC VA Hosp, Dept Neurol, Washington, DC USA

来源：

PAIN | 2015年 / 156卷 / 12期

关键词：

Headache; Occipital neuralgia; Pulsed radiofrequency; Steroid injection; DORSAL-ROOT GANGLION; CHRONIC CLUSTER HEADACHE; CERVICAL RADICULAR PAIN; MECHANICAL ALLODYNIA; RADIO-FREQUENCY; MULTICENTER; BLOCKADE; INFILTRATION; STIMULATION; EFFICACY;

D O I：

10.1097/j.pain.0000000000000373

中图分类号：

R614 [麻醉学];

学科分类号：

100217 [麻醉学];

摘要：

Occipital neuralgia (ON) is characterized by lancinating pain and tenderness overlying the occipital nerves. Both steroid injections and pulsed radiofrequency (PRF) are used to treat ON, but few clinical trials have evaluated efficacy, and no study has compared treatments. We performed a multicenter, randomized, double-blind, comparative-effectiveness study in 81 participants with ON or migraine with occipital nerve tenderness whose aim was to determine which treatment is superior. Forty-two participants were randomized to receive local anesthetic and saline, and three 120 second cycles of PRF per targeted nerve, and 39 were randomized to receive local anesthetic mixed with deposteroid and 3 rounds of sham PRF. Patients, treating physicians, and evaluators were blinded to interventions. The PRF group experienced a greater reduction in the primary outcome measure, average occipital pain at 6 weeks (mean change from baseline 22.743 +/- 2.487 vs 21.377 +/- 1.970; P < 0.001), than the steroid group, which persisted through the 6-month follow-up. Comparable benefits favoring PRF were obtained for worst occipital pain through 3 months (mean change from baseline21.925 +/- 3.204 vs20.541 +/- 2.644; P = 0.043), and average overall headache pain through 6 weeks (mean change from baseline 22.738 +/- 2.753 vs 21.120 +/- 2.1; P = 0.037). Adverse events were similar between groups, and few significant differences were noted for nonpain outcomes. We conclude that although PRF can provide greater pain relief forONandmigrainewith occipital nerve tenderness than steroid injections, the superior analgesia may not be accompanied by comparable improvement on other outcome measures.

引用

页码：2585 / 2594

页数：10

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