High versus low-voltage pulsed radiofrequency of the suprascapular nerve for chronic shoulder pain: A randomized pilot clinical trial

Background Chronic shoulder pain refractory to conservative treatment remains a common and challenging clinical condition. Pulsed radiofrequency (PRF) of the suprascapular nerve (SSN) is a well-established interventional technique, typically applied at 45 V. Emerging evidence suggests that higher voltages may enhance clinical outcomes. This exploratory pilot study aimed to compare changes in pain and function after high-voltage (100 V) versus low-voltage (45 V) PRF of the SSN. Methods A prospective, randomized, single-center, assessor-blinded pilot clinical trial was conducted. Twenty patients with chronic rotator cuff tendinopathy, baseline Visual Analog Scale (VAS) ≥7, and refractory to conservative treatment were included. Patients were randomly assigned to receive PRF of the SSN at either 45 V or 100 V, with identical technical parameters (360 s, 42 °C). Pain (VAS) and function (QuickDASH) were evaluated at baseline, 1 month, and 6 months. Results The 100 V group showed larger observed reductions in pain compared with the 45 V group at both 1 month (between-group difference: 2.7 points; p = 0.011) and 6 months (between-group difference: 2.46 points; p = 0.022). A similar pattern was observed for QuickDASH scores. Improvements in the 45 V group were smaller and did not reach statistical significance. No serious procedure-related adverse events were recorded. Conclusions In this exploratory pilot trial, high-voltage (100 V) PRF of the suprascapular nerve was associated with larger improvements in pain and function than 45 V PRF, although efficacy findings remain exploratory and require confirmation in larger controlled trials. No serious procedure-related adverse events were observed.