A Letter Released to Podiatrists and General Practitioners on August 26, 2008

Radiofrequency Denervation
For Chronic Foot & Ankle Pain

Approximately 40% of adults in the US experience foot problems.¹ For many of them, the problems result in chronic pain that proves refractory to normal care. Because pain free ambulation is so crucial to most activities, chronic foot pain has strong potential to limit patients in their desired activities. My private, referral-based practice has many resources for helping your patients get relief from chronic pain. Radiofrequency denervation shows promise as a treatment capable of relieving otherwise refractory foot and ankle pain.

For more than a decade, physicians have used radiofrequency for pain relief.² The preponderance of published evidence to date (including multiple randomized, controlled trials) supports the efficacy of radiofrequency for controlling chronic pain of the neck and back.^2-11 Recently, Haider and colleagues published a study demonstrating the efficacy of radiofrequency in the upper extremity.¹²

Radiofrequency temporarily degenerates small diameter nociceptive fibers.^13,14 In lumbar facet pain, relief was measured to last a mean time of 10.5 months.⁴ Patients tolerate the procedure well. Insurance typically reimburses for radiofrequency. It can be performed on an outpatient basis, and it can provide lasting relief even in patients with long standing pain.

At my practice, I typically perform a combination of pulsed and constant radiofrequency to maximize the positive outcomes. The recommended treatment plan is 3 to 4 treatments per year. In recent months, I have performed radiofrequency for 15 cases of foot and ankle pain of varying etiologies. Radiofrequency proved successful in 70% of chronic foot and ankle pain cases (i.e. greater than a 30% reduction in pain lasting more than one month). These results are particularly encouraging considering that each of these patients were experiencing chronic pain that had proved refractory to normal care.

Call Neal S. Taub, MD, Physiatrist for
pain management & rehabilitation.

References

1. Karasick D, Wapner K. Hallus valgus deformity: preoperative radiologic assessment. AJR Am J Roentgenol 1990; 155: 119-23.
2. Rohof O. radiofrequency treatment of peripheral nerves. Pain Pract 2002; 2: 257-260.
3. Malik K, Benzon H. Pulsed radiofrequency: a critical review of its efficacy. Anaesth Intensive Care. 2007; 35(6): 863-73.
4. Schofferman J, Kine G. Effectiveness of repeated radiofrequency neurotomy for lumbar facet pain. 2004; 29(21): 2471-3.
5. Simopoulos T, Kraemer J, Nagda J, et al. Response to pulsed and continuous radiofrequency lesioning of the dorsal root ganglion and segmental nerves in patients with chronic lumbar radicular pain. Pain Physician. 2008; 11(2): 137-44.
6. Nath S, Nath C, Petterson K. Percutaneous lumbar zygapophysial (facet) joint neurotomy using radiofrequency current, in the management of chronic low back pain: A randomized double-blind trial. Spine. 2008; 33(12): 1291-1297.
7. Van Wijk R, Geurts J, Wynne H, et al. Radiofrequency denervation of lumbar facet joints in the treatment of chronic low back pain: a randomized, double-blind, sham lesion-control trial. Clin J Pain. 2005; 21(4): 335-44.
8. Martin D, Willis M, Mullinax L, et al. Pulsed radiofrequency application in the treatment of chronic pain. Pain Pract 2007; 7:31-35.
9. Van Zundert J, Patijn J, Kessels A, et al. Pulsed radiofrequency adjacent to the cervical dorsal root ganglion in chronic cervical radicular pain: a double blind sham controlled randomized clinical trial. Pain 2007; 127: 173-182.
10. Mikeladze G, Espinal R, Finnegan R, et al. Pulsed radiofrequency application in treatment of chronic zygapophyseal joint pain. Spine J 2003; 3:360-362.
11. Coohen S, Sireci A, Wu C, et al. Pulsed radiofrequency of the dorsal root ganglia is superior to pharmacotherapy or pulsed radiofrequency of the intercostals nerves in the treatment of chronic postsurgical thoracic pain. Pain Physician 2006; 9:227-235.
12. Haider N, Mekasha D, Chiravuri S, et al. Pulsed radiofrequency of the median nerve under ultrasound guidance. Pain Physician 2007; 10:765-770.
13. Hamann W, Abou-Sherif S, Thompson S, et al. Pulsed radiofrequency applied to dorsal root ganglia causes a selective increase in ATF3 in small neurons. Eur J Pain 2007; 10:171-176.
14. Takahashi N, Tasto J, Ritter M. Pain relief through an antinociceptive effect after radiofrequency application. Am J Sports Med. 2007 May; 35(5): 805-10.