{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:21:05Z","timestamp":1787026865759,"version":"build-2736575974"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Spasticity-Plus Syndrome (SPS) in multiple sclerosis (MS) represents a cluster of symptoms including spasticity, neuropathic pain, spasms, and bladder dysfunction. These manifestations may worsen after trauma or surgery. Pulsed radiofrequency (PRF) offers a minimally invasive neuromodulation strategy that could complement standard treatments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We report the case of a 56-year-old woman with secondary progressive MS (EDSS 6.5) who developed SPS after hip arthroplasty. Despite multiple pharmacological therapies (baclofen, opioids, nabiximols), symptom control remained poor. Two diagnostic nerve blocks were performed, followed by PRF of the femoral and obturator articular branches. Outcomes were monitored using patient-reported measures, the Modified Ashworth Scale, and the Numerical Rating Scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>PRF induced a 50\u201360% reduction in pain and a marked decrease in spasms, with partial improvements in sleep and quality of life. The patient rated PRF as superior to all prior treatments. Benefits were sustained for several months, supporting repeat PRF and adjunctive nerve blocks during follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case illustrates the role of PRF in SPS management when pharmacological options are insufficient or poorly tolerated. PRF provides safe, repeatable peripheral neuromodulation without neuro-destructive effects, enabling multimodal, patient-centered care. Although based on a single case, these findings support the clinical value of the SPS construct and suggest PRF as a promising complementary strategy in MS-related disability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2025.1634960","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T04:12:09Z","timestamp":1758514329000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Peripheral neuromodulation in spasticity-plus syndrome: effects of pulsed radiofrequency on tonic-painful disorders in multiple sclerosis"],"prefix":"10.3389","volume":"16","author":[{"given":"Luigi","family":"Di Lorenzo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmine","family":"D\u2019Avanzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1007\/s00415-024-12750-1","article-title":"Spasticity patterns assessment and recognition for therapeutic approaches (SPARTA) in multiple sclerosis: a multicenter epidemiological study","volume":"272","author":"De Blasiis","year":"2024","journal-title":"J Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"152","DOI":"10.3389\/fneur.2020.001520000000000000847","article-title":"The broad concept of \"spasticity-plus syndrome\" in multiple sclerosis: a possible new concept in the Management of Multiple Sclerosis Symptoms","volume":"11","author":"Fern\u00e1ndez","year":"2020","journal-title":"Front Neurol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"802918","DOI":"10.3389\/fneur.2021.802918","article-title":"Theoretical and therapeutic implications of the spasticity-plus syndrome model in multiple sclerosis","volume":"12","author":"Bruno","year":"2022","journal-title":"Front Neurol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"569","DOI":"10.2147\/CIA.S79961","article-title":"Pulsed radiofrequency treatment of articular branches of femoral and obturator nerves for chronic hip pain","volume":"10","author":"Chye","year":"2015","journal-title":"Clin Interv Aging"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1371644","DOI":"10.3389\/fneur.2024.1371644","article-title":"Practical tool to identify spasticity-plus syndrome amongst patients with multiple sclerosis. Algorithm development based on a conjoint analysis","volume":"15","author":"Fern\u00e1ndez Fern\u00e1ndez","year":"2024","journal-title":"Front Neurol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"59","DOI":"10.3390\/medicines5030059","article-title":"Pain modulation after Oromucosal cannabinoid spray (SATIVEX\u00ae) in patients with multiple sclerosis: a study with quantitative sensory testing and laser-evoked potentials","volume":"5","author":"Turri","year":"2018","journal-title":"Medicine"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1159\/000490376","article-title":"Variability of multiple sclerosis spasticity symptoms in response to THC: CBD Oromucosal spray: tracking cases through clinical scales and video recordings","volume":"10","author":"Flachenecker","year":"2018","journal-title":"Case Rep Neurol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1016\/j.neubiorev.2021.11.037","article-title":"Effects of 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