PULSED RADIOFREQUENCY OF DORSAL ROOT GANGLIA AN ALTERNATIVE FOR DIABETIC TRUNCAL NEUROPATHY RELIEF

BACKGROUND, AIMS. Diabetic Truncal Neuropathy (DTN) is one of the most common forms of Painful Diabetic neuropathy (DNP). Symptoms include sensory and motor disturbances: painful sensations of dysesthesia and/or hypoesthesia, in upper or lower thoracic dermatomes distribution, with allodynia,​ exacerbated at night or during daily activities that involved the affected area; the patients also refer herniated abdomen wall corresponding to affected dermatomes. Despite treatment that includes metabolic control of Diabetes with DM medications, neuromodulators, analgesics, neural blockade, the neuropathic pain still persists. The aim of the study is to demonstrate the efficacy in pain relief of Pulsed Radiofrequency (PRF) of Dorsal Root Ganglia (DRG) of dermatomes affected in DTN.
METHODS. Eight diabetic patients with unilateral or Bilateral DTN, underwent an ambulatory procedure in the operating room with basic monitoring, C arm guided, mild sedation and local anesthetic, Unilateral DRG – PRF of dermatomes (3-6 levels) more affected with 21G RF needles 100mm and 5mm active tip and V2.2 Baylis generator, 4 cycles each level, previous motor (0.8-1.2 mV) and sensory (0.4-0.6mV) stimulations reproducing dermatome irradiation. Discharge two hours after with specific recommendations of Diabetes metabolic control, continue pregabalin and tramadol prescribed several months before the procedure. Subsequent control appointments two weeks, two months and six months after the procedure for VAS Score, Patients' global impression of change, HgA1c, DN4, neuromodulators doses, and analgesic requirements.
RESULTS: In eight patients (n=8) with persistent unilateral or bilateral DTN, with allodynia and hyperesthesia of 3-6 dorsal dermatomes and abdomen wall bulged out, a significant pain relief was obtained during the first 14 days (87.5%, n=7) after the procedure, lowering VAS in more than 60% compared to baseline and progressively improve in the next two months, reaching VAS reduction of 90%, except one patient with moderate relief 60%, and a persistent relief for more than 6 months in subsequent control appointments. The abdomen wall bulged out was visibly reduced since the second appointment, two months after the procedure in 87.5% of patients (n=7). Lowering doses of Pregabalin and tramadol prescribed several months before the procedure, were progressively possible two months after PRF to 50-75% of baseline doses.
CONCLUSION: Pulsed Radiofrequency (PRF) of Dorsal Root Ganglia (DRG) of dermatomes affected is an effective alternative for pain relief in patients with Diabetic Truncal Neuropathy (DTN).