Occipital Nerve Pulsed Radiofrequency Treatment: A Multi-Center Study Evaluating Predictors of Outcome

Objective. Occipital neuralgia (ON) is a challenging condition for which there is no reference standard for treatment. The purpose of this study was to provide outcome data on the largest study to date evaluating pulsed radiofrequency (PRF) for ON and to determine whether any demographic, clinical, or treatment characteristics are associated with success. Design. Retrospective data analysis was conducted in 102 subjects evaluating the effect of myriad factors on treatment success. Setting. This study was conducted in academic civilian and military pain treatment centers. Patients. One hundred and two consecutive patients with a primary diagnosis of ON were treated with PRF of the greater and/or lesser occipital nerve. Outcome Measures. A positive primary outcome was predefined as >= 50% pain relief lasting at least 3 months. The secondary outcome measure was procedural satisfaction. Results. Fifty-two (51%) patients experienced >= 50% pain relief and satisfaction with treatment lasting at least 3 months. Variables associated with a positive outcome included a traumatic inciting event (65.7% success rate; P = 0.03), lower diagnostic block volumes (odds ratio [OR]: 0.72; 95% confidence interval [CI]: 0.62-0.82; P < 0.0001), and employment of multiple rounds of PRF (OR: 2.95; 95% CI: 1.77-4.92; P < 0.0001). Factors correlating with treatment failure included extension of pain anterior to the scalp apex (OR: 0.32; 95% CI: 0.14-0.73; P = 0.006) and ongoing secondary gain issues (OR: 0.19; 95% CI: 0.11-0.33; P < 0.0001). Conclusion. PRF may provide intermediate-term benefit in ON to a significant proportion of refractory cases. Careful attention to selection criteria and treatment parameters may further improve treatment outcomes.