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ORIGINAL ARTICLES
Pulsed Radiofrequency for the Treatment of Occipital Neuralgia: A Prospective Study With 6 Months of Follow-Up
  1. Pascal Vanelderen, MD*,†,
  2. Tom Rouwette, DS‡,
  3. Pieter De Vooght, MD*,
  4. Martine Puylaert, MD*,
  5. René Heylen, MD, PhD*,
  6. Kris Vissers, MD, PhD† and
  7. Jan Van Zundert, MD, PhD*,§
  1. From the *Department of Anesthesiology, Intensive Care Medicine, Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium;
  2. †Department of Anesthesiology, Palliative and Chronic Pain Therapy, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;
  3. ‡Department of Cellular Animal Physiology, Faculty of Science, Radboud University Nijmegen, Nijmegen, The Netherlands; and
  4. §Department of Anesthesiology, University Hospital of Maastricht, Maastricht, The Netherlands.
  1. Address correspondence to: Pascal Vanelderen, MD, Ziekenhuis Oost-Limburg, Campus A. Dumont, Stalenstraat 2, 3600 Genk, Belgium (e-mail: pascal.vanelderen{at}gmail.com).

Abstract

Background and Objectives: Occipital neuralgia is a paroxysmal nonthrobbing, stabbing pain in the area of the greater or lesser occipital nerve caused by irritation of these nerves. Although several therapies have been reported, no criterion standard has emerged. This study reports on the results of a prospective trial with 6 months of follow-up in which pulsed radiofrequency treatment of the greater and/or lesser occipital nerve was used to treat this neuralgia.

Methods: Patients presenting with clinical findings suggestive of occipital neuralgia and a positive test block of the occipital nerves with 2 mL of local anesthetic underwent a pulsed radiofrequency procedure of the culprit nerves. Mean scores for pain, quality of life, and medication intake were measured 1, 2, and 6 months after the procedure. Pain was measured by the visual analog and Likert scales, quality of life was measured by a modified brief pain questionnaire, and medication intake was measured by a Medication Quantification Scale.

Results: During a 29-month period, 19 patients were included in the study. Mean visual analog scale and median Medication Quantification Scale scores declined by 3.6 units (P = 0.002) and 8 units (P = 0.006), respectively, during 6 months. Approximately 52.6% of patients reported a score of 6 (pain improved substantially) or higher on the Likert scale after 6 months. No complications were reported.

Conclusions: Pulsed radiofrequency treatment of the greater and/or lesser occipital nerve is a promising treatment of occipital neuralgia. This study warrants further placebo-controlled trials.

https://doi.org/10.1097/AAP.0b013e3181d24713

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