Radiofrequency ablation for cancer-associated pain

Many treatment options are available for the management of cancer pain including drugs, local excision, radiation, brachytherapy, and nerve blocks. Percutaneous radiofrequency ablation has been used to treat painful neurologic and bone lesions and thus could potentially be used to treat cancer pain in other sites. Two superficial subcutaneous metastatic nodules were treated with percutaneous radiofrequency ablation. The patient received significant pain relief and improved quality of life.     

Transdermal fentanyl for pain control in adults with chronic cancer pain

The transdermal therapeutic system (TTS) for fentanyl is a drug-delivery system for use in patients with chronic pain who require an opioid analgesic. A multicentre, randomized, double-blind, placebo-controlled study was performed to evaluate the efficacy and safety of TTS-fentanyl as an analgesic for chronic cancer pain. One hundred and thirty-eight patients entered a 15-day dose-titration period, followed by a 9-day double-blind period (95 patients) with TTS-fentanyl or placebo. Fifty-five patients entered a follow-up period of indefinite duration. For the majority of patients, TTS-fentanyl 50–75 μg/h provided effective analgesia. Due to an unexpectedly high placebo response, it was not possible to show fentanyl to be statistically superior to placebo at the 5% significance level. Nine patients treated with fentanyl and 13 treated with placebo were withdrawn from the study during the double-blind therapy because of insufficient efficacy (not significant), while 66% of fentanyl-treated patients experienced effective pain control compared with 48% of placebo-treated patients (p = 0.071). During the course of the double-blind therapy, the mean dose of rescue morphine increased slightly more in the placebo group than in the fentanyl group. At the end of the double-blind phase, the investigators rated trial medication as being ‘good'; or ‘excellent'; in 30 patients in the fentanyl group and 23 in the placebo group. TTS-fentanyl appeared to be well tolerated, with a low incidence of constipation, somnolence and nausea. Due to an unexpectedly high placebo response it was not possible to demonstrate fentanyl to be statistically superior to placebo. This may reflect the practical difficulties of performing clinical trials in cancer patients with great inter-individual variability.     

Acute postoperative pain control for children with chronic disabilities

Children have historically been undertreated for pain. Children with chronic disabilities may face multiple, complex surgeries that cause severe postoperative pain. In addition, underlying problems with increased muscle tone can cause painful postoperative spasms. Gillette Children's Specialty Healthcare treats children with chronic disabilities. Our orthopaedic surgeons have developed a single surgical approach referred to as "multiple lower extremity procedures" (MLEPs) to correct the patient's primary, underlying orthopaedic deformities all under one anesthesia. Because of the intensity of postoperative pain caused by this approach, Gillette Children's uses epidural analgesia or patient-controlled/nurse-controlled analgesia to manage postoperative pain.     

Intraventricular morphine administration for control of chronic cancer pain

Twenty cancer patients with severe chronic pain have been treated with intraventricular morphine sulfate. Adequate pain relief until death was achieved in 10 patients; 1 patient has been treated for 9 months and is still being treated. In 2 patients, the effects of the morphine sulfate on their unilateral pelvic pain wore off after 4 and 6 months because of tumor progression. At that time, they underwent chordotomy procedures elsewhere. The treatment was discontinued in 4 patients for reasons other than inadequate pain relief, such as medical complications or resolution of pain. In 3 patients, the procedure was abandoned when emotional and psychological factors interfered with pain control. Dose requirements of intraventricular morphine sulfate varied greatly, depending on the total daily dose of systemic narcotic intake at the onset of the study. Intraventricular morphine sulfate is a feasible and reliable method to achieve pain relief in selected cancer patients with severe chronic pain when the maximum tolerated dose of systemic narcotic analgesics has become insufficient to control their pain.     

Radiofrequency ablation of incompetent perforator veins

Chronic venous insufficiency continues to be a major source of disability and cost, with accompanying socio-economic burdens. Incompetent perforator veins play a significant role in chronic venous insufficiency. This article describes the technique of radiofrequency ablation of incompetent perforating veins for patients with chronic venous insufficiency. Patient evaluation, the evolution of the treatment technique, and details of current treatment are provided. Radiofrequency ablation of incompetent perforating veins is feasible, has promising early results, and extends the armamentarium of minimally invasive venous treatments.     

Radiofrequency ablation of colorectal liver metastases

Background Untreated patients with colorectal liver metastases rarely survive 3 years, and the 3-year survival rate for patients treated with chemotherapy is 3%. The best survival rates are for the small subgroup that has operable disease, i.e., 39% at 5 years. Radiofrequency ablation (RFA) offers a new opportunity to destroy liver metastases in patients who are not surgical candidates because of disease distribution or comorbidity.Methods Acceptance criteria were a maximum of four or five liver lesions with a maximum diameter of 4 or 5 cm and no evidence of active extrahepatic disease. Nearly all treatments were performed percutaneously using ultrasound, computed tomography, or magnetic resonance imaging (or some combination) for guidance and monitoring. RFA is a minimally invasive procedure that can be readily repeated. General anesthesia facilitates the procedure but is not essential. Multiple overlapping ablations are required to ensure optimal treatment in all but the smallest tumors.Results In our cohort of 167 patients with colorectal liver metastases, 73 fulfilled the optimal acceptance criteria (5 or fewer tumors that were ≤ 5 cm). The median survival periods were 38 months, with a 5-year survival rate of 30%, after the diagnosis of liver metastases and 31 months, with a 5-year survival rate of 25%, after the first ablation.Conclusion RFA increases the therapeutic options for patients with colorectal metastases. Until controlled trials can better define the role of RFA, there are several groups of patients who are not surgical candidates and can be considered for RFA.     

Radiofrequency ablation: a nursing perspective

Radiofrequency ablation (RFA) has emerged as a safe and predictable technology for treating certain patients with cancer who otherwise have few treatment options. Nurses need to be familiar with all phases of the RFA procedure to create an optimal environment for patients. This article offers a brief review of the RFA procedure and nurses' responsibilities in caring for these patients. Before RFA, nurses should focus on patient education and aggressive hydration. During the procedure, nurses can prevent injury by placing grounding pads appropriately, monitoring vital signs, and medicating patients as needed. After RFA, nurses should assess the skin puncture site, provide adequate pain relief, and, again, hydrate patients. Nurses who care appropriately for RFA recipients may help to improve patient outcomes and make an otherwise frightening procedure more comfortable.     

Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial

Chronic osteoarthritis (OA) pain of the knee is often not effectively managed with current non-pharmacological or pharmacological treatments. Radiofrequency (RF) neurotomy is a therapeutic alternative for chronic pain. We investigated whether RF neurotomy applied to articular nerve branches (genicular nerves) was effective in relieving chronic OA knee joint pain. The study involved 38 elderly patients with (a) severe knee OA pain lasting more than 3 months, (b) positive response to a diagnostic genicular nerve block and (c) no response to conservative treatments. Patients were randomly assigned to receive percutaneous RF genicular neurotomy under fluoroscopic guidance (RF group; n = 19) or the same procedure without effective neurotomy (control group; n = 19). Visual analogue scale (VAS), Oxford knee scores, and global perceived effect on a 7-point scale were measured at baseline and at 1, 4, and 12 weeks post-procedure. VAS scores showed that the RF group had less knee joint pain at 4 (p < 0.001) and 12 (p < 0.001) weeks compared with the control group. Oxford knee scores showed similar findings (p < 0.001). In the RF group, 10/17 (59%), 11/17 (65%) and 10/17 (59%) achieved at least 50% knee pain relief at 1, 4, and 12 weeks, respectively. No patient reported a post-procedure adverse event during the follow-up period. RF neurotomy of genicular nerves leads to significant pain reduction and functional improvement in a subset of elderly chronic knee OA pain, and thus may be an effective treatment in such cases. Further trials with larger sample size and longer follow-up are warranted.     

Radiofrequency or neuromodulation treatment of chronic pain,when is it useful?

The management of chronic pain is challenging for the patient and the physician. Besides pharmacologic treatment pain therapists dispose of several minimal invasive interventional techniques. When used for the correct diagnosis and under the appropriate conditions, those techniques have been documented to provide pain relief and improve the patient's quality of life. Too often the use of interventional pain management techniques is postponed until all conservative treatment options fail to provide adequate pain relief or cause intolerable side effects. Evidence is starting to accumulate indicating that earlier use in the treatment algorithm may be beneficial for the patient in terms of pain relief, improved functionality and hence improved quality of life. Though little cost-effectiveness studies are available there are indications that the initial costs are recovered by the reduced medical needs. The interventional pain management techniques are commonly classified according to the degree of invasiveness: therapeutic blocks and epidural corticosteroid administration, (pulsed) radiofrequency techniques, spinal cord and peripheral nerve stimulation, motor cortex stimulation and spinal drug administration. In this article the place within the treatment algorithm of chronic pain for (pulsed) radiofrequency and neuromodulation techniques will be discussed.     

右心室流出道室性心动过速的射频消融治疗

目的 评价射频消融治疗右心室流出道室性心动过速(室速)的有效性和安全性.方法 对37例右心室流出道室速患者进行射频消融治疗,观察其疗效及安奎性,并随访观察复发的情况.结果 37例右心室流出道室速经射频消融治疗成功33例,成功率为89.2%,复发2例,无严重的并发症.结论 射频消融治疗右心室流出道室速是一种安全有效的治疗手段.