Ultrasound-Guided Pulsed Radiofrequency of the Sciatic Nerve for Chronic Lower Limb Pain: A Real-World Cohort Experience

Background: Chronic neuropathic or mixed lower limb pain represents a frequent challenge in pain management units. The sciatic nerve ultrasound-guided pulsed radiofrequency (PRF) is a minimally invasive neuromodulation technique that may provide analgesia without thermal nerve injury. Objective: To describe the outcomes of ultrasound-guided pulsed radiofrequency of the sciatic nerve in patients with chronic lower limb pain. Methods: A single-center, retrospective, observational study including patients treated with ultrasound-guided sciatic nerve PRF between January 2020 and November 2025. Collected variables included clinical information, visual analogue scale (VAS), EuroQol-5D, previous analgesic consumption, complications, and global subjective perceived improvement. Pre- and post-treatment outcomes were compared using paired Student’s t-tests. Results: A total of 266 patients were analyzed (152 (57.1%) women; mean age 67.8 ± 13.1 years). Overall clinical improvement (VAS reduction ≥3 points) was achieved in 181 (68.05%) patients, and 61 (33.83%) of them reduced analgesic consumption. The highest response percentages were observed in neurogenic claudication (83.3%), ankle/foot pain (80.8%), distal neuropathic pain (80%), and ischemic pain (71.4%). Significant improvements were observed in VAS and EuroQol-5D scores (p < 0.0001). Mean duration of clinical benefit was 5.1 ± 1.4 months, with effects persisting for up to 10 months in some patients. Only mild, transient complications were reported in 11 cases (4.14%). Conclusions: Ultrasound-guided pulsed radiofrequency of the sciatic nerve appears to be a safe, minimally invasive, and potentially effective option for chronic nociceptive, neuropathic, or mixed lower limb pain. This study is conceived as one of the largest clinical published investigations, contributing to real evidence on patients and highlighting the clear necessity of additional controlled studies.