Open AccessPulsed Compared to Thermal Radiofrequency to the Medial Calcaneal Nerve for Management of Chronic Refractory Plantar Fasciitis: A Prospective Comparative Study
Author(s) -
Ayman Mamdouh Osman,
Dina Elhammady,
Mamdouh Ali Kotb
Publication year - 2016
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj/2016.19.e1181
Subject(s) - medicine , pulsed radiofrequency , plantar fasciitis , heel , refractory (planetary science) , orthopedic surgery , prospective cohort study , patient satisfaction , anesthesia , surgery , physical therapy , pain relief , physics , astrobiology , anatomy
Background: Radiofrequency (RF) treatment is a minimally invasive procedure that hasbeen used for more than 3 decades in treating various chronic pain syndromes. Conventional(continuous) RF treatment occasionally results in worsening or even initiating a new type ofpain. The use of pulsed radiofrequency (PRF), which has a non- or minimally neurodestructiveneuromodulatory effect, serves as an alternative to conventional RF therapy in many medicalsituations.Objectives: To evaluate the effect of applying PRF for 6 minutes vs. thermal radiofrequency(TRF) for 90 seconds to the medial calcaneal nerve for treatment of chronic refractory plantarfasciitis pain.Study Design: Prospective comparative study.Setting: Pain, Orthopedic, and Rheumatology and Rehabilitation Clinics of Assiut UniversityHospital.Methods: Twenty patients with refractory chronic bilateral plantar fasciitis received PRF tothe medial calcaneal nerve for 6 minutes for one heel and TRF to the same nerve on the otherheel (as their own control) for 90 seconds. Numerical verbal rating scale (NVRS) at waking upfrom bed and after prolonged walking, and satisfaction score were used for assessment ofstudied patients at one, 3, 6, 12, and 24 weeks from the intervention.Results: All studied patients showed significant improvement in their pain scale after theintervention that lasted for 24 weeks; however, the PRF heels had significantly better painscale and satisfaction scores at the first and third weeks assessments when compared to theTRF heels. Effective analgesia was achieved after one week or less after PRF compared to 3weeks for the TRF (P < 0.001).Limitations: No randomization.Conclusions: PRF to the medial calcaneal nerve is a safe and effective method for treatmentof chronic plantar fasciitis pain. The onset of effective analgesia can be achieved more rapidlywith PRF compared to TRF on the same nerve. Further randomized trials are needed to confirmthe therapeutic effect and optimizing the dose of RF needed.Key words: Pulsed radiofrequency, thermal radiofrequency, medial calcaneal nerve, plantarfasciitis, plantar aponeurosis, visual analogue scale