Pulsed Radiofrequency Treatment: Evidence for and Applications in Chronic Pain

Abstract

BACKGROUND: Pulsed radiofrequency (PRF) is a neuromodulatory technique that has been widely used for pain management and has recently gained attention as a nondestructive alternative to conventional radiofrequency ablation (RFA), particularly for peripheral neuropathic pain. Over the past decade, PRF has been increasingly investigated for its potential benefits in various chronic pain conditions. OBJECTIVE: This review aims to summarize the fundamental principles, mechanisms of action, available evidence, and clinical applications of PRF in chronic pain management. STUDY DESIGN: Narrative review. METHODS: A comprehensive literature search was conducted using PubMed, Scopus, and Google Scholar for studies on PRF published up to 2024. Key words included "pulsed radiofrequency," "pulse radiofrequency," "pulsed RF," and "pulse RF." Relevant case reports, case series, observational studies, randomized controlled trials (RCTs), meta-analyses, systematic reviews, and review articles were included. RESULTS: PRF has shown promising results in managing various neuropathic pain conditions, particularly radicular pain and postherpetic neuralgia. Clinical evidence also supports its effectiveness in trigeminal neuralgia, occipital neuralgia, cervicogenic headache, chronic migraine, meralgia paresthetica, pudendal neuralgia, and coccygodynia, as well as musculoskeletal conditions such as knee osteoarthritis and shoulder pain. Emerging applications, including intraarticular and transcutaneous PRF, have demonstrated potential benefits. Adjusting PRF settings, such as high-voltage PRF, extended-duration PRF, and pulsed dose radiofrequency, may further enhance treatment effectiveness, though additional validation is needed. LIMITATIONS: This review is narrative in nature and not a systematic analysis. The included studies vary in quality, ranging from case reports to systematic reviews, depending on the availability of research for each condition. Additionally, significant heterogeneity exists in PRF methodologies, treatment parameters, and outcome measures, with a lack of standardized protocols contributing to variability in clinical outcomes. CONCLUSION: PRF is a safe, non-ablative technique that modulates pain through electrical fields. It has demonstrated effectiveness in neuropathic pain, particularly radicular pain and postherpetic neuralgia. PRF offers long-term pain relief with minimal risks, though further research is needed to optimize its parameters and expand its applications in chronic pain management.