Recommendations from Pain Societies
Leading pain societies, including the International Spine Intervention Society (ISIS) and the American Society of Interventional Pain Physicians (ASIPP), have issued guidelines on radiofrequency ablation for chronic pain management. These emphasize accurate patient selection, validated diagnostic blocks, and standardized procedural techniques.
Consensus statements acknowledge the advantages of multitined electrodes such as Nimbus Stratus, highlighting improved lesion coverage and reproducibility.
Guidelines further recommend systematic use of validated pain and function assessment tools, ensuring objective monitoring of clinical outcomes.
Dedicated training programs and reference centers are considered essential to maintain safety and standardization.
Role of Stratus in Global Protocols
Nimbus Stratus is increasingly incorporated into international protocols as an advanced tool for nerve ablation, due to its ability to create extended and continuous lesions. This feature is recognized as enhancing nerve capture rates and reducing technical failures.
Multicenter studies have supported its integration, consolidating its role within evidence-based treatment pathways.
The use of Stratus is most prominent in sacroiliac joint and cervical pain, particularly in patients confirmed by positive diagnostic blocks.
Inclusion in global protocols reflects the growing acceptance of Stratus as a standard option in interventional pain management.
Regional Variations and Standardization
Geographical differences exist in how RFA is integrated into care pathways. In the U.S., RF interventions are often introduced earlier compared to Europe, where conservative care is prolonged before interventional options.
In Asian protocols, multimodal care integrating physical therapy immediately after RFA is common, while European practice often follows a more sequential approach.
Standardization across regions is a key objective to reduce variability and strengthen global evidence. Adoption of unified protocols that include Stratus is highlighted in consensus papers.
Harmonization efforts are directed at facilitating data comparability and establishing international benchmarks.
Clear Indications and Contraindications
The main indications for Stratus include chronic sacroiliac and cervical pain refractory to conservative treatment, confirmed by ≥50% pain relief following diagnostic blocks. Lumbar facet pain is another well-supported application.
Absolute contraindications include local infection, uncorrected coagulopathy, and hemodynamic instability. Relative contraindications include pregnancy, uncontrolled psychiatric disorders, and lack of patient cooperation.
Multidisciplinary evaluation is strongly advised to ensure appropriate patient selection and optimize outcomes.
Clear criteria help improve safety and maintain consistency across clinical centers.
Quality Monitoring and Clinical Outcomes
Quality monitoring involves systematic outcome tracking with validated tools such as NPRS, ODI, NDI, and EQ-5D. These allow for robust assessment of efficacy and patient-centered results.
Guidelines recommend periodic audits of success rates, complication rates, and long-term follow-ups.
International registries collecting multicenter data contribute to stronger evidence and guideline refinement.
Transparent data reporting ensures continuous quality improvement in interventional pain practice.
Integration into Hospital Pathways
The integration of multitined RFA systems into hospital pathways requires alignment with physiotherapy, pharmacological support, and rehabilitation services. This multimodal approach maximizes long-term clinical benefits.
Stratus is positioned after failure of conservative measures but before invasive surgical interventions.
Incorporating RFA into hospital-based care pathways ensures uniformity, cost-effectiveness, and continuity of care.
This integration strengthens the role of Stratus in modern pain management programs worldwide.
References
- McCormick Z., Burnham R., Wright E., Allan J. Randomized Controlled Trial of Cervical Medial Branch Radiofrequency Ablation for Chronic Neck Pain. Regional Anesthesia and Pain Medicine, 2018.
Al-Kaisy A., Pang D., Desai M., McNamee D. NIMBUS: A Novel Multi-Tined Expandable Electrode for Percutaneous Radiofrequency Lesioning of the Sacroiliac Joint. Orthopaedic Proceedings, 2018.
