SAFETY OF THE RADIOFREQUENCY DENERVATION FOR CHRONIC PAIN TREATMENT - SINGLE CENTRE EXPERIENCE FROM OSIJEK UNIVERSITY HOSPITAL CENTRE

Liječenje bolesnika koji pate od kronične boli bilo kojeg uzroka vrlo je zahtjevno i zahtijeva više modalitetni pristup analgeticima, nefarmakološkim metodama (fi zikalna terapija i akupunktura), injekcijama lokalnog anestetika i kortikosteroida unutar zglobnih prostora ili u okolinu živaca, a svaki dio ovog pristupa nosi određeni rizik povezan s nuspojavama i komplikacijama. Oralni protuupalni lijekovi pomažu smanjiti bol i upalu, no u određenim skupinama bolesnika su kontraindicirani ili nose veći rizik od nuspojava i komplikacija. Opioidni analgetici mogu biti teško podnošljivi, zbog mučnine ili, u težim slučajevima, povraćanja i opstipacije te bolesnici nerijetko odustaju od tih analgetika. Koanalgetici (antidepresivi i antikonvulzivi) su također lijekovi sa značajnim nuspojavama i većina ih bolesnika teško podnosi i nerado uzima. Nefarmakološke metode liječenja kronične boli su uglavnom vezane uz minimalne ili nikakve komplikacije, no ograničenog su analgetskog učinka. Injekcije lokalnog anestetika i kortikosteroida u zglobne prostore ili epiduralno nose također određene rizike od komplikacija. RF (radiofrekvencijska denervacija, neurotomija, ablacija) u literaturi se opisuje kao minimalno invazivni postupak kojim se u svrhu prekida bolnog signala u mozak na živčanom tkivu stvara toplinska lezija. RF najčešće primjenjujemo u sljedećim kroničnim bolnim stanjima: neuralgija trigeminalnog živca, bolovi u kralježnici uzrokovani degenerativnim upalnim promjenama fasetnih zglobova te artroza zgloba kuka i koljena. Tijekom ovog postupka, kao i tijekom svake druge medicinske intervencije, moguće su komplikacije koje su u literaturi vrlo rijetko opisane. U ovom članku donosimo pregled literature i naša iskustva vezana uz komplikacije RF živaca za najčešće bolne sindrome.Treatment of patients suffering from chronic pain of any cause is very demanding and often involves multimodal approach. Analgesics, non-pharmacological methods (physical therapy and acupuncture), local anesthetics and corticosteroids as intraarticular injection or near the nerves are parts of this multimodal approach. Each part of this approach carries a certain risk of side effects and complications. Oral anti-infl ammatory drugs reduce pain and infl ammation, but in certain groups of patients they are contraindicated or represent a greater risk for side effects and complications. Opioid analgesics could be less tolerable for some patients during the treatment due to nausea or, in severe cases, vomiting and constipation, and patients often abandon these analgesics. Co-analgesics (antidepressants and anticonvulsants) are also medicines with signifi cant side effects, most of them are diffi cult to tolerate and patients are reluctant to take them. Non-pharmacological methods for treating chronic pain are mostly associated with minimal or no complications, but with limited analgesic effect. Intraarticular injections of local anesthetics and corticosteroids or injections in the epidural space also represent certain risks for complications. Radiofrequency denervation (neurotomy, ablation) is described in the literature as a minimal invasive procedure in order to induce thermal lesions on the nerves to stop the pain signals to the brain. Radiofrequency denervation is most commonly used in the following chronic pain conditions: trigeminal nerve neuralgia, cervical or back pain caused by degenerative infl ammatory changes in facet joints and osteoarthritis of hip and knee joints. During this procedure, as well as during any other medical intervention, complications are possible, but rarely described in the literature. In this article, we provide an overview of the literature and our experiences associated with the complications of radiofrequency denervation of the nerves most commonly used