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Chronic pain is a frequent, intricate, and adverse condition that has a considerable influence on individuals and society at large. In India, its prevalence is around 20%. Although a spectrum of conservative treatment modalities is available, a significant proportion of patients with chronic pain syndromes remain refractory and require surgical intervention. In these groups of patients, radiofrequency ablation (RFA) techniques are safe minimally invasive treatments and provide significant and durable pain relief. Thus, we aimed to formulate the Indian Society for the Study of Pain (ISSP) guidelines for the management of chronic pain syndromes with various RFA techniques. An in-depth literature review by experts in Pain Medicine practising in India, was used to produce 16 statements across 4 common chronic pain syndromes, including knee pain, headache and facial pain, lumbar facet joint pain, and sacroiliac joint pain. The quality of evidence was assessed with the Third US Preventive Service Task Force guidance document and the strength of the recommendation was determined by the Delphi consensus process. The level of evidence for most of the statements was I. Moreover, for most statements, the level of agreement between the experts was good (≥80% of the experts). The ISSP guidelines for the management of chronic pain syndromes are developed by experts in pain medicine. For most of the statements, the highest level of evidence was available and inter-expert agreement was good. However, further high-quality research is required to formulate more inclusive guidelines in this evolving pain medicine speciality. [ABSTRACT FROM AUTHOR]

Background: Idiopathic trigeminal neuralgia (TGN) is a chronic pain disorder causing unilateral, severe brief stabbing recurrent pain in the distribution of one or more branches of the trigeminal nerve. Conventional radiofrequency (CRF) and pulsed radiofrequency (PRF) are two types of minimally invasive treatment. CRF selectively ablates the part of ganglion to provide the relief, but it has been found to be associated with some side effects such as dysesthesia or sensory loss in 6%–28% and loss of corneal reflex in 3%–8% of patients. PRF is a comparatively newer modality which is a nondestructive and neuromodulatory method of delivering radiofrequency energy to the gasserian ganglion to produce a therapeutic effect. Aims: We aimed to compare the efficacy of CRF with long-duration, fixed voltage PRF in the treatment of idiopathic TGN. Setting: This study was conducted in a tertiary care center research institute. Study Design: This was a prospective randomized trial. Materials and Methods: Twenty-seven adult patients of TGN were included in the study and randomly allocated into two groups (CRF and PRF). All procedures were performed operation suite with C-arm fluoroscopic guidance. Both, pre- and postprocedure, the patients were assessed for pain on the Visual Analog Scale (VAS) and Barrow Neurological Institute (BNI) Pain Intensity Scale at 1 week and thereafter at 1, 2, 3, and 6 months. Patients with a BNI score ≥4 after 1 month were considered a failure and offered other modes of treatment. A reduction in VAS score ≥50% and a BNI score <4 were considered as effective. Statistical Analysis: Discreet variables were recorded as proportions, ordinal variables and continuous variables with non-Gaussian distribution as medians with interquartile range, and continuous variables with Gaussian distribution as mean ± standard deviation. Association between ordinal variables was tested by Fisher's exact test/Chi-square test whenever appropriate. Equality of means/median was tested by using paired/unpaired t-test or nonparametric tests depending upon the distribution of data. P ≤ 0.5 was considered statistically significant. Data analysis was performed using STATA version 13.04 windows. Results: Efficacy in terms of decrease in VAS ≥50% at 1 month was 33.33% and 83.33% in the PRF and CRF groups, respectively, which was statistically significant(P = 0.036). Effective reduction in BNI scores at the 7th day, 1 month, and 2 months postprocedure was evaluated and found in 41.67% and 83.33% of patients in the PRF and CRF groups, respectively, which was statistically insignificant (P = 0.089). There was a statistically significant reduction in BNI scores in PRF and CRF group patients at 3 and 6 months (at 3 months, 33.33% and 83.33%, P = 0.036 and at 6 months, 25% and 83.33%, P = 0.012). In the CRF group, mild hypoesthesia was evident in three patients which improved by the end of 1 month while no side effects were seen in the PRF group. Conclusion: CRF is a more effective procedure to decrease pain in comparison to long-duration, fixed voltage PRF for the treatment of idiopathic TGN. Although the side effects are more with CRF, they are mild and self-limiting. Limitation: The limitations of this study were as follows: small sample size and short duration. [ABSTRACT FROM AUTHOR]

Summary: Background: The efficacy of PRF for lumbar facet joint pain is not well established because comparative studies with other modes of management are sparse. Aim: The purpose of this study was to compare the efficacy of conventional radiofrequency (CRF) and pulsed radiofrequency (PRF) denervation in the treatment of lumbar facet joint pain. Methods: Lumbar facet joint pain was confirmed in 40 patients undergoing double medial branch blocks. Among them, 16 patients received CRF for pain management and 18 patients were offered PRF. Outcome was assessed before treatment and 3 months and 6 months after treatment. Changes in pain intensity were evaluated using a visual analog scale (VAS). Physical functioning was evaluated using a Revised Oswestry Disability Index (ODI). Results: In the CRF group, the VAS scores after treatment were significantly lower than before treatment at 3 months (p <0.001) and 6 months (p =0.001). The revised ODI scores after treatment were lower at 3 months (p <0.001) and 6 months (p =0.001). In the PRF group, the VAS scores after treatment were also lower at 3 month (p <0.001) and 6 months (p <0.001). The revised ODI scores after treatment were lower at 3 months (p <0.001) and 6 months (p <0.001). The VAS scores in the CRF group were significant lower than scores in PRF group at 3 month (p =0.01) and 6 months (p =0.03). The differences in revised ODI scores between the two groups at 3 months and 6 months were not significant. Conclusions: Both PRF and CRF resolved low back pain from lumbar facet joints. However, CRF was more effective than PRF. [ABSTRACT FROM AUTHOR]