Pulsed Radiofrequency 2 Hz Preserves the Dorsal Root Ganglion Neuron Physiological Ca²⁺ Influx, Cytosolic ATP Level, Δψm, and pERK Compared to 4 Hz: An Insight on the Safety of Pulsed Radiofrequency in Pain Management

Abstract

Background

Pulsed radiofrequency (PRF) is beneficial for radicular pain and is commonly administered at pulse frequencies of 2 or 4 Hz. However, its effects on healthy neurons have not yet been widely studied. This study aims to determine the effect of PRF at 2 Hz and 4 Hz on the physiology of healthy dorsal root ganglion (DRG) neurons.

Methods

An in vitro experimental study was conducted using DRG neuron cultures divided into three groups. Control cells received no treatment, one cell group received 20 ms 2 Hz PRF for 360 s, and one cell group received a 4 Hz PRF 10 ms pulse for 360 s with similar energy. Ca²⁺ influx, mitochondrial membrane potential (Δψm), cytosolic Adenosine triphosphate (ATP), and phosphorylated extracellular signal-regulated kinase (pERK) levels were measured. The data were analyzed using the One-Way ANOVA variance with α=5%.

Results

DRG neurons exposed to PRF 2 Hz did not experience a significant change in Ca²⁺ influx, whereas PRF 4 Hz caused a significant decrease in Ca²⁺ influx compared to the basal level. PRF at 2 Hz did not cause a change in Δψm, whereas PRF at 4 Hz caused a significant decrease in Δψm (p<0.05). Both 2 and 4 Hz PRF resulted in a significant elevation in cytosolic ATP concentration, but the 2 Hz PRF had a higher cytosolic ATP than the 4 Hz group (p<0.05). Both 2 and 4 Hz did not show a significant difference in pERK intensity with respect to the control (p>0.05), indicating that there was no significant neuron activation.

Conclusion

Both frequencies did not significantly activate DRG neurons, but with similar energy delivery, PRF 2 Hz preserved the physiological properties of healthy neurons better than PRF 4 Hz did. A 2 Hz PRF is the preferred frequency in clinical applications for neuron-targeted therapy.

Keywords:

• pulsed radiofrequency
• neurons
• physiology
• dorsal root ganglion neuron

Ethical Statement

The Brawijaya University Ethical Clearance Committee approved the study protocol (No. 114-KEP-UB-2020).

Disclosure

The authors report no conflicts of interest in this work.