INTRODUCTION Chronic radicular neuropathic pain is a major clinical problem with a life time prevalence of more than 50%. Pulsed radiofrequency (PRF) treatment is a recognised therapy. However, the pathophysiology of chronic neuropathic pain (CNP) and the mechanism of action of PRF remains ill-defined. Improving our knowledge of the mechanisms of CNP and PRF action will enhance our ability to treat patients with this common debilitating problem more effectively. This study aims to characterise the CSF cellular and peptide constituents in patients with CNP and the effect of pulsed radiofrequency (PRF) on these constituents and reported pain. MATERIALS AND METHODS Prospective randomised tripled-blinded control trial of patients receiving PRF treatment versus sham for radicular pain. All patients received local anaesthetic to the appropriate dermatome to confirm diagnosis. Clinical assessment using standard clinical assessment tools and examination of CSF using flow cytometry and ELISA for cellular and peptide constituents was carried out before and 3 months after treatment. RESULTS Ten patients were randomised to PRF (n = 5) or Sham (n = 5) treatment. PRF resulted in a significant reduction in pain score (NRS) at 3 months (6.8 to 2.6, p < .05). PRF reduced the TNF-α concentration and CD3+ count in CSF. CD4/CD8 ratio of patients with CNP was lower than historical controls (1.4 versus 3.0-4.2). The majority of CD3+ cells in the CNP patients were activated effector memory cells (80%) versus the surveillance central memory cells (85%) seen in healthy controls. CONCLUSIONS PRF is superior to local anaesthetic administration for the management of radicular pain and is associated with CSF constituent modulation in vivo. Patients with CNP have lymphocyte characteristics which suggest immune activation.

中文翻译：

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背根神经节脉冲射频治疗对慢性根性疼痛患者脑脊液细胞和肽成分影响的表征：一项随机、三盲、对照试验

引言 慢性根性神经性疼痛是一个主要的临床问题，其终生患病率超过 50%。脉冲射频 (PRF) 治疗是公认的治疗方法。然而，慢性神经性疼痛 (CNP) 的病理生理学和 PRF 的作用机制仍然不明确。提高我们对 CNP 和 PRF 作用机制的了解将增强我们更有效地治疗患有这种常见衰弱问题的患者的能力。本研究旨在表征 CNP 患者的脑脊液细胞和肽成分，以及脉冲射频 (PRF) 对这些成分和报告的疼痛的影响。材料和方法 接受 PRF 治疗与假手术治疗根性疼痛的患者的前瞻性随机三盲对照试验。所有患者都接受了适当的皮刀局部麻醉以确认诊断。在治疗前和治疗后 3 个月进行使用标准临床评估工具的临床评估和使用流式细胞术和 ELISA 检测细胞和肽成分的 CSF。结果 10 名患者随机接受 PRF（n = 5）或假手术（n = 5）治疗。PRF 导致 3 个月时疼痛评分 (NRS) 显着降低（6.8 至 2.6，p < .05）。PRF 降低了 CSF 中的 TNF-α 浓度和 CD3+ 计数。CNP 患者的 CD4/CD8 比率低于历史对照（1.4 对 3.0-4.2）。CNP 患者中的大多数 CD3+ 细胞是激活的效应记忆细胞 (80%)，而在健康对照中观察到的监视中枢记忆细胞 (85%)。结论 PRF 在治疗神经根性疼痛方面优于局部麻醉给药，并且与体内 CSF 成分调节相关。CNP 患者具有提示免疫激活的淋巴细胞特征。