The Effectiveness and Safety of Low- vs High-Voltage Pulsed Radiofrequency for lumbosacral radicular Pain: A Systematic Review and Meta-Analysis

Background: Lumbosacral radicular pain (LRP) often caused by intervertebral disc herniation, leads to chronic disability and reduced quality of life (QoL). Pulsed radiofrequency (PRF) is a minimally-invasive treatment offering neuromodulation without neural damage. While standard PRF uses 45 V, the potential benefits of high-voltage (HV) PRF over low-voltage (LV) PRF remain unclear. The objective of this systematic review and meta-analysis was to evaluate the effectiveness and safety of HV PRF versus LV PRF in managing chronic LRP (CLRP). Materials and Methods: The study protocol was registered in PROSPERO (CRD42024568875). Multiple databases (Cochrane Library, PubMed/MEDLINE, Scopus, and ProQuest) were searched for randomized and non-randomized studies published in English and Bahasa Indonesia up to May 20, 2024. The risk of bias and risk of bias in non-randomized studies of interventions tools were used to assess the risk of bias. Results: Three studies (213 participants) met the inclusion criteria; of which one randomized controlled trial and one non-randomized study were meta-analyzed (196 participants). Meta-analysis showed substantial heterogeneity (I² = 93, P < 0.01). A random-effects model indicated a slightly greater decrease in numeric rating scores in the HV PRF group (standardized mean differences 0.36, 95 CI -1.71; 2.43). Both HV and LV PRF groups showed clinical efficacy in pain reduction and QoL improvement. No serious complications were noted. Conclusion: HV PRF appears to be a safe and potentially more effective option than LV PRF for CLRP. However, further large, high-quality studies are needed to confirm its benefits, optimize treatment settings, and identify patients most likely to respond to this therapy. 2025 Bali Journal of Anesthesiology.