Dorsal Root Ganglion Pulsed Radiofrequency Treatment for Chronic Radicular Pain: A Narrative Mini Review

Main Article Content

Alberto Negro, M.D.,Ph.D. Vincenzo D’Agostino, M.D.,Ph.D. Luigi Della Gatta, M.D. Francesco Somma, M.D. Fabio Tortora, M.D.



Chronic cervical and lumbar radicular pain represents a very widespread neuropathic pain in the population with serious repercussions on the individual and social health.

To date, we do not have sufficient evidence available to allow us to make recommendations on the optimal therapy, despite the fact that various ways of treating root pain have been described over the years. Currently, conservative treatment of radicular pain relies on combined therapeutic, pharmacological and physiotherapeutic management.

Interventional therapeutic procedures are reserved for those patients with root pain refractory to conservative therapies.

Radio frequency (RF) can provide a good treatment option with Pulsed Radio frequency (PRF) modality.

We evaluate clinical and radiologic effects of the therapeutic outcome of pulsed radiofrequency (PRF) treatment adjacent to the dorsal root ganglion (DRG) for patients with chronic intractable lumbar and cervical radicular pain in this narrative minireview, describing mechanism of action, biological effects and evidence for clinical effects and safety in recently published studies.

Article Details

How to Cite
NEGRO, Alberto et al. Dorsal Root Ganglion Pulsed Radiofrequency Treatment for Chronic Radicular Pain: A Narrative Mini Review. Medical Research Archives, [S.l.], v. 9, n. 4, apr. 2021. ISSN 2375-1924. Available at: <>. Date accessed: 14 may 2021. doi:
Research Articles


1. Bennett MI, Smith BH, Torrance N, Lee AJ. Can pain can be more or less neuropathic? Comparison of symptom assessment tools with ratings of certainty by clinicians. Pain 2006;122 :289–94;

2. Dieleman JP, Kerklaan J, Huygen FJ, Bouma PA, Sturkenboom MC. Incidence rates and treatment of neuropathic pain conditions in the general population. Pain 2008;137(3):681–8;

3. Treede RD, Jensen TS, Campbell JN, et al. Neuropathic pain: Redefinition and a grading system for clinical and research purposes. Neurology 2008;70(18):1630–5;

4. Borenstein, D. (2010) The role of the rheumatologist in managing pain therapy. Nat Rev Rheumatol 6: 227–231;

5. Zundert, J.V.J., Joosten, E.A.J. and Richebé, P. (2010) Pulsed radiofrequency adjacent to the DRG for radicular pain: does it work and how? Abstract from the 3rd International Congress on Neuropathic Pain, 30th May 201;

6. Radhakrishnan K, Litchy WJ, O’Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994;117(pt 2):325–335;

7. Konstantinou K, Dunn KM. Sciatica: review of epidemiological studies and prevalence estimates. Spine (Phila Pa 1976). 2008;33:2464–2472;

8. Khoromi S, Patsalides A, Parada S, Salehi V, Meegan JM, Max MB. Topiramate in chronic lumbar radicular pain. J Pain. 2005;6:829–836;

9. Dworkin RH, O’Connor AB, Backonja M, et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain. 2007;132:237–251

10. Doth AH, Hansson PT, Jensen MP, Taylor RS. The burden of neuropathic pain: a systematic review and meta-analysis of health utilities. Pain. 2010;149:338–344;

11. Weber H, Holme I, Amlie E. The natural course of acute sciatica with nerve root symptoms in a double-blind placebo-controlled trial evaluating the effect of piroxicam. Spine (Phila Pa 1976). 1993;18:1433–1438;

12. Van Boxem K, Huntoon M, Van Zundert J, Patijn J, van Kleef M, Joosten EA. Pulsed radiofrequency: a review of the basic science as applied to the pathophysiology of radicular pain: a call for clinical translation. Reg Anesth Pain Med. 2014 Mar-Apr;39(2):149-59. doi: 10.1097/AAP.0000000000000063. PMID: 24553305;

13. Pinto RZ, Maher CG, Ferreira ML, et al. Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis. BMJ. 2012;344:e497;

14. Luijsterburg PA, Verhagen AP, Ostelo RW, van Os TA, Peul WC, Koes BW. Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic review. Eur Spine J. 2007;16:881–899;

15. Luijsterburg PA, Verhagen AP, Ostelo RW, et al. Physical therapy plus general practitioners' care versus general practitioners' care alone for sciatica: a randomised clinical trial with a 12-month follow-up. Eur Spine J. 2008;17:509–517;

16. Albert HB, Manniche C. The efficacy of systematic active conservative treatment for patients with severe sciatica: a single-blind, randomized, clinical, controlled trial. Spine (Phila Pa 1976). 2012;37:531–542;

17. Thoomes EJ, Scholten-Peeters W, Koes B, Falla D, Verhagen AP. The effectiveness of conservative treatment for patients with cervical radiculopathy: a systematic review. Clin J Pain. 2013;29:1073–1086;

18. Jacobs WC, van Tulder M, Arts M, et al. Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review. Eur Spine J. 2011;20:513–522;

19. Dworkin RH, O’Connor AB, Audette J, et al. Recommendations for the pharmacological management of neuropathic pain: an overview and literature update. Mayo Clin Proc. 2010;85:S3–S14;

20. Van Kleef M, Liem L, Lousberg R, Barendse G, Kessels F, Sluijter M. Radiofrequency lesion adjacent to the dorsal root ganglion for cervicobrachial pain: a prospective double blind randomized study. Neurosurgery. 1996;38:1127–1131;

21. Slappendel R, Crul BJ, Braak GJ, et al. The efficacy of radio frequency lesioning of the cervical spinal dorsal root ganglion in a double blinded randomized study: no difference between 40 degrees C and 67 degrees C treatments. Pain. 1997;73:159–163;

22. Geurts JW, van Wijk RM, Wynne HJ, et al. Radiofrequency lesioning of dorsal root ganglia for chronic lumbosacral radicular pain: a randomised, double-blind, controlled trial. Lancet. 2003;361:21–26;

23. Sluijter ME (2001) Pulsed radiofrequency. In Radiofrequency, part 1. Fliovopress SA, Meggen (LU), Switzerland. p. 55–68 (186);

24. Sluijter ME, Cosman ER, Rittmann WB, Van Kleef M. The effects of pulsed radiofrequency fields applied to the dorsal root ganglion - a preliminary report. Pain Clinic 1998;11:109–17;

25. Cosman ER Jr, Cosman ER Sr (2005) Electric and thermal field effects in tissue around radiofrequency electrodes. Pain Med 6(6):405 424;

26. Sluijter ME (2005) Pulsed radiofrequency. Anesthesiology 103 (6):1313, author reply 1313-4;

27. Sluijter ME, van Kleef M (2007) Pulsed radiofrequency. Pain Med 8(4):388–389, author reply 390-1;

28. Cohen SP, Van Zundert J (2010) Pulsed radiofrequency: rebel without cause. Reg Anesth Pain Med 35(1):8–10;

29. Teixeira A, Sluijter ME (2006) Intradiscal high-voltage, longduration pulsed radiofrequency for discogenic pain: a preliminary report. Pain Med 7(5):424–428;

30. Cahana A (2005) Pulsed radiofrequency: a neurobiologic and clinical reality. Anesthesiology 103(6):1311, author reply 1313-4;

31. Cahana A, Van Zundert J, Macrea L, van Kleef M, Sluijter M (2006) Pulsed radiofrequency: current clinical and biological literature available. Pain Med 7(5):411–423;

32. Weaver JC (1993) Electroporation: a general phenomenon for manipulating cells and tissues. J Cell Biochem 51(4):426–435;

33. Sluijter ME, Teixeira A, Serra V, Balogh S, Schianchi P (2008) Intra-articular application of pulsed radiofrequency for arthrogenic pain–report of six cases. Pain Pract 8(1):57–61;

34. Erdine S, Yucel A, Cimen A, Aydin S, Sav A, Bilir A. Effects of pulsed versus conventional radiofrequency current on rabbit dorsal root ganglion morphology. Eur J Pain. 2005;9:251–256;

35. Podhajsky RJ, Sekiguchi Y, Kikuchi S, Myers RR (2005) The histologic effects of pulsed and continuous radiofrequency lesions at 42 degrees C to rat dorsal root ganglion and sciatic nerve. Spine (Phila Pa 1976) 30(9):1008–1013;

36. Erdine S, Bilir A, Cosman ER, Cosman ER Jr Ultrastructural changes in axons following exposure to pulsed radiofrequency fields. Pain Pract. 2009;9:407–417;

37. Tun K, Cemil B, Gurcay AG, et al. Ultrastructural evaluation of pulsed radiofrequency and conventional radiofrequency lesions in rat sciatic nerve. Surg Neurol. 2009;72:496–500;

38. Aksu R, Ugur F, Bicer C, Menku A, Guler G, Madenoglu H, Canpolat DG, Boyaci A (2010) The efficiency of pulsed radiofrequency application on L5 and l6 dorsal roots in rabbits developing neuropathic pain. Reg Anesth Pain Med 35(1):11–15;

39. Higuchi Y, Nashold BS, Sluijter ME, Cosman E, Pearlstein RD. Exposure of the dorsal root ganglion in rats to pulsed radio frequency currents activates dorsal horn lamina I and II neurons. Neurosurgery. 2002;50:850–856;

40. Van Zundert J, de Louw AJ, Joosten EA, et al. Pulsed and continuous radiofrequency current adjacent to the cervical dorsal root ganglion of the rat induces late cellular activity in the dorsal horn. Anesthesiology. 2005;102:125–131;

41. Hamann W, Abou-Sherif S, Thompson S, Hall S. Pulsed radio frequency applied to dorsal root ganglia causes a selective increase in ATF3 in small neurons. Eur J Pain. 2006;10:171–176;

42. Protasoni M, Reguzzoni M, Sangiorgi S, et al. Pulsed radio frequency effects on the lumbar ganglion of the rat dorsal root: a morphological light and transmission electron microscopy study at acute stage. Eur Spine J. 2009; 18:473–478;

43. Chang MC, Cho YW, Ahn SH. Comparison between bipolar pulsed radiofrequency and monopolar pulsed radiofrequency in chronic lumbosacral radicular pain: A randomized controlled trial. Medicine (Baltimore) 2017;96(9):e6236;

44. Lee DG, Ahn SH, Lee J. Comparative effectivenesses of pulsed radiofrequency and transforaminal steroid injection for radicular pain due to disc herniation: A prospective randomized trial. J Korean Med Sci 2016;31(8):1324–30;

45. Koh W, Choi SS, Karm MH, et al. Treatment of chronic lumbosacral radicular pain using adjuvant pulsed radiofrequency: A randomized controlled study. Pain Med 2015;16(3):432–41;

46. Shanthanna H, Chan P, McChesney J, Thabane L, Paul J. Pulsed radiofrequency treatment of the lumbar dorsal root ganglion in patients with chronic lumbar radicular pain: A randomized, placebo-controlled pilot study. J Pain Res 2014;7:47–55;

47. Abej_on D, Garcia-del-Valle S, Fuentes ML, G_omez-Arnau JI, Reig E, van Zundert J. Pulsed radiofrequency in lumbar radicular pain: Clinical effects in various etiological groups. Pain Pract 2007;7(1):21–6;

48. Das B, Conroy M, Moore D, Lysaght J, McCrory C. Human dorsal root ganglion pulsed radiofrequency treatment modulates cerebrospinal fluid lymphocytes and neuroinflammatory markers in chronic radicular pain. Brain Behav Immun 2018;70:157–65;

49. Gabrhelik T, Michalek P, Berta E, Adamus M, Pieran M, Dolecek L. Pulsed radiofrequency of radicular pain. Ceska Slov Neurol. Neurochirurg 2007;70:533–7;

50. Kim SJ, Park SJ, Yoon DM, Yoon KB, Kim SH. Predictors of the analgesic efficacy of pulsed radiofrequency treatment in patients with chronic lumbosacral radicular pain: A retrospective observational study. J Pain Res 2018;11:1223–30;

51. Lee DG, Cho YW, Ahn SH, Chang MC. The effect of bipolar pulsed radiofrequency treatment on chronic lumbosacral radicular pain refractory to monopolar pulsed radiofrequency treatment. Pain Physician 2018;21 (2):E97–103;

52. Mehta V, Snidvongs S, Ghai B, Langford R, Wodehouse T. Characterization of peripheral and central sensitization after dorsal root ganglion intervention in patients with unilateral lumbosacral radicular pain: A prospective pilot study. Br J Anaesth 2017;118(6):924–31;

53. Van Boxem K, van Bilsen J, de Meij N, et al. Pulsed radiofrequency treatment adjacent to the lumbar dorsal root ganglion for the management of lumbosacral radicular syndrome: A clinical audit. Pain Med 2011;12(9):1322–30;

54. Van Boxem K, de Meij N, Kessels A, Van Kleef M, Van Zundert J. Pulsed radiofrequency for chronic intractable lumbosacral radicular pain: A six-month cohort study. Pain Med 2015;16 (6):1155–62;

55. Tortora F, Negro A, Russo C, Cirillo S, Caranci F. Chronic intractable lumbosacral radicular pain, is there a remedy? Pulsed radiofrequency treatment and volumetric modifications of the lumbar dorsal root ganglia. Radiol Med. 2021 Jan;126(1):124-132. doi: 10.1007/s11547-020-01212-z. Epub 2020 May 4. PMID: 32367318;

56. Van Zundert J, Patijn J, Kessels A, Lame I, van Suijlekom H, van Kleef M. Pulsed radiofrequency adjacent to the cervical dorsal root ganglion in chronic cervical radicular pain: A double blind sham controlled randomized clinical trial. Pain 2007;127(1–2):173–82;

57. Choi GS, Ahn SH, Cho YW, Lee DK. Short-term effects of pulsed radiofrequency on chronic refractory cervical radicular pain. Ann Rehabil Med 2011;35(6):826–32;

58. Choi GS, Ahn SH, Cho YW, Lee DG. Long-term effect of pulsed radiofrequency on chronic cervical radicular pain refractory to repeated transforaminal epidural steroid injections. Pain Med 2012;13(3):368–75;

59. Yoon YM, Han SR, Lee SJ, Choi CY, Sohn MJ, Lee CH. The efficacy of pulsed radiofrequency treatment of cervical radicular pain patients. Korean J Spine 2014;11(3):109–12;

60. Vuka I, Marciuš T, Došenović S, Ferhatović Hamzić L, Vučić K, Sapunar D, Puljak L. Efficacy and Safety of Pulsed Radiofrequency as a Method of Dorsal Root Ganglia Stimulation in Patients with Neuropathic Pain: A Systematic Review. Pain Med. 2020 Dec 25;21(12):3320-3343. doi: 10.1093/pm/pnaa141. PMID: 32488240;

61. Egorov OE, Evzikov GY. Repeated radiofrequency dorsal root ganglion neurotomy in a patient with painful radiculopathy. A case report and literature review. Nevrologicheskii Zhurnal 2015;20(1):28–33;

62. Kim K, Jo D, Kim ED. Pulsed radiofrequency to the dorsal root ganglion in acute herpes zoster and postherpetic neuralgia. Pain Physician 2017;20:E411–8;

63. Fianyo E, Oniankitan O, Tagbor Komi C, Kakpovi K, Houzou P, Koffi-Tessio Viwalé ES, Mijiyawa M. Cost of common low back pain and lumbar radiculopathy in rheumatologic consultation in Lomé. Tunis Med. 2017 Mar;95(3):168-171. PMID: 29446809.

Most read articles by the same author(s)

Obs.: This plugin requires at least one statistics/report plugin to be enabled. If your statistics plugins provide more than one metric then please also select a main metric on the admin's site settings page and/or on the journal manager's settings pages.