Pulsed radiofrequency of the dorsal root ganglia is superior to pharmacotherapy or pulsed radiofrequency of the intercostal nerves in the treatment of chronic postsurgical thoracic pain

Background: Chronic postsurgical thoracic pain (CPTP) represents a major therapeutic challenge characterized by an absence of clinical studies to guide treatment. Recently, the implementation of pulsed radiofrequency (RF) has generated intense interest in the medical community as a safe and potentially effective treatment for neuropathic pain. To date, there are no studies comparing pulsed RF to more conventional therapeutic modalities for any pain condition. Objectives: To compare treatment outcomes between pharmacotherapy, pulsed RF of the intercostal nerves (ICN) and pulsed RF of the dorsal root ganglia (DRG) in CPTP. Methods: Retrospective data analysis involving 49 patients. Results: At 6-week follow-up, 61.5% of the pulsed RF DRG group reported ≥ 50% pain relief vs. 27·3% in the medical management (MM) group and 21·4% in the ICN group (P=0·12). At 3-month follow-up, 53·8% in the DRG group continued to report ≥ 50% pain relief vs. 19·9% in the MM and 6·7% in the ICN groups, respectively (P=0·02). Among the pulsed RF patients who did report a successful outcome, the mean duration of pain relief was 2·87 months in the ICN group and 4·74 months in the DRG group (P=0·01). Conclusions: Pulsed RF of the DRG was a superior treatment to pharmacotherapy and pulsed RF of the ICN in patients with CPTP. Prospective studies are needed to confirm these results and identify the best candidates for this treatment.