PRF
Re: PRF
Kathy, fly to Denver! I get treated like a princess at Denver pain management. Nerve block and 2 days later prf
PN after using pickaxe doing yardwork 6/11
Potter MRI: Scar tissue abutting L pudendal.
Hibner consult 10/11 w/ plan: 2 mo. PT
No meds work for me
PRF X 3 times in Denver ( was pain free for 5 months after second)
Potter MRI: Scar tissue abutting L pudendal.
Hibner consult 10/11 w/ plan: 2 mo. PT
No meds work for me
PRF X 3 times in Denver ( was pain free for 5 months after second)
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Dr. Jason G. Attaman
- Posts: 54
- Joined: Sun Jan 11, 2015 8:56 pm
- Location: Seattle, Washington State, USA
- Contact:
Re: PRF aka Pulsed Radiofrequency Treatment of the Pudendal
I have performed pulsed radiofrequency treatment (PRF) to patients for many years. I also perform thermal radiofrequency treatment or radiofrequency ablation/neurotomy, which is by far the most common type of radiofrequency treatment in use.
The terminology is very confusing. Pulsed radiofrequency is a neuromodulatory procedure, meaning that it helps the nerves function better, and it does not harm the nerves. The needle is heated to no more than 42 deg C. Anything over this temperature will lead to destruction of the nerve. The mechanism of action in PRF is NOT heat, but rather electromagnetic fields created by the radiofrequency generator. PRF is listed as procedure code 64999, and as such is not paid for by 99% of insurance plans in the USA. This is very unfortunate, and necessitates that ethical physicians must charge patients directly for the procedure lest they be prosecuted for fraud for billing insurance companies for a procedure that they do not cover.
Continuous radiofrequency treatment/ablation/neurotomy is a DESTRUCTIVE procedure in which a section of nerve is heated to at least 60 deg C and destroyed by heat. It does harm the nerves and does not help them function better, rather it shuts them down. There are many excellent uses for this procedure, but it is RARELY used for pudendal neuralgia. This is primarily because the pudendal nerve can contribute some motor innervation to the rectal muscles. Destroying the pudendal nerve could lead to difficulties controlling your rectum and lead to incontinence issues. While I have performed this procedure in very select circumstances, it is rarely done.
Therefore for nerves such as the pudendal nerve, we generally use the pulsed mode.
I have used pulsed radiofreqeuncy treatment for various refractory nerve pain issues with generally good success. The literature on pulsed radiofrequency is not as extensive as continuous radiofrequency treatment, unfortunately.
"2009;12;633-638. Successful Treatment of Refractory Pudendal Neuralgia with Pulsed Radiofrequency
Case Report
Ellen E. Rhame, MD, Kenneth A. Levey, MD, and Christopher G. Gharibo, MD
Pudendal neuralgia (PN) involves severe, sharp pain along the course of the pudendal nerve, often aggravated with sitting. Current therapies include medication management, nerve blocks, decompression surgery, and neuromodulation. The ideal management for PN has not been determined.
We present a case of a female with 1.5 years of sharp, burning pain of the left gluteal and perineal regions. She could not sit for longer than 10 to 15 minutes. Sacroiliac joint, epidural, and piriformis injections did not improve her pain. She had tried physical therapy, occupational therapy, massage, and acupuncture but the pain persisted. Medication treatment with oxycodone-acetaminophen, extended release morphine sulfate, amitriptyline, and gabapentin provided only minor relief and she had failed other multianalgesic therapy. She had been unable to work at her desk job for over a year. She had a positive response to 2 diagnostic pudendal nerve blocks with lidocaine that provided pain relief for several hours. This patient elected to undergo pulsed radiofrequency (PRF) of the left pudendal nerve in hopes of achieving a longer duration and improved pain relief. PRF was carried out at a frequency of 2 Hz and a pulse width of 20 milliseconds for a duration of 120 seconds at 42 degrees Celsius. After the procedure she reported tolerating sitting for 4 to 5 hours. Her multianalgesic therapy was successfully weaned. At 5 months follow-up she felt motivated to return to work. One and a half years after the procedure the patient is only taking oxycodone-acetaminophen for pain relief and still has good sitting tolerance. There were no procedure-related complications.
To our knowledge PRF for the treatment of PN has not been reported elsewhere in the literature. PRF is a relatively new procedure and is felt to be safer than continuous radiofrequency. Current literature suggests that PRF delivers an electromagnetic field, which modifies neuro-cellular function with minimal cellular destruction. We conclude that PRF of the pudendal nerve offers promise as a potential treatment of PN that is refractory to conservative therapy."
"Christopher Bui,1 Sanjog Pangarkar,2 and Scott I. Zeitlin3
1 Department of Physical Medicine and Rehabilitation, West Los Angeles Veterans Administration/UCLA, Los Angeles, CA 90073, USA 2 Department of Physical Medicine and Rehabilitation, West Los Angeles Veterans Administration, California Pain Medicine Centers,
Los Angeles, CA 90073, USA
3 Department of Urology, Department of Ob/Gyn, David Geffen School of Medicine at UCLA, Los Angeles, CA 90073, USA
Correspondence should be addressed to Christopher Bui; chrisbui.ucla@gmail.com
Received 5 February 2013; Accepted 5 March 2013
Academic Editors: L. Henningsohn, J. Park, and F. M. Solivetti
Copyright © 2013 Christopher Bui et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background and Aims. This report demonstrates the utility of a pudendal nerve block by pulsed radiofrequency ablation (RFA) for the treatment of male pelvic pain and urinary urgency and hesitancy. Methods. The patient is an 86-year-old gentleman with a 30- year history of urinary hesitancy and urgency. The patient also had pain in the area of the perineum but considered it a secondary issue. The patient was seen by a number of specialists, tried various medications, and underwent a variety of procedures to no avail. Therefore, the patient underwent a pulsed RFA of the pudendal nerve. Results. The patient underwent a pulsed RFA of the pudendal nerve; the patient reported marked improvement in his pelvic pain as well as a drastic reduction in his urinary urgency and hesitancy. Conclusion. Urinary urgency and hesitancy and male pelvic pain are some of the most common symptoms affecting men. Pudendal nerve block by pulsed RFA is an effective treatment of pelvic pain. It may also hold some therapeutic value in the treatment of urinary urgency and hesitancy as our case demonstrated. Further studies are needed to help clarify both the anatomy of the pelvis as well as if pudendal blocks are effective in treating more than pelvic pain."
The terminology is very confusing. Pulsed radiofrequency is a neuromodulatory procedure, meaning that it helps the nerves function better, and it does not harm the nerves. The needle is heated to no more than 42 deg C. Anything over this temperature will lead to destruction of the nerve. The mechanism of action in PRF is NOT heat, but rather electromagnetic fields created by the radiofrequency generator. PRF is listed as procedure code 64999, and as such is not paid for by 99% of insurance plans in the USA. This is very unfortunate, and necessitates that ethical physicians must charge patients directly for the procedure lest they be prosecuted for fraud for billing insurance companies for a procedure that they do not cover.
Continuous radiofrequency treatment/ablation/neurotomy is a DESTRUCTIVE procedure in which a section of nerve is heated to at least 60 deg C and destroyed by heat. It does harm the nerves and does not help them function better, rather it shuts them down. There are many excellent uses for this procedure, but it is RARELY used for pudendal neuralgia. This is primarily because the pudendal nerve can contribute some motor innervation to the rectal muscles. Destroying the pudendal nerve could lead to difficulties controlling your rectum and lead to incontinence issues. While I have performed this procedure in very select circumstances, it is rarely done.
Therefore for nerves such as the pudendal nerve, we generally use the pulsed mode.
I have used pulsed radiofreqeuncy treatment for various refractory nerve pain issues with generally good success. The literature on pulsed radiofrequency is not as extensive as continuous radiofrequency treatment, unfortunately.
"2009;12;633-638. Successful Treatment of Refractory Pudendal Neuralgia with Pulsed Radiofrequency
Case Report
Ellen E. Rhame, MD, Kenneth A. Levey, MD, and Christopher G. Gharibo, MD
Pudendal neuralgia (PN) involves severe, sharp pain along the course of the pudendal nerve, often aggravated with sitting. Current therapies include medication management, nerve blocks, decompression surgery, and neuromodulation. The ideal management for PN has not been determined.
We present a case of a female with 1.5 years of sharp, burning pain of the left gluteal and perineal regions. She could not sit for longer than 10 to 15 minutes. Sacroiliac joint, epidural, and piriformis injections did not improve her pain. She had tried physical therapy, occupational therapy, massage, and acupuncture but the pain persisted. Medication treatment with oxycodone-acetaminophen, extended release morphine sulfate, amitriptyline, and gabapentin provided only minor relief and she had failed other multianalgesic therapy. She had been unable to work at her desk job for over a year. She had a positive response to 2 diagnostic pudendal nerve blocks with lidocaine that provided pain relief for several hours. This patient elected to undergo pulsed radiofrequency (PRF) of the left pudendal nerve in hopes of achieving a longer duration and improved pain relief. PRF was carried out at a frequency of 2 Hz and a pulse width of 20 milliseconds for a duration of 120 seconds at 42 degrees Celsius. After the procedure she reported tolerating sitting for 4 to 5 hours. Her multianalgesic therapy was successfully weaned. At 5 months follow-up she felt motivated to return to work. One and a half years after the procedure the patient is only taking oxycodone-acetaminophen for pain relief and still has good sitting tolerance. There were no procedure-related complications.
To our knowledge PRF for the treatment of PN has not been reported elsewhere in the literature. PRF is a relatively new procedure and is felt to be safer than continuous radiofrequency. Current literature suggests that PRF delivers an electromagnetic field, which modifies neuro-cellular function with minimal cellular destruction. We conclude that PRF of the pudendal nerve offers promise as a potential treatment of PN that is refractory to conservative therapy."
"Christopher Bui,1 Sanjog Pangarkar,2 and Scott I. Zeitlin3
1 Department of Physical Medicine and Rehabilitation, West Los Angeles Veterans Administration/UCLA, Los Angeles, CA 90073, USA 2 Department of Physical Medicine and Rehabilitation, West Los Angeles Veterans Administration, California Pain Medicine Centers,
Los Angeles, CA 90073, USA
3 Department of Urology, Department of Ob/Gyn, David Geffen School of Medicine at UCLA, Los Angeles, CA 90073, USA
Correspondence should be addressed to Christopher Bui; chrisbui.ucla@gmail.com
Received 5 February 2013; Accepted 5 March 2013
Academic Editors: L. Henningsohn, J. Park, and F. M. Solivetti
Copyright © 2013 Christopher Bui et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background and Aims. This report demonstrates the utility of a pudendal nerve block by pulsed radiofrequency ablation (RFA) for the treatment of male pelvic pain and urinary urgency and hesitancy. Methods. The patient is an 86-year-old gentleman with a 30- year history of urinary hesitancy and urgency. The patient also had pain in the area of the perineum but considered it a secondary issue. The patient was seen by a number of specialists, tried various medications, and underwent a variety of procedures to no avail. Therefore, the patient underwent a pulsed RFA of the pudendal nerve. Results. The patient underwent a pulsed RFA of the pudendal nerve; the patient reported marked improvement in his pelvic pain as well as a drastic reduction in his urinary urgency and hesitancy. Conclusion. Urinary urgency and hesitancy and male pelvic pain are some of the most common symptoms affecting men. Pudendal nerve block by pulsed RFA is an effective treatment of pelvic pain. It may also hold some therapeutic value in the treatment of urinary urgency and hesitancy as our case demonstrated. Further studies are needed to help clarify both the anatomy of the pelvis as well as if pudendal blocks are effective in treating more than pelvic pain."
Re: PRF
Pulsed radiofrequency neuromodulation immediately made me worse, I mean literally as I stepped out of the hospital. The pain was bad for 2 months afterwards before it started to subside and after that other symptoms started to reccur. A total disaster as far as I'm concerned....
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Dr. Jason G. Attaman
- Posts: 54
- Joined: Sun Jan 11, 2015 8:56 pm
- Location: Seattle, Washington State, USA
- Contact:
Re: PRF
Pulsed radiofrequency treatment can be an excellent option for pudendal neuralgia, but it is not covered by 99% of insurance plans FYI. That is rather unfortunate.
Re: PRF
Sorry to hear it didn't help you, Bob. Thanks for the feedback. I wish you the best in finding a treatment that helps.
Violet
Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
Re: PRF
Well Bob, maybe this physician you are referring to has helped many other people. I don't know anyone who can cure every case of PN. But I have said before on this forum that PRF has mixed reviews and I think the information is out there for people to know that there isn't a 100% guarantee for any therapies used to treat PN.
There are some things that medicine cannot cure. We are all, after all, going to die some day and no one will be able to cure us. Does that mean we shouldn't try anything -- because there isn't a 100% guarantee of a cure? What if there is a chance of improvement?
Violet
There are some things that medicine cannot cure. We are all, after all, going to die some day and no one will be able to cure us. Does that mean we shouldn't try anything -- because there isn't a 100% guarantee of a cure? What if there is a chance of improvement?
Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.