To the Editor,


We appreciate the comments by Dr. Raghuraman about our article on radiofrequency ablation for the sympathetic nervous system.

We fully recognize the utility of newer radiofrequency ablation modalities, i.e., cooled radiofrequency ablation and bipolar radiofrequency ablation. However, given that we identified almost no articles discussing these therapies in treating sympathetic nervous system painful conditions, we made the intentional choice to exclude these ablative therapies from our review.

As for the analysis and conclusions, we performed a narrative review article and not a meta-analysis. In our article we characterized and summarized the findings of other articles as reported by the original authors. The request Dr. Raghuraman is asking for requires a meta-analysis that will test all articles, their strengths and confounders. The articles published were too heterogenous in type, intervention, cohort, and pain syndromes and thus were not sufficient to perform a meta-analysis.

Again, we thank Dr. Raghuraman for his comments. We fully agree with the need for more research in this area—notably research exploring various ablative modalities, with longitudinal follow-up and functional parameters.

Sincerely,

Alaa Abd-Elsayed, MD, MPH and Jay Karri, MD, MPH