RADIOFREQUENCY IN CHRONIC PAIN: EXPERIENCE FROM THE CIRIÈ/LANZO PAIN THERAPY CENTER

E. Moriondo, M. Fadde | ASL TO 4 Pain Therapy, Ciriè, Torino

INTRODUCTION
In recent decades, chronic pain management has evolved significantly thanks to minimally invasive interventional techniques such as radiofrequency (RF). RF is now widely used due to its effectiveness, repeatability, safety, and potential for personalization. The choice between continuous (CRF) and pulsed RF (PRF), as well as the selection of target structures, should be based on thorough clinical and diagnostic evaluation. The Ciriè and Lanzo Pain Therapy Units, part of ASL TO4 in Piedmont, Italy, serve a population of about 500,000 people. Staffed by five anesthesiologists with specialized training in chronic pain, the centers treat non-cancer chronic pain using an integrated approach including pharmacologic therapies, acupuncture, ultrasound- or X-ray-guided infiltrations, mesotherapy, botulinum toxin for headaches, and RF procedures. With over 4,000 annual treatments, the units are high-volume regional pain centers.
METHODS
A retrospective, single-center study was conducted from January 8, 2024, to February 28, 2025 (13 months), to evaluate patient satisfaction and complications two months after the two most used RF procedures in our center:
1. CRF for lumbar facet joint syndrome under fluoroscopy
2. CRF of genicular nerves for chronic knee pain
Inclusion criteria: Severe chronic pain due to lumbar facet syndrome or chronic knee pain unresponsive to corticosteroid and hyaluronic acid injections. Exclusion: Patients with radicular pain, especially at L3-L4, were excluded from genicular RF. Procedures:
- Facet Syndrome: 40 patients (72% female), mean age 67. RF with an 18G, 100 mm V-tip needle under fluoroscopy following SIS guidelines. Motor and sensory stimulation confirmed correct positioning.
- Genicular RF (GNRA): 13 patients (77% female), mean age 72.3. RF performed at three anatomical sites using an 18G cannula at 80°C for 90 seconds.
RESULTS
GNRA:
- 11 out of 13 patients (84%) reported significant pain reduction at two months.
- No complications occurred.
- Two patients later underwent knee replacement.
- RF was safe even in patients with pacemakers and on anticoagulants.
Facet Syndrome:
- 39 out of 40 patients (97.5%) were satisfied at two months. One had only brief relief.
- No complications observed.
- Three patients received bilateral treatment in separate sessions.
DISCUSSION
GNRA: Results are consistent with the literature. Anatomical variability in genicular nerve innervation may limit effectiveness. Future plans include ultrasound-guided approaches, cryoablation, bipolar RF, and targeting more points. Despite the small sample, outcomes were positive. Collaboration with orthopedic and rehab teams will continue, especially for patients awaiting or recovering from knee replacements. Facet Syndrome: We are satisfied with results. To improve selection, dual diagnostic blocks may be considered. Long-term benefits will also be evaluated. The high success rate may reflect the small sample, short follow-up, and realistic patient expectations.
CONCLUSIONS
RF is a safe, effective option for managing chronic pain from lumbar facet syndrome and knee osteoarthritis. High satisfaction, low complications, and good clinical outcomes support its role in modern pain protocols.