Retrospective Assessment of Analgesic Effects After Radiofrequency Ablation of the
Greater and Lesser Occipital Nerves in Patients with Occipital Neuralgia
Lance Hoffman MD ; Harsh Sachdeva MD ; James Fortman II, MD ; Jim Bruns MD
University of Cincinnati
Occipital neuralgia is an uncommon disorder characterized by severe pain involving the
posterior scalp in the distribution of the greater and lesser occipital nerves. In cases refractory
to pharmacotherapy, more invasive treatment options may be warranted. Multiple treatment
modalities have been described in the literature, though there have been few studies to evaluate
the efficacy of these treatment options. Specifically, there is limited published data regarding
the utility and efficacy of radiofrequency ablation (RFA) for the treatment of occipital neuralgia.
Material and Methods:
After obtaining institutional review board approval, all patients who underwent RFA of the
greater and lesser occipital nerves at the University of Cincinnati by the department of Pain
Medicine between January 1, 2013 and March 23, 2016 were identified. As many of the patients
identified in this study underwent more than one round of RFA, only the data from each patient’s
first RFA procedure was collected. The procedure was performed in a similar fashion in all
patients, with RFA being carried out in lesion mode at 80 °C for 180 seconds using 20 gauge
RFL 50 mm insulated needles (5 mm active tip) with each needle approximating the greater and
lesser occipital nerve.
Medical records were reviewed for each patient’s pre-procedure numeric rating score (NRS),
one-month post-procedure NRS, patient defined percent pain relief, and length of pain relief.
The primary outcomes were defined as the difference between pre-procedure and one-month
post-procedure NRS (mean change from baseline), percent pain relief and length of relief.
Continuous variables were compared using paired t-tests assuming equal or unequal variance
when appropriate. Two-tailed p-values ≤ 0.05 were considered to be statistically significant.
A total of 50 patients were identified in this study. Four patient records were excluded due to
insufficient data as a result of loss to follow-up. The average patient age was 46.48, SD 13.58.
A majority of patients were female (17.4% - male, 82.6% - female). Among this patient
population, 54.3% underwent bilateral RFA’s and 45.7% underwent unilateral RFA.
There was a significant difference between pre- and post-procedure NRS scores (6.74 vs 2.7;
p<0.001). The mean reduction in pain scores at one-month post-procedure was 4.02, SD 3.31.
The mean patient defined percent pain relief was 76.3%, SD 24.99%. The mean length of relief
was noted to be 6.49 months, SD 5.14. There was no difference between reductions in pain
scores, patient defined percent relief, or length of relief between males and females (p=0.12,
p=0.38, and p=0.49 respectively).
In this study, there was a statistically significant reduction in pain scores at one month with an
average length of relief for greater than six months. These promising results add to the evidence
supporting the use of RFA as a safe and effective treatment modality for patients diagnosed
with occipital neuralgia. Given the inherent pitfalls of retrospectives studies, a prospective,
randomized-control trial should be undertaken in order to elucidate the effectiveness of RFA for
the treatment of occipital neuralgia.