For Professionals

Key points

• Opioid burden is the strongest modifiable negative predictor. Each 1 mg/day increase in MME cut the odds of success by ~2%; responders averaged 17.0 mg/day vs 40.4 mg/day in non-responders. This supports pre-procedural opioid tapering as a way to improve outcomes, and fits a wider literature on opioids blunting interventional pain treatments.
• Surgical subtype matters more than surgery per se. Prior fusion or decompression roughly tripled the odds of failure (OR 0.315), plausibly via epidural fibrosis, altered biomechanics and central sensitisation (FBSS/PSPS-T2), while prior discectomy was prognostically neutral — so a discectomy history should not exclude a patient from DRG-PRF, whereas fusion history warrants careful counselling or alternative approaches.
• The model is promising. Higher baseline pain paradoxically predicted better response (OR 1.558), a finding the authors flag as needing external validation. More broadly: AUC 0.734 means roughly one in three patients is misclassified; the study is retrospective, single-centre, limited to a pain-only endpoint at 6 months and omits psychological predictors (depression, catastrophising) and procedural parameters. External validation in independent cohorts is required.

A merger of two international expert-panel efforts on pulsed radiofrequency (PRF), a non-destructive neuromodulation technique introduced by Menno Sluijter in 1998:

• Leiden 2024 — standardized technical parameters (the "how")
• Nice 2025 — structured clinical algorithms per pain condition (the "when and where")

The field's problem was never that PRF doesn't work; it's that everyone did it differently and no one wrote down why; this consensus summarizes the parameters and the decision tree and asks that ablation become the exception rather than the default.

This is the most recent paper in the collection — published in 2026 — and provides a comprehensive narrative review of PRF's immunological mechanisms, synthesizing 12 key studies selected from an initial pool of 126 articles. It is notable for being published in an immunology journal, reflecting PRF's expanding identity beyond pain medicine.

This first systematic review of TcPRF in chronic pain synthesized eight RCTs (n = 467) covering musculoskeletal conditions (knee osteoarthritis, shoulder pain, subacromial impingement syndrome, lateral epicondylitis) and neuropathic pain syndromes (carpal tunnel syndrome, diabetic neuropathic pain, chronic migraine). Risk of bias was assessed using the Cochrane RoB 2 tool.

This Osaka University mouse study used a monoiodoacetic acid (MIA)-induced knee pain model to trace the precise mechanism behind PRF's anti-inflammatory effects. PRF was applied to the sciatic nerve — distant from the joint — and outcomes were assessed behaviorally, histologically, and biochemically.

This Brazilian-Dutch case series reports three patients treated with transcutaneous STP (Sluijter-Teixeira-Poisson) pulsed radiofrequency for spinal conditions — all of whom had failed conservative therapy and were unwilling or unable to undergo invasive procedures. Treatment was delivered via adhesive skin patches using a Spring2 generator, with three sessions per patient.

This Dutch retrospective study from Amphia Hospital (Breda, The Netherlands) is the first to examine TcPRF specifically for upper extremity OA. Thirty-seven patients with shoulder, elbow, or hand/wrist OA — the majority having experienced pain for over a year — received a single 15-minute TcPRF treatment using a Springlife Medical device (Spring2), with follow-up at 1, 2, and 6 weeks.

This paper — published posthumously in memory of Menno Sluijter, PRF's inventor — presents a comprehensive theoretical framework for understanding how PRF exerts systemic anti-inflammatory effects, and introduces the term RedoxPRF for this application.

This Japanese in vitro study examined how PRF affects gene expression in astrocytes — the glial cells that play a central role in neuroinflammation and neuropathic pain. Mouse astrocyte cell lines were exposed to PRF (480 kHz, 20 ms pulses, 45V, 30 min) and subsequently analyzed using microarray technology covering over 56,000 probes.

This Brazilian review paper explores whether combining PRF with orthobiologics — primarily PRP, but also bone marrow aspirate and adipose tissue-derived products — could produce synergistic therapeutic effects beyond what either approach achieves alone.

This Brazilian rat study investigated whether PRF could reduce oxidative stress and inflammation following acute muscle trauma. Twenty-four male Wistar rats were divided into four groups (control, PRF only, trauma only, trauma + PRF), with PRF delivered using a Spring2 device — notably one of the few studies explicitly naming the Spring device in the methods.

This in vitro study explored a novel question: can PRF activate platelet-rich plasma (PRP), and could the two therapies be usefully combined? PRP from 11 healthy volunteers was divided into four groups — resting control, thrombin-activated (positive control), PRF-treated, and thrombin + PRF combined — and assessed for markers of platelet activation and cellular safety.

This Australian double-blind, randomized, placebo-controlled trial is one of the strongest pieces of clinical evidence for TcPRF to date. Fifty-one patients awaiting shoulder surgery were randomized to active (80V) or sham (0V) TcPRF, delivered as a single session at six standardized electrode positions around the shoulder. Assessments were performed at 4 and 12 weeks by a blinded observer.