Ding Y, Yao P, Li H, et al. Evaluation of combined radiofrequency and chemical blockade of multi-segmental lumbar sympathetic ganglia in painful diabetic peripheral neuropathy. J Pain Res. 2018 Jul 26;11:1375-1382. doi: 10.2147/JPR.S175514. eCollection 2018. (Original study)

Background: Painful diabetic peripheral neuropathy (PDPN) is one of the most common complications of diabetes. PDPN seriously affects the quality of life and is difficult to treat; therefore, there is an urgent need for new cost-effective treatment methods for PDPN.

Objective: To investigate the efficacy and safety of radiofrequency thermocoagulation (RF) combined with anhydrous ethanol (AE) chemical blockade of lumbar sympathetic ganglia (LSG) in patients with PDPN using computed tomography (CT).

Study design: Retrospective comparative study.

Setting: Shengjing Hospital of China Medical University.

Methods: Ninety patients diagnosed with PDPN were enrolled in this study. The patients were randomly divided into AE group (A, n=30), RF group (B, n=30), and RF+ AE group (C, n=30). The follow-up included preoperative basic conditions, visual analog scale (VAS), the total remission rate (TRR), skin temperature (ST) and the improvement of numbness and hyperalgesia in the lower extremities, complications, and degree of satisfaction (DOS) before and after surgery.

Results: Postoperative VASs were significantly decreased compared to preoperative VASs in all groups (P<0.05). The VAS in group A began to increase 3 months (3M) after surgery; VAS scores at 3M, 6 months (6M) and 1 year (1Y) were significantly different compared to group B and C (P<0.05); VAS in group B began to increase after 6M; VAS scores at 6M and 1Y were significantly different compared to group C (P<0.05); Moreover, group C maintained relatively long duration of pain relief. TRR in group A, group B and group C at 1Y after operation was 66.7%, 73.3% and 93.3%, respectively; TRR in group C was statistically different compared to groups A and B (P<0.05). Higher ST in the lower extremities was observed after surgery in all groups compared to peroration (P<0.05); nonetheless, the difference was not statistically significant. The numbness and hyperalgesia improved in all three groups after surgery compared to preoperational time, the numbness in group C was significantly higher compared to groups A and B. In addition, no severe complications were observed. At 6M and 1Y after surgery, the degree of satisfaction in patients from group C was significantly higher compared to groups A and B.

Conclusion: Radiofrequency thermocoagulation combined with AE chemical blockade of the LSG was safe and effective. Nevertheless, the details underlying analgesic mechanisms still need to be investigated.

Discipline Area Score
Physician 5 / 7
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Comments from MORE raters

Physician rater

Testing invasive methods of pain relief with no control group? No detail given on type and duration of diabetes or previous treatments. It seems surprising that apparently only 9 of 123 declined participation. We are told very little about adverse reactions, just that some needed 'nutritional nerve treatment'. I am skeptical about this paper.

Physician rater

This is encouraging data. It would be great if similar results were found in a larger study.

Physician rater

The manuscript describes a modern approach for the treatment of painful peripheral diabetic neuropathy. The method shows an advanced technological level and the results are promising. It is clear that this approach can only be offered at specialized centers. Good work.
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