Predictors of Success After Intercostal Nerve Radiofrequency Treatment for Intercostal Neuralgia

This retrospective cohort study analyzed anonymized medical records of adults (≥18 years) with intercostal neuralgia (post-traumatic, postherpetic, or idiopathic) treated in Pain Clinic of Mersin University Faculty of Medicine who underwent ultrasound-guided intercostal conventional radiofrequency ablation (CRF) or pulsed radiofrequency (PRF) between January 1, 2018 and May 30, 2025.

Primary outcome is treatment response at 6 months, defined by IMMPACT criteria as a ≥50% reduction or ≥4-point decrease in NRS-11 from baseline; secondary outcomes include changes in NRS-11 over time, and exploratory analyses evaluate whether clinical factors (e.g., age, sex, pain duration, diagnosis, presence of allodynia, and number of treated intercostal levels )are associated with response using multivariable logistic regression (p < 0.05 considered statistically significant).

The findings are expected to clarify which patient and clinical characteristics are linked to better outcomes after intercostal nerve radiofrequency and to support more individualized decision-making in the management of intercostal neuralgia.

• Intercostal Nerve Conventional Radiofrequency Ablation (CRF) (Procedure): Ultrasound-guided intercostal nerve lesioning at 80°C for 90 seconds following sensory stimulation.
• Intercostal Nerve Pulsed Radiofrequency (PRF) (Procedure): Ultrasound-guided intercostal pulsed radiofrequency delivered at 42°C for 240 seconds.

Primary outcomes

• Treatment response at 6 months (IMMPACT-defined responder rate) [6 months]: Responder defined as ≥50% reduction or ≥4-point decrease in NRS-11 compared with baseline.

Secondary outcomes

• Change in NRS-11 pain score from baseline [Baseline, 3 months, and 6 months]: NRS-11 ranges from 0 (no pain) to 10 (worst imaginable pain).

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Age ≥ 18 years.
* Diagnosis of intercostal neuralgia (post-traumatic, postherpetic, or idiopathic) with thoracic neuropathic pain for at least 1 month
* Underwent ultrasound-guided intercostal nerve radiofrequency treatment (conventional radiofrequency ablation \[CRF\] or pulsed radiofrequency \[PRF\]) as part of routine clinical care
* Documented baseline NRS-11 pain score prior to the procedure and follow-up NRS-11 data available through at least 6 months after treatment.

Exclusion Criteria:

* Thoracic pain attributable to malignancy-related causes (e.g., active malignant invasion, spinal metastasis) or an intrathoracic mass
* History of thoracic surgery at the corresponding thoracic dermatome level (e.g., thoracotomy or VATS)
* Prior radiofrequency treatment at the same intercostal nerve site
* Receipt of other interventional treatments targeting the intercostal nerve during the study period (e.g., cryoablation or chemical neurolysis)
* Insufficient follow-up data (less than 6 months of follow-up NRS-11 documentation).

• Results publication: Huang X, Ma Y, Wang W, Guo Y, Xu B, Ma K. Efficacy and safety of pulsed radiofrequency modulation of thoracic dorsal root ganglion or intercostal nerve on postherpetic neuralgia in aged patients: a retrospective study. BMC Neurol. 2021 Jun 24;21(1):233. doi: 10.1186/s12883-021-02286-6. PMID 34162352
• Results publication: Engel AJ. Utility of intercostal nerve conventional thermal radiofrequency ablations in the injured worker after blunt trauma. Pain Physician. 2012 Sep-Oct;15(5):E711-8. PMID 22996865