Ultrasound Guided PRF for Occipital Neuralgia. Ali Zahran, MD Pain Fellow, McMaster University

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Reginald Stevenson
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1 Ultrasound Guided PRF for Occipital Neuralgia Ali Zahran, MD Pain Fellow, McMaster University

2 Background: Occipital neuralgia (ON) is described as paroxysmal pain in the distribu9on of the greater or lesser occipital nerves or of the third occipital nerve Occipital neuralgia [G52.80] IHS. The most common cause of occipital neuralgia is irrita9on of the greater occipital nerve (GON) or lesser occipital nerve (LON). This can be due to a variety of vascular, neurogenic or musculo- skeletal pathologies.

3 Background The GON is more frequently involved (90%) than the LON (10%). In 8.7% of pa9ents, both the GON and LON are responsible for ON. Hammond, S.R. and G. Danta, Occipital neuralgia.clin Exp Neurol, : p The ON could be due to cervical trauma to the GON or LON, such as in whiplash injuries. Other poten9al e9ologies include compression of the occipital nerves by degenera9ve cervical spine changes, cervical disc disease, and tumors affec9ng the C2 and C3 nerve roots. Vanelderen, P., et al., 8. Occipital neuralgia. Pain Pract, (2): p

4 Background Current opcons for management include : Physio/manual therapy, transcutaneous electrical nerve s9mula9on (TENS). Pharmalogical treatments that may include NSAIDs, tricyclic an9depressents and an9epilep9cs. Interven9onal treatments include infiltra9on with local anesthe9cs and cor9costeroids or botulinum toxin A, subcutaneous neuros9mula9on, and PRF. Van Suijlekom, H., et al., 6. Cervicogenic headache. Pain Pract, (2): p Vanelderen, P., et al., 8. Occipital neuralgia. Pain Pract, 2010.

Evidence for Management of ON Technique EvaluaCon Subcutaneous s9mula9on of the nervi occipitales 2 C+ Botulinum toxin A injec9on 2 C+ Single infiltra9on of the nervi occipitales with

5 Evidence for Management of ON Technique EvaluaCon Subcutaneous s9mula9on of the nervi occipitales 2 C+ Botulinum toxin A injec9on 2 C+ Single infiltra9on of the nervi occipitales with local anesthe9c and cor9costeroids 2 C+ Pulsed radiofrequency treatment of the nervi occipitales 2 C+ Pulsed radiofrequency treatment of the cervical ganglion spinale (dorsal root gangion 0

6 The effec9veness and safety of using PRF for neuropathic pain has also been evaluated in a number of studies [3, 16, 17, 21-35]. However, specific to occipital neuralgia and PRF, there has been only one small pilot RCT published to date [24] and a few cohort studies and case reports [21-23, 25, 26]. 3. Vanelderen, P., et al., 8. Occipital neuralgia. Pain Pract, Malik, K. and H.T. Benzon, Pulsed radiofrequency, Chua, N.H., K.C. Vissers, and M.E. Sluijter, Huang, J.H., et al., Van Zundert, J., et al., Vanelderen, P., et al., Choi, H.J., et al., Gabrhelik, T.M., P.; Adamus, M., Lee, J.S., et al., Navani, A., et al., 2006.

8 Study Design prospeccve observaconal study. Pa9ent recruitment Consented pa9ents Diagnos9c block PRF procedure Assess outcomes (1, 3 & 6 mo) Pa9ents may request rescue interven9on, which will be documented

9 Data Collec?on: The baseline for each pa9ent will be recorded and will include the following: VAS (pain scale) pre and post the interven9on Medica9on use Pa9ent sa9sfac9on Complica9ons and side effects

10 Study objeccves The study aims to clarify the value of PRF administered via ultrasound- guided technique for : 1. Reducing pain for short & long term. 2. Improving quality of life. 3. Pain medica9on usage. 4. Short and long term side effects of PRF. 5. Safety of using U/S technique for ON.

11 Exclusion criteria: 1. Coagulopathies, and bleeding disorder. 2. Infec9on at the site of injec9on. 3. Pain less than 4 / Anatomical deformity or derangements of the occipital nerve. 5. Allergy to LA. 6. Age younger than 18yrs and older than 85 yrs.

12 Sample size, recruitment rate &Dura?on of treatment and follow- up: Dura9on of recruitment planned to be 5 months at an average rate of 10 pa9ents a month. A total of 50 pa9ents will be the expected number. 30 min. of treatment in OR Follow ups: 30 min, 1, 2, 3, 4, 5, 6 hours aler the interven9on. 24 hour and 1 week phone call follow- up. 1, 3, 6 months (VAS, meds, side effects).

13 What would we gain from this study? 1. Provides more robust evidence for evalua9on of the efficacy & safety of PRF for occipital neuralgia. 2. Evaluate the long term efficacy of PRF on pain as well as the pa9ent sa9sfac9on. 3. Show the efficacy, safety and the accuracy of using U/S for ON. 4. Find out the real number of pa9ents suffering from ON. 5. Create policies and guidelines for using U/S and PRF for ON in our PMC.. 6. Educa9on for pain fellows and Anesthesia residents.

14 Thank You

Pulsed Radiofrequency Therapy versus Greater Occipital Nerve Block in the Management of Refractory Cervicogenic Headache A Pilot Study

$Pulsed Radiofrequency Therapy versus Greater Occipital Nerve Block in the Management of Refractory Cervicogenic Headache A Pilot Study$ Prague Medical Report / Vol. 112 (2011) No. 4, p. 279 287 279) Pulsed Radiofrequency Therapy versus Greater Occipital Nerve Block in the Management of Refractory Cervicogenic Headache A Pilot Study Gabrhelík