Radiofrequency vs. pulse radiofrequency: The end of the controversy

Radiofrequency (RF) denervation is a percutaneous procedure involving the destruction of nerves using heat generated by a RF current (thermal RF) or neuromodulation of nerve electrical conduction. Current evidence strongly supports thermal RF for the treatment of trigeminal neuralgia, cervical and lumbar facet spondylosis, and sacroiliac joint pain. Despite the popularity of this technique, comparative efficacy studies have failed to support the use of PRF for the abovementioned indications. However, these comparative studies have often targeted those sites commonly addressed and proven efficacious by thermal RF. In contrast, PRF might prove more valuable in modulating nerve conduction in other pain syndromes, such as neuropathic pain conditions. At present, only anecdotal evidence is available on the use of PRF in these conditions. As thermal RF, by definition, is contraindicated in neuropathic pain syndromes, it seems that the two techniques are essentially different and the indications for PRF still need to be defined.