1. 2020;23;E559-E580Use of Radiofrequency Ablation for the Management of Facial Pain: A Systematic Review
   Systematic Review
   Alan D. Kaye, MD, PhD, Omar Viswanath, MD, Mark Jones, MD, Ivan Urits, MD, Lisa Huang, MD, Rodrigo C. Quispe, MD, Faizan Khan, MD, Vwaire Orhurhu, MD, and Alaa Abd-Elsayed, MD.

BACKGROUND: Neuropathic facial pain occurs due to pathologic dysfunctions of a nerve responsible for mediating sensory fibers to the head. Surgical interventions, in cases of failed medical therapy, include microvascular decompression, radiofrequency (RF) ablation, percutaneous balloon decompression, and stereotactic radiosurgery. In this review, we focused on RF ablation as a treatment for chronic facial pain.

OBJECTIVES: The objective of this review was to summarize available evidence behind RF ablation for facial pain, including pain outcome measures, secondary outcomes, and complications.

STUDY DESIGN: Systematic review.

SETTING: This systematic review examined studies that applied the use of RF ablation for management of facial pain.

METHODS: This systematic review was reported following the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two reviewers independently scored the methodological quality of the selected studies. Due to heterogeneity of studies, a best-evidence synthesis of the available prognostic factors was provided.

RESULTS: We reviewed 44 studies and assessed their short- and long-term pain relief measurements, as well as secondary outcomes including patient satisfaction, quality of life improvements, decrease in oral medication use, and recurrence rates. Maximal pain relief was achieved in treatment groups using combined continuous radiofrequency (CRF) and pulsed radiofrequency (PRF) therapies, followed by CRF therapy alone and finally PRF therapy alone. All treatment regimens improved secondary outcomes. Common complications of treatment included facial numbness, masseter weakness, cheek hematomas, diminished corneal reflex, and dry eyes.

LIMITATIONS: A large variability in definitions of trigeminal neuralgia, RF technique, and patient selection bias was observed in our selected cohort of studies. In addition, there was a paucity of strong longitudinal randomized controlled trials and prospective studies.

CONCLUSIONS: This systematic review found evidence that RF ablation is efficient in treating patients with facial pain, as well as in improving quality of life and reducing oral medication use. Maximal pain control is achieved using combined CRF and PRF therapy. Complications are uncommon and include facial numbness, masseter weakness, cheek hematomas, diminished corneal reflex, and dry eyes.

KEY WORDS: Radiofrequency, ablation, facial pain, chronic pain, trigeminal neuralgia, neuropathic pain, continuous radiofrequency, pulse radiofrequency