Background and aims Pulsed radiofrequency (PRF) on the dorsal root ganglion is a technique frequently used in pain centres throughout the world for the management of lumbo-radicular neuropathic pain. Evidence regarding the clinical outcome of this intervention is still limited, although a fundamental pathophysiologic working mechanism at the spinal level has been published.

Methods We propose a new hypothesis to explain the central effects of this technique: the modification of the pain signal at the spinal level should ultimately have its effect on the dynamic pain connectome. We are currently conducting a pilot trial to demonstrate these changes on fMRI imaging, where we compare the difference in activity of resting state fMRI before and after PRF on the dorsal root ganglion.

Results We hypothesize that patients with neuropathic chronic pain have alterations in resting state baseline fMRI. After PRF intervention on the DRG a reduction of chronic pain is expected, with accompanying reversibility of the altered functional neuroimaging: an increase in contralateral thalamic rCBF, a greater DM connectivity with pgACC accompanying less connectivity with insular cortex and an increase in FC between PAG and vmPFC/rACC.

Conclusions This hypothesis and feasibility study should provide fertile ground for further investigations and clinical studies on this topic.