PULSED RADIOFREQUENCY THERAPY IN ELDEERLY PEOPLE WITH TRIGEMINAL NEURALGIA: A CASE REPORT

Abstract

Introduction: Trigeminal neuralgia (TN) is a neuropathic pain disorder involving the trigeminal nerve and is recognized as one of the most severe forms of facial pain. Pulsed radiofrequency (PRF) is a minimally invasive intervention that delivers short bursts of radiofrequency current while limiting thermal tissue injury. It may be an alternative for patients with inadequate pain relief from pharmacological treatment. Case: An older man presented with severe pain involving the right upper and lower jaws and was clinically diagnosed with suspected atypical trigeminal neuralgia. Fluoroscopy-guided PRF was performed on the right trigeminal nerve using a C-arm, with a temperature limit of 42°C, voltage of 45 V, pulse width of 20 ms, frequency of 2 Hz, and duration of 8 minutes. One week after the procedure, the visual analog scale (VAS) pain score decreased from 8 to 0. Oral pharmacological therapy was continued. Discussion: Conventional radiofrequency (CRF) can provide pain relief but may cause thermal injury and sensory complications. PRF has been investigated as a neuromodulatory approach. Experimental studies suggest that PRF may alter neuronal activity through mechanisms involving reduced extracellular signal-regulated kinase phosphorylation, decreased calcium influx, and changes in mitochondrial membrane potential and intracellular ATP levels. These effects may contribute to reduced neuronal excitability and pain sensitization. However, evidence regarding the comparative efficacy and safety of PRF and CRF in trigeminal neuralgia remains limited, and optimal PRF parameters have not been established. The short-term pain relief in this case should be interpreted cautiously because pharmacological therapy was continued and follow-up was limited to one week. Conclusion: Fluoroscopy-guided PRF was followed by complete pain relief at one-week follow-up in a patient with clinically suspected trigeminal neuralgia. Further controlled studies with longer follow-up are needed to evaluate its efficacy, safety, and optimal treatment parameters.