Long-term Follow-up of the Effectiveness and Safety of High-voltage Pulsed Radiofrequency Treatment for Infraorbital Neuralgia: A Retrospective Study.

Background: Infraorbital neuralgia is a refractory facial pain that may cause various psychological disorders. There is no optimal treatment for infraorbital neuralgia because few relevant studies have been conducted. Pulsed radiofrequency (PRF) is a minimally invasive procedure that has been proven effective in treating trigeminal neuralgia and other painful diseases. Our previous study demonstrated that high-voltage PRF was effective in patients with infraorbital neuralgia. However, there is little literature on the long-term follow-up of infraorbital neuralgia treated with high-voltage PRF with a large sample size.

Objectives: To explore the long-term effectiveness and safety of high-voltage PRF guided by computed tomography for patients with infraorbital neuralgia who failed conservative treatment.

Study design: Monocentric, retrospective, observational study.

Setting: This study enrolled patients with infraorbital neuralgia who failed conservative treatment for infraorbital neuralgia and who underwent a high-voltage PRF procedure at the Department of Pain Management in Beiging Tiantan Hospital.

Methods: From January 2013 through June 2022, a total of 223 patients were included in this study; 16 were excluded according to the exclusion criteria. Finally, the medical records of 207 patients were extracted and analyzed including demographic data, intraoperative records, pain-related baseline, data and side effects. Treatment efficacy was evaluated using the Barrow Neurological Institute scores for pain. The Barrow Neurological Institute pain intensity score, onset time, perioperative complications and the time of recurrence were routinely followed up at month one, month 3, month 6 and every year postoperatively. Recurrence-free survival curves were presented by a Kaplan-Meier plot.

Results: The initial pain relief rate after the high-voltage PRF treatment was 86.0%. The cumulative recurrence-free survival rates were 85.5% (at month one), 82.6% (at month 3), 77.8% (at month 6), 65.7%(at month 12), 61.7% (at month 24), 55.8% (at month 48), 47.6% (at month 96) and 45.2% (at month 120) postoperatively. The median follow-up time of the 207 patients was 67.0 months (interquartile range, 38.0-93.0 months; range from 12 months to 125 months), with a median recurrence-free time of 80 months according to the Kaplan-Meier estimator.

Limitations: This was a retrospective observational study. Multicenter, prospective, randomized controlled studies should be conducted. In addition, the optimal parameters for PRF treatment of infraorbital neuralgia need to be further explored.

Conclusion: Computed tomography-guided high-voltage PRF treatment provides a minimally invasive and effective treatment option for patients with infraorbital neuralgia who fail conservative treatment, which could be considered as a preferred treatment before more invasive treatments.