TY - JOUR
T1 - Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness
AU - Cohen, Steven P.
AU - Lee Peterlin, B.
AU - Fulton, Larry
AU - Neely, Edward T.
AU - Kurihara, Connie
AU - Gupta, Anita
AU - Mali, Jimmy
AU - Fu, Diana C.
AU - Jacobs, Michael B.
AU - Plunkett, Anthony R.
AU - Verdun, Aubrey J.
AU - Stojanovic, Milan P.
AU - Hanling, Steven
AU - Constantinescu, Octav
AU - White, Ronald L.
AU - McLean, Brian C.
AU - Pasquina, Paul F.
AU - Zhao, Zirong
N1 - Publisher Copyright:
© 2015 International Association for the Study of Pain.
PY - 2015
Y1 - 2015
N2 - Occipital neuralgia (ON) is characterized by lancinating pain and tenderness overlying the occipital nerves. Both steroid injections and pulsed radiofrequency (PRF) are used to treat ON, but few clinical trials have evaluated efficacy, and no study has compared treatments. We performed a multicenter, randomized, double-blind, comparative-effectiveness study in 81 participants with ON or migraine with occipital nerve tenderness whose aim was to determine which treatment is superior. Forty-two participants were randomized to receive local anesthetic and saline, and three 120 second cycles of PRF per targeted nerve, and 39 were randomized to receive local anesthetic mixed with deposteroid and 3 rounds of sham PRF. Patients, treating physicians, and evaluators were blinded to interventions. The PRF group experienced a greater reduction in the primary outcome measure, average occipital pain at 6 weeks (mean change from baseline-2.743 ± 2.487 vs-1.377 ± 1.970; P < 0.001), than the steroid group, which persisted through the 6-month follow-up. Comparable benefits favoring PRF were obtained for worst occipital pain through 3 months (mean change from baseline-1.925 ± 3.204 vs-0.541 ± 2.644; P 0.043), and average overall headache pain through 6 weeks (mean change from baseline-2.738 ± 2.753 vs-1.120 ± 2.1; P 0.037). Adverse events were similar between groups, and few significant differences were noted for nonpain outcomes. We conclude that although PRF can provide greater pain relief for ON and migraine with occipital nerve tenderness than steroid injections, the superior analgesia may not be accompanied by comparable improvement on other outcome measures.
AB - Occipital neuralgia (ON) is characterized by lancinating pain and tenderness overlying the occipital nerves. Both steroid injections and pulsed radiofrequency (PRF) are used to treat ON, but few clinical trials have evaluated efficacy, and no study has compared treatments. We performed a multicenter, randomized, double-blind, comparative-effectiveness study in 81 participants with ON or migraine with occipital nerve tenderness whose aim was to determine which treatment is superior. Forty-two participants were randomized to receive local anesthetic and saline, and three 120 second cycles of PRF per targeted nerve, and 39 were randomized to receive local anesthetic mixed with deposteroid and 3 rounds of sham PRF. Patients, treating physicians, and evaluators were blinded to interventions. The PRF group experienced a greater reduction in the primary outcome measure, average occipital pain at 6 weeks (mean change from baseline-2.743 ± 2.487 vs-1.377 ± 1.970; P < 0.001), than the steroid group, which persisted through the 6-month follow-up. Comparable benefits favoring PRF were obtained for worst occipital pain through 3 months (mean change from baseline-1.925 ± 3.204 vs-0.541 ± 2.644; P 0.043), and average overall headache pain through 6 weeks (mean change from baseline-2.738 ± 2.753 vs-1.120 ± 2.1; P 0.037). Adverse events were similar between groups, and few significant differences were noted for nonpain outcomes. We conclude that although PRF can provide greater pain relief for ON and migraine with occipital nerve tenderness than steroid injections, the superior analgesia may not be accompanied by comparable improvement on other outcome measures.
KW - Headache
KW - Occipital neuralgia
KW - Pulsed radiofrequency
KW - Steroid injection
UR - http://www.scopus.com/inward/record.url?scp=84965019205&partnerID=8YFLogxK
U2 - 10.1097/j.pain.0000000000000373
DO - 10.1097/j.pain.0000000000000373
M3 - Article
C2 - 26447705
AN - SCOPUS:84965019205
SN - 0304-3959
VL - 156
SP - 2585
EP - 2594
JO - Pain
JF - Pain
IS - 12
ER -