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      Radiofrequência na dor crônica Translated title: Radiofrequency in chronic pain Translated title: Radiofrecuencia en el dolor crónico

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          Abstract

          Radiofrequência (RF) é uma técnica minimamente invasiva alvo-seletiva e tem sido usada durante muitos anos para o tratamento de diferentes doenças, como dor lombar crônica, neuralgia trigeminal e outros. Trata-se de uma corrente elétrica alternada com frequência oscilatória de 500.000 hz, que flui através de um eletrodo introduzido percutaneamente. O calor é formado ao redor do eletrodo porque o tecido age como um resistor. Essa técnica pode, portanto, ser usada para causar lesões em tecidos nervosos no tratamento de dor crônica. O objetivo desta revisão é abordar alguns aspectos importantes do mecanismo e evolução da radiofrequência na dor crônica. Serão abordados os aspectos básicos da Física e o mecanismo de ação da radiofrequência, método que tem sido usado para tratar dores crônicas de diferentes etiologias, além da evolução com o advento da radiofrequência pulsátil. O uso da radiofrequência no manejo da dor crônica é uma ferramenta útil em diferentes condições dolorosas e tem sido usada com sucesso por mais de 25 anos. Seu mecanismo de ação ainda não foi totalmente elucidado. A radiofrequência pulsátil é, em particular, uma técnica minimamente destrutiva e poderá ser uma alternativa à forma convencional de tratamento para a dor por radiofrequência.

          Translated abstract

          Radiofrequency (RF) is a minimally invasive target-selective technique that has been used with success for many years in the treatment of different pathologies, like low back pain, trigeminal neuralgia and others. RF is an alternating electric field with oscillation in the frequency of 500.000 Hz that flows through a percutaneously introduced electrode. The heat will be produced around the electrode, because the tissue acts as a resistor. Therefore, radiofrequency may be used to ablate nervous tissue in the treatment of chronic pain. The objective of this study was to review a few important aspects of the mechanism and evolution of radiofrequency in chronic pain. The basic aspects of Physics and the mechanism of radiofrequency, a method which has been used to treat different etiologies of chronic pain, besides the evolution that came with the introduction of pulsed radiofrequency will be herein elucidated. The application of radiofrequency in the management of chronic pain may be a useful tool in the management of several chronic pain conditions and have been successfully used in clinical practice for more than 25 years. Its mechanism of action has not been totally elucidated yet. Pulsed radiofrequency, in private, is a minimally destructive procedure that may offer alternatives for the pain treatment with radiofrequency.

          Translated abstract

          Radiofrecuencia (RF) es una técnica mínimamente invasiva con blanco selectivo, y ha sido usada durante muchos años para el tratamiento de diferentes patologías como dolor lumbar crónico, neuralgia trigeminal entre otros. Radiofrecuencia es una corriente eléctrica alternada con frecuencia oscilatoria de 500.000 hz. La corriente fluye por medio de un electrodo introducido percutáneamente y el calor es formado alrededor del electrodo, porque el tejido actúa como una resistencia. Por lo tanto, la radiofrecuencia puede ser usada para causar lesiones en tejidos nerviosos para tratamiento de dolor crónico. El objetivo de esta revisión es abordar algunos aspectos importantes del mecanismo y evolución de la radiofrecuencia en el dolor crónico. Serán abordados los aspectos básicos de la física y el mecanismo de acción de la RF, método que ha sido usado para tratar dolores crónicos de diferentes etiologías, además de la evolución con el advenimiento de la radiofrecuencia pulsátil.El uso de la radiofrecuencia en el manejo del dolor crónico es una herramienta útil en diferentes condiciones dolorosas y ha sido usado con suceso por más de 25 años. Su mecanismo de acción aun no está totalmente elucidado. La radiofrecuencia pulsátil es en particular una técnica mínimamente destructiva y podrá ser una alternativa a la forma convencional para el tratamiento de dolor por radiofrecuencia.

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          Most cited references32

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          Percutaneous radiofrequency denervation of spinal facets. Treatment for chronic back pain and sciatica.

          C Shealy (1975)
          A technique for radiofrequency localization and coagulation of articular nerves supplying the spinal facets is described and results are reported from a series of 207 patients followed 6 to 21 months (mean 31 months). Relief of pain was achieved in 79% of previously unoperated patients, in 41% of those with laminectomy but no fusion, and in 27% of those with an earlier fusion. No neurological complications were encountered.
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            The longer term effect of pulsed radiofrequency for neuropathic pain.

            R Munglani (1999)
            Pulse radiofrequency has been recently described as a technique to apply a relatively high voltage near a nerve but without the usual effects of a rise in temperature or subsequent nerve injury. In this set of case reports, the effect of pulsed radiofrequency (PRF) is described in patients with neuropathic pain syndromes which have been poorly controlled with other oral and invasive treatments. Whilst anecdotal, the results have been remarkable and should encourage further research into this technique. Observations from the basic science tend to support the concept that PRF may induce some sort of long-term depression in the spinal cord.
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              Technical aspects of radiofrequency.

              Radiofrequency (RF) is an alternating electric field with an oscillating frequency of 500,000 Hz. If the resulting current flows through a percutaneously introduced electrode, heat will be produced around the electrode because the body tissue acts as a resistor. RF can, therefore, be used to ablate nervous tissue in the treatment of chronic pain. This method has gained acceptance for percutaneous cordotomy and for the treatment of trigeminal neuralgia. For spinal pain, the method had little success initially, but since the introduction of small diameter instrumentation, the results have markedly improved. he mechanism of action of RF has not been challenged until recently even though there was awareness that some observations were not consistent with the heat concept. The formation of heat is not the only occurrence during RF treatment, however. The tissue surrounding the electrode is also exposed to the RF electric field. This exposure has a biological effect as has been demonstrated both in cells in a cell culture and in the exposure to RF of dorsal root ganglia, resulting in transsynaptal induction of early gene expression in the dorsal horn. The mode of action of RF is, therefore, uncertain at the moment. The method of pulsed RF is based on the concept that the production of heat has been a by-product of RF treatment and that the clinical effect is due to exposure to the electric field. In pulsed RF, the generator output is interrupted to allow for the elimination of heat in the silent period. The early results have been encouraging, but the results of controlled, prospective studies are not yet available. Since there are now 2 almost diametrically opposed views on the mode of action of RF, it is difficult to give recommendations for treatment. The decision is easy for indications for which heat RF has traditionally been contraindicated such as the treatment of peripheral nerves and trigger points. When the application of heat carries a potential risk, for instance if the dorsal root ganglion is the target structure, the use of pulsed RF is also recommended. As for the medial branch the situation is controversial. Since there are controlled studies available showing the effect of heat lesions, it is recommended that the technique should not be changed until further studies have been completed. Finally, the equipment for RF treatment is described and safety issues are discussed.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                coluna
                Coluna/Columna
                Coluna/Columna
                Sociedade Brasileira de Coluna (São Paulo )
                2177-014X
                June 2009
                : 8
                : 2
                : 200-205
                Affiliations
                [1 ] World Institute of Pain Brasil
                [2 ] World Institute of Pain
                [3 ] Universidade Federal de Pernambuco Brazil
                Article
                S1808-18512009000200017
                10.1590/S1808-18512009000200017
                cb22ce2a-1253-4f85-9ad5-8dafb74d91fe

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1808-1851&lng=en
                Categories
                ORTHOPEDICS
                REHABILITATION

                Orthopedics,Physiotherapy
                Enfermedad crónica,Ondas radioeléctricas,Dor,Doença crônica,Ondas de rádio,Pain,Chronic disease,Radio waves,Dolor

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