Predictors of Treatment Success After Intercostal Nerve Radiofrequency for Intercostal Neuralgia: A Retrospective.

BACKGROUND

Intercostal neuralgia, which is characterized by neuropathic pain along the distribution of the intercostal nerves (ICNs), can impair patients' quality of life substantially. ICN-targeted radiofrequency (RF) treatment is used increasingly in current practice; however, data on factors that predict the success of such treatments remain limited.

OBJECTIVES

This study aims to evaluate factors associated with treatment success in patients with intercostal neuralgia who underwent ICN-targeted RF treatment.

STUDY

DESIGN

A retrospective cohort study.

SETTING

A single-center retrospective study conducted at Mersin University Faculty of Medicine Hospital.

METHODS

This retrospective chart review included adults who had post-traumatic, postherpetic, or idiopathic intercostal neuralgia and underwent ultrasound-guided conventional radiofrequency ablation (CRF) or pulsed radiofrequency treatment (PRF) on their ICNs between January 1, 2018, and May 30, 2025. Pain intensity (measured on the NRS-11) was assessed at baseline and at 3 and 6 months after the procedure. The primary outcome was the 6-month treatment response (according to IMMPACT criteria: ≥ 50% pain reduction or a ≥ 4-point decrease in NRS score from its baseline counterpart). Group comparisons and multivariable logistic regression were performed to evaluate the outcomes and predictors of response.

RESULTS

Sixty patients were included in the analysis (CRF, n = 31; PRF, n = 29). At both 3 and 6 months, mean NRS scores were significantly lower in the CRF group than in the PRF group (3 months: 2.77 ± 1.80 vs 5.83 ± 2.55; P < 0.001; 6 months: 2.81 ± 1.93 vs 6.31 ± 2.34; P < 0.001). In the multivariable model, which included age, gender, presence of allodynia, baseline NRS score, and RF modality, only RF modality was identified as an independent predictor of treatment response (OR 9.395; 95% CI 2.363-37.359; P = 0.001).

LIMITATIONS: The single-center setting, relatively small sample size, and retrospective study design.

CONCLUSIONS

Ultrasound-guided intercostal CRF may provide clinically meaningful analgesia for patients with refractory intercostal neuralgia. Although both modalities were associated with short-term pain improvement, CRF produced significantly more sustained pain reduction at 3 and 6 months and emerged as the sole independent predictor of treatment success.