A Letter Released to Medical Practitioners on
August 29, 2010

Current Research in Radiofrequency and
Chronic Shoulder Pain

Radiofrequency denervation refers to a treatment wherein practitioners insert a fine electrode into the skin. The skin is first anesthetized. A high frequency current emitted by the electrode creates a very precise lesion that can temporarily degenerate small diameter nociceptive fibers. The denervation creates pain relief that typically lasts for three or more months. The process avoids the basal lamina to allow for nerve regeneration. At my practice, before administering radiofrequency treatments, we can use a phenol injection to the targeted nerve to first verify that neurolysis of that nerve will create pain relief.

We have previously written to you about the success of radiofrequency denervation in the treatment of intractable low back pain and chronic foot and ankle pain. In 2009 and 2010, four new studies concerning radiofrequency for chronic shoulder pain were published.^1-4 In each study, radiofrequency was applied to the suprascapular nerve. In each study, radiofrequency created significant pain relief and improved function for close to 80% of patients. Pain relief lasted more than three months. Steroid injection combined with radiofrequency produced no additional effect.² When steroid injections work independently, they seem to produce greater analgesic effect than radiofrequency alone.¹ For this reason, practitioners may consider steroid injections for shoulder pain before radiofrequency. However, radiofrequency was shown effective in chronic shoulder pain cases that proved refractory to other treatments.³ Therefore, radiofrequency may be considered when steroids, activity modification, and physical therapy have not produced the desired degree of pain relief.

In cases of chronic shoulder pain and other pain conditions, radiofrequency serves as just one of the many treatments and services available to patients you refer. Possibilities include:

• Ultrasound diagnostics
• Chemical nerve block
• Ultrasound guided steroid injections
• Therapeutic yoga
• Medical acupuncture
• Medication review / medication management
• Topical analgesics
• Activity modification
• Rehabilitation management
• Trigger point injections
• Other non-surgical pain management solutions
  

References

1. Eyigor C, Eyigor S, Korkmaz O, Uyar M. Intra-articular corticosteroid injections versus pulsed radiofrequency in painful shoulder: a prospective, randomized, single-blinded study. Clin J Pain. 2010 Jun; 26 (5): 386-92.
2. Gabrheilik T, Michaelek P, Adamus M, et al. Effeect of pulsed radiofrequency therapy on the suprascapular nerve in shoulder pain of various aetiology. Ir J Med Sci. 2010 June 5. [Epub ahead of print].
3. Keskinbora K, Aydinli I. Long-term results of suprascapular pulsed radiofrequency in chronic shoulder pain. Agri [Turkish]. 2009 Jan; 21 (1): 16-21.
4. Liliang P, Lu K, Liang C, et al. Pulsed radiofrequency lesioning of the suprascapular nerve for chronic shoulder pain: a preliminary report. Pain Med. 2009 Jan; 10 (1): 70-5.