Abstract: The Use of Pulsed Radiofrequency Energy Therapy to Reduce Pain and Edema with Necrotising Fasciitis (44th Annual Conference (June 9-13, 2012))

Deborah Mauffray, RN, WOCN, Biloxi MS Veterans Administration Medical Center, Wound Care Specialist, Biloxi, MS

Objective: To report the use of pulsed radiofrequency energy (PRFE) therapy to reduce extreme pain for a patient with necrotizing fasciitis treated post-surgically with Negative Pressure Wound Therapy (NPWT).

Discussion:

The patient with necrotizing fasciitis was admitted with a post-surgical debridement wound of the perineal and scrotal areas. NPWT was in use upon transfer. The patient experienced wound pain at 5-7 [VAS 10 point scale]. Pain diminished only when there was a good NPWT seal, which was infrequent due to the undulating surfaces at this location. Dressing changes were extremely long and painful at 10/10 [VAS 10 point scale] and required 3-4 staff to assist. Premedication with IV morphine was needed to enable him to tolerate the procedure. Additionally, he took oral analgesics for wound pain and arthritis. Dressing changes were frequent due to the location of the wound.

We discontinued the NPWT and started PRFE therapy. Almost immediately, the patient reported that he no longer had wound pain nor pain with dressing changes thus the need to medicate with IV morphine was eliminated. The patient stated that he no longer took his oral analgesics for wound pain but continued them for arthritic pain only. In addition to pain reduction, the healing trajectory was essentially uninterrupted. (Figure 1)

PRFE is indicated for the palliative treatment of postoperative pain and edema in superficial soft tissue. The proposed mechanism of analgesia with PRFE is two-fold. In vitro, enhanced intracellular communication results in accelerated modulation of key inflammatory mediators. The net effect is to promote the intrinsic progression through and out of the inflammatory phase resulting in reduction of the pain associated with that initial stage of healing. Recent research also suggests a role in PRFE in activation of opioid pathways to reduce pain. ⁶

Further investigation into this biophysical technology is warranted.

6116 The Use of Pulsed Radiofrequency Energy Therapy to Reduce Pain and Edema with Necrotising Fasciitis