Peripheral Stimulation of the Saphenous and Superior Lateral Genicular Nerves for Chronic Knee Pain

Background: Chronic knee pain is a major widespread problem causing significant impairment of daily function. Pulsed radiofrequency has been shown to reduce severe chronic joint pain as a non-pharmacological and less invasive treatment method. Objective: We aimed to compare the effectiveness of unipolar and bipolar intraarticular pulsed radiofrequency methods in chronic knee pain control. Study Design: Prospective, randomized, double-blind study. Setting: Pain clinic in Cukurova University Faculty of Medicine. Methods: One hundred patients, aged 20 – 70 years with grade 2 or 3 knee osteoarthritis were included in this study. Patients were randomly allocated into 2 groups to receive either unipolar (group U, n = 50) or bipolar (group B, n = 50) intraarticular pulsed radiofrequency (IAPRF) with a 45 V voltage, 2 Hz frequency, 42° C temperature, 10 msec pulse width, and 10 minute duration. We recorded visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index LK 3.1WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index LK 3.1) scores of patients at baseline and one, 4, and 12 weeks after the procedure. The primary outcome was the percentage of patients with ≥ 50% reduction in knee pain at 12 weeks after the procedure. Results: There was a significant difference between the groups according to VAS scores at all post-intervention time points. In group B, 84% of patients, and in the group U, 50% of patients achieved at least 50% knee pain relief from the baseline to 3 months. In group B, WOMAC scores were significantly lower than the group U at one and 3 months. Limitations: Lack of long-term clinical results and supportive laboratory tests. Conclusion: Bipolar IAPRF is more advantageous in reducing chronic knee pain and functional recovery compared with unipolar IAPRF. Further studies with longer follow-up times, laboratorybased tests, and different generator settings are required to establish the clinical importance and well-defined mechanism of action of PRF. This study protocol was registered at clinicaltrials.gov (identifier: NCT02141529), on May 15, 2014. Institutional Review Board (IRB) approval date: January 16, 2014, and number: 26/9 Key words: Chronic pain, intraarticular, knee joint, knee osteoarthritis, pain management, pulsed radiofrequency treatment, quality of life, recovery of function

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Different Cardiovascular Responses to Central and Peripheral Stimulation of AVP Receptors

Clinical and Experimental Hypertension Part A Theory and Practice ◽

10.3109/10641968409046113 ◽

1984 ◽

Vol 6 (10-11) ◽

pp. 1981-1985 ◽

Cited By ~ 1

Author(s):

P. Rohmeiss ◽

H. Becker ◽

Th. Unger

Keyword(s):

Cardiovascular Responses ◽

Peripheral Stimulation ◽

Stimulation Of

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Red Nucleus Stimulation Inhibits Within the Inferior Olive

Journal of Neurophysiology ◽

10.1152/jn.1998.80.6.3127 ◽

1998 ◽

Vol 80 (6) ◽

pp. 3127-3136 ◽

Cited By ~ 14

Author(s):

K. M. Horn ◽

T. M. Hamm ◽

A. R. Gibson

Keyword(s):

Inferior Olive ◽

Red Nucleus ◽

Salient Feature ◽

Cutaneous Stimulation ◽

Motor Pathways ◽

Peripheral Stimulation ◽

Dorsal Columns ◽

Dorsolateral Funiculus ◽

Somatosensory Responses ◽

Stimulation Of

Horn, K. M., T. M. Hamm, and A. R. Gibson. Red nucleus stimulation inhibits within the inferior olive. J. Neurophysiol. 80: 3127–3136, 1998. In the anesthetized cat, electrical stimulation of the magnocellular red nucleus (RNm) inhibits responses of rostral dorsal accessory olive (rDAO) neurons to cutaneous stimulation. We tested the hypothesis that RNm-mediated inhibition occurs within the inferior olive by using stimulation of the ventral funiculus (VF) of the spinal cord in place of cutaneous stimulation of the hindlimb. Fibers in the VF terminate on hindlimb rDAO neurons, so inhibition of this input would have to occur within the olive. rDAO responses elicited by VF stimulation were inhibited by prior stimulation of the RNm, indicating that inhibition occurs within the olive. In contrast, evoked potentials recorded from the VF or dorsal columns following hindlimb stimulation were not affected by prior stimulation of RNm, indicating that stimulation of the RNm does not inhibit olivary afferents at spinal levels. RNm stimulation that inhibited rDAO responses had little effect on evoked somatosensory responses in thalamus, indicating that inhibition generated by activity in RNm may be specific to rDAO. To test limb specificity of RNm-mediated inhibition, conditioning stimulation was applied to the dorsolateral funiculus at thoracic levels, which selectively activates RNm neurons projecting to the lumbar cord. Stimulation at thoracic levels inhibited evoked responses from hindlimb but not forelimb regions of rDAO, suggesting that inhibitory effects of RNm activity are limb specific. Several studies have reported that olivary neurons have reduced sensitivity to peripheral stimulation during movement; it is likely that RNm-mediated inhibition occurring within the olive contributes to this reduction of sensitivity. Inhibition of rDAO responses by descending motor pathways appears to be a salient feature of olivary function.

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