McCormick, Zachary L

Abstract Background Radiofrequency ablation (RFA) of neuromas has emerged as a potential treatment option for refractory neuroma‐associated postamputation pain (PAP). Objective To evaluate the feasibility of using internally cooled radiofrequency ablation (C‐RFA) for treating neuroma‐associated PAP. Design Prospective single‐arm pilot study. Setting Tertiary academic medical center. Participants Eight participants with neuroma‐associated PAP (mean age 56.5 [ interquartile range, 50.5–68.5] years; mean body mass index 30.2 [ interquartile range, 26.3–34.8] kg/m 2 ). Intervention Participants were recruited and treated with C‐RFA between 2019 and 2023. Main Outcome Measures Pain and functional outcomes were assessed at 1, 3, 6, and 12 months after C‐RFA using Numeric Rating Scale (NRS), Groningen Activity Restriction Scale (GARS), Patient Global Impression of Change (PGIC), and Medication Quantification Scale III (MQS‐III). Responder definitions for each outcome measure were ≥50% NRS reduction, ≥30% GARS improvement, ≥6 on PGIC, and ≥6.8‐point MQS‐III reduction. Results NRS responder rates at 1, 3, 6, and 12 months were 25.0% (95% CI, 7.0%–59.1%), 50.0% (95% CI, 21.5%–78.5%), 37.5% (95% CI, 13.7%–69.4%), and 50.0% (95% CI, 21.5%–78.5%), respectively. Responder rates for GARS were 25.0% (95% CI, 7.1%–59.1%) at 1 month and 12.5% (95% CI, 2.2%–47.1%) at 3, 6, and 12 months. The proportion of PGIC responders was 37.5% (95% CI, 13.7%–69.4%) at 1 and 3 months and 12.5% (95% CI, 2.2%–47.1%) at 6 and 12 months. MQS‐III responder rates were 25.0% (95% CI, 7.1%–59.1%) at 1 month, 12.5% (95% CI, 2.2%–47.1%) at 3 months, and 37.5% (95% CI, 13.7%–69.4%) at 6 and 12 months. There were no complications associated with the C‐RFA procedure. Conclusions These findings indicate the feasibility of neuroma C‐RFA as a treatment for refractory neuroma‐associated PAP but also suggest that further patient selection and C‐RFA technique optimization are warranted before investigating this treatment paradigm in a larger prospective study.

Abstract Objective The aim of this study was to evaluate the efficacy and safety of a 60‐day peripheral nerve stimulation (PNS) treatment targeting the occipital nerves for reducing pain and improving function in individuals diagnosed with cervicogenic headache or occipital neuralgia. Background Headache conditions are prevalent and commonly disabling, and conventional therapeutic strategies are often insufficient. Development of a percutaneous 60‐day PNS treatment has created new opportunities to evaluate PNS of the occipital nerves. Methods This study was an institutional review board‐approved, multicenter, prospective, single‐arm study that enrolled participants from October 2022 to March 2024. Participants with cervicogenic headache or occipital neuralgia received a 60‐day PNS treatment targeting the occipital nerves. The primary endpoint was the proportion reporting clinically significant (≥30%) reductions in average pain and/or pain interference at end of treatment (EOT). Additional analysis included the proportion of participants with ≥50% reduction in average pain intensity and/or pain interference and additional outcomes including Patient Global Impression of Change, six‐item Headache Impact Test, and Neck Disability Index. Results At EOT, 90% of participants (18/20) met the primary endpoint. Further, 85% (17/20) and 83% (15/18) reported ≥50% reductions in pain and/or pain interference at EOT and 3 months, respectively. Clinically meaningful improvements were observed in functional and headache‐related disability and quality‐of‐life measures. All study‐related adverse events were non‐serious. Conclusion Most participants reported significant reductions in pain and/or pain interference following 60‐day PNS targeting the occipital nerves. Outcomes through 3 months demonstrate how 60‐day PNS offers an effective approach for the treatment of headache.

AbstractRecently, basivertebral nerve (BVN) radiofrequency ablation has been developed for the treatment of chronic low back pain (CLBP) thought to arise from the vertebral body endplates (VEPs). This review describes the relevant neuroanatomy and pathobiology of VEP degeneration and injury, imaging correlates of presumed VEP pain, randomized controlled trials performed, appropriate patient selection, and safety. Anatomic, histological, and clinical evidence supports the concept of the VEP as a source of CLBP and the nociceptive role of the BVN. BVN radiofrequency ablation appears to be an effective treatment for a subset of patients with CLBP and evidence of Modic change types 1 and 2 in the L3 to S1 VEPs who have failed to respond to conservative treatment. However, all studies performed to date have been industry sponsored, and future non–industry-funded trials will be needed to confirm these results.