The Leiden-Nice Consensus (2024-2025)-Technical Standardization and Clinical Algorithms for Pulsed Radiofrequency for...

Pulsed radiofrequency (PRF) has emerged as a safe, minimally invasive clinical strategy for the management of acute and chronic pain syndromes. Over the past two decades, its range of clinical applications has expanded across spinal, peripheral nerves, and intra-articular interventions. Despite the growing evidence supporting the clinical efficacy of PRF, two major challenges remain: (a) the lack of standardized technical parameters and the absence of structured clinical algorithms guiding physicians in selecting the targets and therapeutic strategies. In April 2024, an international panel of pain specialists convened in Leiden, the Netherlands to propose standardized technical guidelines for PRF procedures, resulting in the Leiden Consensus 2024, which focuses on reproducible parameters such as voltage, exposure time, electrode configuration, and procedural technique. Subsequently, during expert consensus discussions held in Nice, France, in 2025, the same international workgroup addressed a second critical gap in the field: clinical decision-making in interventional pain management. The Nice 2025 Consensus therefore developed practical diagnostic and therapeutic algorithms for common chronic pain conditions, including cervical facet pain, shoulder pain, knee osteoarthritis, sacroiliac pain, hip pain, thoracic pain, and central sensitization syndromes. This integrated consensus manuscript combines both initiatives into a comprehensive clinical framework. The Leiden Consensus proposes reproducible technical standards for PRF procedures, while the Nice Consensus provides stepwise clinical pathways emphasizing diagnosis-driven interventions and prioritizing nondestructive neuromodulation strategies. A central principle of the consensus is that PRF may be considered the first-line interventional treatment for peripheral nerve-related chronic noncancer pain, reserving ablative radiofrequency techniques for cases that are refractory to neuromodulation. The present document represents a living consensus intended to guide clinical practice worldwide while stimulating future research and evidence generation in the rapidly evolving field of PRF pain therapy.