Table 3.
A snapshot of the results in a few subsets of chronic pains treated from 2004 to 2019 out of 12,000 patients
| Conditions | Patients | Brief synopsis of improvements and the extent of benefit |
|---|---|---|
| Neuropathic pains[5,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27] | 1221 | >90% pts achieved the endpoint of meaningful and lasting pain relief. Combination USGDN with PRF of local nerves or botulinum toxin A (Botox)/trigger point injections, showing that these were neuromyopathic pains |
| CRPS-1 & CRPS-2[5,12-17] | 220 | >95% of pts achieved end points of 100% pain relief, 90% disability relief, and return to work within USGDN (69/220 pts) |
| Postspine injury (formerly termed causalgia) | 3 | All pts had resolution of pains with lumbar sympathetic PRF + USGDN and discontinued opioids. One patient with a high-velocity rifle shot injury has no pain, can walk with calipers for exercise, and created a national record in pistol shooting. He returned to a desk job in the elite special forces of Indian army. He visits us once a year for maintenance USGDN. Two others after traffic accidents are largely pain-free and lead active lives. |
| Brachial plexus injuries (BPI) | 11 | 10 pts had complete pain relief with only USGDN, indicating BPI pain was probably myofascial. 5 regained normal movements with USGDN suggesting that the motor deficit in BPI might be due to low grade co-contraction impeding movements |
| Poststroke pains | 18 | 13 pts had >80% pain relief after 3 USGDN sessions and motor improvement after 10-12 sessions. 3 patients received ultrasound guided botox injection into muscles in addition to USGDN. Two patients did not improve |
| Deafferentation pains | 2 | One patient became pain-free with only USGDN and the other with intrathecal pump with baclofen for her painful spasms. USGDN led to motor improvement suggesting that motor deficit might be due to low-grade cocontraction impeding movements. |
| Phantom pains | 3 | One pediatric patient and 2 adults reported a distinct reduction of the frequency, duration as well as intensity of phantom pains with USGDN alone. One adult requires maintenance USGDN (2-3 sessions) once in 3-6 months. |
| Herpes and postherpetic neuralgia | 35 | 30/35 pts received USGDN alone, local intercostal nerve PRF + USGDN in 5 pts. >90% achieved endpoint of reduction of pain hyperaesthesia and allodynia within 3 USGDN sessions and complete, lasting relief with 10-12 sessions with no later recurrences. |
| Trigeminal neuralgia (Article in review) | 62 | >80% pts achieved the endpoint of remission with complete pain relief with minimal or no medications with USGDN of masticatory and neck muscles alone (42/62 pts). Ultrasound demonstrates masticatory muscle twitches coinciding with neuromyalgic attacks. In 20/62 pts, mandibular nerve PRF preceded USGDN to reduce the frequent intense pains. |
| Postsurgical neuropathy[18,19,25] | 108 | >90% of patients achieved endpoint of pain relief and improved functionality, stop/reduce opioids with USGDN alone, or in combination with local blocks/PRF/botox, and physiotherapy. |
| Failed back surgery syndrome[18] | 102 | >70% of patients reached the endpoint of pain relief, stop/reduce opioids with combination of USGDN with neural interventions. Neural interventions improved pain but USGDN improved both pain and disability. Pts could resume active professional life after USGDN (One more Publication not included in references) |
| Back pain from various causes | 1209 | >85% of patients reached the endpoint of pain relief, could stop/reduce opioids, Neural interventions improved pain but USGDN relieved pain and allowed them to increase activity till they could resume active professional lives. |
| Knee pain from osteoarthritis[27] | 396 | >95% of patients achieved endpoints of pain relief, improved functionality graded by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), stopped/reduced opioids. USGDN with or without neural interventions (PRF) led to consistent predictable increase in activity and resumption of active lifestyles. |
| Knee pain from rheumatoid arthritis (RA) | 10 | ALL patients achieved endpoint of pain relief, could stop/reduce opioids, neuromodulators but continued RA treatment. Combination of USGDN with PRF showed consistent predictable but dramatic pain reduction achieving hitherto impossible active lifestyles (SF16 and WOMAC) (Publication not included in references) |
| Frozen shoulder | 110 | >85% of patients achieved endpoint of pain relief, could stop/reduce analgesics. USGDN alone (15 sessions) or in combination with PRF of the composite nerve supply of all shoulder muscles allowed a sustained, painless return of all shoulder movements within 30-45 days. |
| Headaches and migraine | 81 | >95% of patients achieved endpoint of pain relief with USGDN and USG-guided Botox into all the neck muscles including those of suboccipital triangle. C1-C3 PRF was done in selected patients to address the composite nerve supply of neck muscles. The frequency and the severity of attacks and medications were reduced by >90% |
| Chronic pelvic pain[26] | 20 | >85% achieved the endpoint of meaningful pain relief, improved urinary/rectal function improved quality of life (SF16), could stop/reduce opioids after a combination of continuous caudal block, Botox, and USGDN of pelvic floor muscles. |
| Myofascial pains | 647 | >90% of patients achieved the endpoint of pain relief, could stop/reduce analgesics while increasing activities. Combination of USGDN with Botox/trigger point injections/PRF of nerves to local muscles allowed a sustained, painless return to higher levels of activity with physiotherapy for strengthening. |
| Writer’s cramp | 6 | All 6 had complete pain relief of pain after 8-10 sessions of USGDN (publication not included in references) |
| Fibromyalgia | 11 | Endpoint of lasting pain relief was not possible but >60% had pain relief with a combination of USGDN with Botox/trigger point injections/PRF of nerves to local muscles allowed a better quality of life on SF16. But pains kept coming up elsewhere. |
| Cancer pain[19,20,21,22,23,24] | 294 | Neuropathic pains after cancer and its therapies are majorly neuromyopathic and respond to a combination of neural blocks, USGDN, and USGDN-guided Botox. >80% of patients achieved endpoint of a good quality of life with pains <1-2 with minimization of opioid doses. |
CRPS, complex regional pain syndrome; PRF, pulsed radiofrequency; Pts, patients; USGDN, ultrasound guided dry needling; More references are available from our publications for the conditions treated but could not be included due to limited allowance for the number of references. Trigeminal neuralgia patients with frequent pains (VAS >6) were selected for PRF prior to USGDN.