Effect of Radiofrequency on Dorsal Root Ganglion Versus Transforaminal Steroids Injection on Tumor Necrosis Factor-Alpha Level in Lumbar Radicular Pain

Pain Physician. 2023 Oct;26(6):E671-E677.


Background: The mechanism of pain control with pulsed radiofrequency (PRF) is unclear.

Objectives: We aimed to compare the efficacy of combined PRF on dorsal root ganglion (DRG) with transforaminal epidural steroid injection (TFESI) vs TFESI-alone on pain improvement and serum tumor necrosis factor-alpha (TNF-a) level in lumbar disc-related radicular pain.

Study design: Prospective, randomized, controlled trial.

Setting: Neurology and Pain Management clinics.

Methods: A total of 80 patients with lumbar disc prolapse were divided into 2 groups: combined PRF on DRG with TFESI group and TFESI-alone group. The Numeric Rating Scale (NRS-11), Oswestry Disability Index (ODI), and Functional Rating Index (FRI) before intervention and at 2 weeks, 1 month, and 3 months after the intervention were observed. Serum TNF-a level was assessed pre- and post-intervention at 3 months.

Results: The scores of NRS-11, ODI, and FRI showed a significant improvement at 2 weeks, 1 month, and 3 months following intervention in both combined PRF & TFESI group and TFESI-alone group (P < 0.001 in all comparisons), with no significant difference between the 2 groups. Serum TNF-a levels showed a statistically significant reduction, 3 months following intervention in the combined PRF & TFESI group (P < 0.001), but not in the TFESI-alone group (P = 0.297) (P between groups < 0.001).

Limitations: The main limitation of this study is that TNF-a level was not assessed earlier to see how long the steroids might reduce TNF-a. On the other hand, further study with extended follow-up periods is needed to confirm the long-term lowering effect of TNF-a provided by PRF.

Conclusions: Combined PRF on DRG with TFESI showed similar outcomes to TFESI-alone in relieving pain in patients with lumbar disc prolapse. However, PRF on DRG caused a significant decrease in TNF-a serum levels at 3 months.

Keywords: lumbar disc prolapse; transforaminal steroids injection; tumor necrotic factor-alpha; Pulsed radiofrequency.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Ganglia, Spinal
  • Humans
  • Injections, Epidural
  • Intervertebral Disc Displacement* / drug therapy
  • Intervertebral Disc Displacement* / therapy
  • Low Back Pain* / drug therapy
  • Low Back Pain* / pathology
  • Lumbar Vertebrae / pathology
  • Prolapse
  • Prospective Studies
  • Radiculopathy* / drug therapy
  • Steroids / therapeutic use
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / therapeutic use


  • Tumor Necrosis Factor-alpha
  • Steroids