Radiofrequency or neuromodulation treatment of chronic pain, when is it useful?

The management of chronic pain is challenging for the patient and the physician. Besides pharmacologic treatment pain therapists dispose of several minimal invasive interventional techniques. When used for the correct diagnosis and under the appropriate conditions, those techniques have been documented to provide pain relief and improve the patient's quality of life. Too often the use of interventional pain management techniques is postponed until all conservative treatment options fail to provide adequate pain relief or cause intolerable side effects. Evidence is starting to accumulate indicating that earlier use in the treatment algorithm may be beneficial for the patient in terms of pain relief, improved functionality and hence improved quality of life. Though little cost-effectiveness studies are available there are indications that the initial costs are recovered by the reduced medical needs. The interventional pain management techniques are commonly classified according to the degree of invasiveness: therapeutic blocks and epidural corticosteroid administration, (pulsed) radiofrequency techniques, spinal cord and peripheral nerve stimulation, motor cortex stimulation and spinal drug administration. In this article the place within the treatment algorithm of chronic pain for (pulsed) radiofrequency and neuromodulation techniques will be discussed.