Intercostal Nerves Pulsed Radiofrequency for Intractable Neuralgia Treatment in Athletes with Sport Trauma of the Chest: A Case‑Series Study

Document Type : Original Article


1 Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Orthopedics Surgery and Sports Medicine, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran



Background: Athletes with trauma to the chest could be injured and suffer from an acute disturbing chest wall pain due to intercostal
neuralgia. Pulsed radiofrequency (PRF) is an emerging safe therapy in many neurologic pain syndromes. Objectives: This study aimed
to determine the effect of PRF on intercostal neuralgic pain in athletes complaining of severe chest pain and limited range of motion.
Materials and Methods: This case‑series study was conducted on athlete patients who suffered from severe chest pain that has limited their
function. Eighteen athletes who were absent from physical training and sports activity due to intercostal neuralgia in their current season
were admitted to our pain clinic. Intercostal nerve PRF was used to treat patients. Pain scale and return to sports activity were measured
after PRF. Results: The mean time of absence from sports activity was 1.3 ± 0.6 weeks. The mean score of pain severity (numeric rating
scale [NRS]) was 8.46 ± 1.85. In this study, 16 of 18 (88%) patients had effective pain relief (NRS <3) after PRF therapy. Besides, the NRS
scores reduced by at least 90% in 16 of 18 (88%) patients as compared to the baseline. The mean NRS score was followed‑up for 4 weeks.
The scores significantly decreased at 1 (P = 0.001), 2 (P = 0.0015), and 4 (P = 0.0002) weeks following PRF compared to pre‑PRF time.
Conclusions: Pulsed radiofrequency is a suitable therapy for athletes with intercostal nerve entrapment pain, which provides adequate and
quick pain relief, thus enabling them to resume their sport activities.


1. Engel AJ. Utility of intercostal nerve conventional thermal
radiofrequency ablations in the injured worker after blunt trauma. Pain
Physician 2012;15:E711‑8.
2. Nagda JV, Davis CW, Bajwa ZH, Simopoulos TT. Retrospective
review of the efficacy and safety of repeated pulsed and continuous
radiofrequency lesioning of the dorsal root ganglion/segmental nerve
for lumbar radicular pain. Pain Physician 2011;14:371‑6.
3. Luo F, Lu J, Shen Y, Meng L, Wang T, Ji N, et al. Effectiveness and safety
of pulsed radiofrequency treatment guided by computed tomography for
refractory neuralgia of infraorbital nerve: A Pilot study. Pain Physician
4. Sluijter ME, Cosman E, Rittmann W, Van Kleef M. The effects of pulsed
radiofrequency fields applied to the dorsal root ganglion – A preliminary
report. Pain Clin 1998;11:109‑17.
5. van Boxem K, van Eerd M, Brinkhuizen T, Patijn J, van Kleef M,
van Zundert J, et al. Radiofrequency and pulsed radiofrequency
treatment of chronic pain syndromes: The available evidence. Pain Pract
6. van Kleef M, Vanelderen P, Cohen SP, Lataster A, Van Zundert J,
Mekhail N, et al. 12. Pain originating from the lumbar facet joints. Pain
Pract 2010;10:459‑69.
7. Hashemi M, Hashemian M, Mohajerani SA, Sharifi G. Effect of pulsed
radiofrequency in treatment of facet‑joint origin back pain in patients
with degenerative spondylolisthesis. Eur Spine J 2014;23:1927‑32.
8. Van Zundert J, Patijn J, Kessels A, Lamé I, van Suijlekom H,
van Kleef M, et al. Pulsed radiofrequency adjacent to the cervical dorsal
root ganglion in chronic cervical radicular pain: A double blind sham
controlled randomized clinical trial. Pain 2007;127:173‑82.
9. Vanelderen P, Van Zundert J. Radiofrequency treatment of the sacroiliac
joint: Quo vadis? Pain Pract 2011;11:1‑2.
10. van Kleef M, van Genderen WE, Narouze S, Nurmikko TJ, van Zundert J,
Geurts JW, et al. 1. Trigeminal neuralgia. Pain Pract 2009;9:252‑9.
11. Hamann W, Abou‑Sherif S, Thompson S, Hall S. Pulsed radiofrequency
applied to dorsal root ganglia causes a selective increase in ATF3 in
small neurons. Eur J Pain 2006;10:171‑6.
12. Cahana A, Van Zundert J, Macrea L, van Kleef M, Sluijter M. Pulsed
radiofrequency: Current clinical and biological literature available. Pain
Med 2006;7:411‑23.
13. Wu YT, Ho CW, Chen YL, Li TY, Lee KC, Chen LC, et al.
Ultrasound‑guided pulsed radiofrequency stimulation of the
suprascapular nerve for adhesive capsulitis: A prospective, randomized,
controlled trial. Anesth Analg 2014;119:686‑92.
14. Gulati A, Shah R, Puttanniah V, Hung JC, Malhotra V. A retrospective
review and treatment paradigm of interventional therapies for patients
suffering from intractable thoracic chest wall pain in the oncologic
population. Pain Med 2015;16:802‑10.
15. Abejón D, Reig E. Is pulsed radiofrequency a neuromodulation
technique? Neuromodulation 2003;6:1‑3.
16. Vallejo R, Tilley DM, Williams J, Labak S, Aliaga L, Benyamin RM,
et al. Pulsed radiofrequency modulates pain regulatory gene expression
along the nociceptive pathway. Pain Physician 2013;16:E601‑13.
17. Van Boxem K, Huntoon M, Van Zundert J, Patijn J, van Kleef M,
Joosten EA, et al. 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;39:149‑59.
18. Kesikburun S, Yaşar E, Uran A, Adigüzel E, Yilmaz B. Ultrasound‑guided
genicular nerve pulsed radiofrequency treatment for painful knee
osteoarthritis: A Preliminary report. Pain Physician 2016;19:E751‑9.
19. Akkaya T, Ozkan D. Ultrasound‑guided pulsed radiofrequency treatment
of the intercostal nerve: Three cases. J Anesth 2013;27:968‑9.
20. Cohen SP, Sireci A, Wu CL, Larkin TM, Williams KA, Hurley RW,
et al. Pulsed radiofrequency of the dorsal root ganglia is superior to
pharmacotherapy or pulsed radiofrequency of the intercostal nerves
in the treatment of chronic postsurgical thoracic pain. Pain Physician
21. Martin DC, Willis ML, Mullinax LA, Clarke NL, Homburger JA,
Berger IH, et al. Pulsed radiofrequency application in the treatment of
chronic pain. Pain Pract 2007;7:31‑5.