Ultrasound-guided pulsed radiofrequency (PRF) neuromodulation of the suprascapular nerve combined with the injection of short-acting corticosteroids may safely and effectively relieve chronic shoulder pain for up to 24 weeks, according to study results published in Pain Practice.
Anesthetic block of the suprascapular nerve often provides brief periods of relief in patients with chronic shoulder pain. When a suprascapular nerve block is deemed insufficient, neurolysis may be required, and PRF may be used for improved outcomes with longer-lasting relief, in the absence of damage to surrounding tissues. Investigators sought to assess the safety and efficacy of PRF under ultrasound guidance for the management of chronic shoulder pain.
A total of 30 patients aged 18 to 75 years with chronic shoulder pain were asked to rate their pain using a 0 to 10 visual analog scale (VAS) and evaluated for active range of motion of the affected shoulder upon flexion, extension, abduction, adduction, internal rotation, and external rotation using a goniometer. Participants then underwent diagnostic suprascapular nerve blocks using 1% lignocaine (2 mL) and patients who reported >50% pain relief post-block (n=28) were scheduled to receive PRF of the suprascapular nerve 2 weeks later.
Of the initial 30 participants, 27 received PRF and were included for analysis. After infiltration with 2 mL of 1% lignocaine, 3 cycles of PRF were applied at 42°C for 120 seconds. After PRF completion, the suprascapular nerve area was bathed in 4 mg of dexamethasone to prevent neuritis. Pain and range of motion were assessed immediately after the PRF procedure combined with corticosteroids (day 0), and at 4, 8, 12, and 24 weeks post-procedure.
Patients reported a significant reduction in pain on VAS (P <.05) immediately following the procedure, an effect which was attributed to the dexamethasone injection, with sustained pain reduction through 24 weeks, which was attributed to the PRF procedure. There were also significant increases in active range of motion in all directions (P <.05 for all) after the combination of PRF and steroid injection. No neuritis or deafferentation were observed in any of the patients, and mild discomfort related to the procedure was the only reported adverse event during the study.
Study limitations include its single arm design, small sample size, and the lack of assessment of patient quality of life.
“PRF treatment of suprascapular nerve may be an alternative method of providing prolonged relief for chronic shoulder pain,” concluded the authors.
Sinha P, Sarkar B, Goswami S, Karmakar PR, Dasgupta SR, Basu S. Effectiveness of combination of ultrasonography guided pulsed radiofrequency neuromodulation and block with short acting corticosteroid of suprascapular nerve in chronic shoulder pain. Pain Pract. July 2019. doi:10.1111/papr.12820