الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Pain is a common symptom that significantly impacts a patient‘s quality of life, with an overall weighted mean prevalence of pain of 47% in all patients with thoracic cage metastasis .
Under treatment of cancer pain is associated with adverse psychological and physical outcomes that cause suffering and a lower standard of living. In addition, physical symptoms like anorexia, insomnia, excessive fatigue, impaired mental function, and decreased vital capacity, are also experienced. When pain is not adequately managed, cancer patients tend to withdraw from social and family situations.
Thoracic cage is one of the most common sites of metastasis in patients with lung cancer. Pain is due to tumor invasion of ribs is severe and difficult to treat. Conventional treatment in the form of NSAIDs, Opioids, bisphosphates and radiotherapy may fail to control pain of some patients.
Interventional pain techniques may be considered when an adequate medical management fails to provide satisfactory analgesia or when side effects occur. The benefits of interventional approaches include better analgesia without drug-related side effects and potential for opioid dose reduction thus avoiding central side effects.
DRG is the gate for all sensations that are transmitted to the spinal cord and higher centers so it became a clinical target for the delivery of steroids, surgical ablation (ganglionectomy), radio-frequency ablation, pulsed radiofrequency therapy, and neuromodulation therapy. It has been confirmed that blocking DRG has marked effects on the intractable pain.
Primary sensory neuron cell bodies are grouped together in the DRG. Aβ, Aδ, and c fibers are some of these fibers. from the periphery to the DRG and then the central nervous system, each of these fibers is in charge of transmitting sensory signals. In particular, C fibers actively contribute to chronic pain. It has been observed that abnormal pain signaling occurs within the DRG cell bodies via C-fiber nociceptors.
In recent years, the use of PRF to treat chronic pain conditions has generated intense interest in the pain community. DRG pulsed radiofrequency could be done under fluoroscopy or Computed Tomography (CT) guidance. Ultrasound is another modality that gained popularity among pain physicians as it allows better visualization of soft tissues and vasculature with no risk of radiation
The aim of this study was to investigate the effect of ultrasound guided pulsed radiofrequency of thoracic dorsal root ganglion on metastatic thoracic cage pain intensity and impact of pain on daily life and functionality of patients with lung cancer.
33 patients were randomized equally to either group 1 (n = 15) that received PRF plus local anesthetic to thoracic DRG, or group 2 (n = 15) that received local anesthetic only without active PRF. The primary outcome variable was reduction of pain intensity measured by visual analogue scale (VAS) at post intervention follow up period. The secondary outcome variables were improvement of patient‘s functionality 1 week post intervention, improvement
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of patient‘s general activity, mood, walking ability, relations with other people, sleep and enjoyment of life measured by brief pain inventory scale at 2 weeks, 1, 2 and 3 months post intervention, and to detect accuracy of ultrasound in identifying correct vertebral level and correct PRF cannula tip position in the transforaminal space.
Results of the current study showed that VAS score decreased significantly in the immediate post intervention compared to pre intervention time in both groups (P< 0.001). VAS also significantly decreased in group1 compared to group2 at 1, 3 and 7 days post procedure (P< 0.001). There was significant improvement in functional status measured by FACIT-F scale in both groups at 1 week post intervention compared to pre intervention (P= 0.001) with no significant difference between the 2 groups (P=0.933). BPI showed that worst, least, average pain and pain right now in addition to interference of pain with mood, sleep and enjoyment of life all were lower in the group 1 in post intervention compared to pre intervention time and more in group 1 than group 2 (P< 0.001). Interference of pain with patient‘s general activity and walking ability didn‘t show significant difference between the 2 studied groups. Interference of pain with relations with other people significantly decreased in group1 than group 2 only at 2 weeks post intervention. Satisfaction with pain relief measured by Likert scale 1 week post intervention, showed that 60% of patients in group1 was either very satisfied or satisfied compared with 80% of patients were either dissatisfied or very dissatisfied in group2.