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Radiofrequency Ablation in Pain Management

Radiofrequency Ablation in Pain Management

What is radiofrequency ablation?

Radiofrequency ablation (RFA), also called rhizotomy, is a nonsurgical, minimally invasive procedure that uses heat to burn or destroy a nerve in order to reduce or stop the transmission of pain signals. Radiofrequency waves ablate, or “burn,” the nerve that is causing the pain, essentially eliminating the transmission of pain signals to the brain.

RFA’s are frequently used to treat chronic pain and conditions like arthritis of the spine (spondylosis) and sacroiliitis. It can also used to treat neck, back, knee, pelvic and peripheral nerve pain.

The benefits of radiofrequency ablation include:

  • Immediate pain relief.
  • Little to no recovery time.
  • Decreased need for pain medication
  • Improved mobility and function
  • Postponing or avoiding surgery

Who is a candidate?

RFA’s work best for arthritic conditions of the spine, as the nerves responsible for carrying the pain impulses can be targeted safely with a needle. Patients who have received steroid injections and experienced successful pain relief are ideal candidates, because an RFA can duplicate and prolong the effects felt by a facet joint injection.

What to expect during your Procedure?

As with all our other procedures, at the time of the procedure, you will be asked to sign consent forms, list medications you are presently taking, and if you have any allergies to medication. The procedure may last between 15-45 minutes, followed by a recovery period. We will require that you bring a driver as well.

Step 1: Preparation

You will lie face down on an X ray table. A local anesthetic is administered to numb the treatment area. You will experience minimal discomfort throughout the procedure, and we will need you to remainawake and aware during the procedure to provide feedback. A low dose sedative(Versed), is usually given for this procedure.

Step 2: Needle Insertion

From a patient’s perspective the technique for nerve ablation is almost identical to that used for facet joint injections. The procedure is done under fluoroscopy (X-ray), the doctor inserts a needle into the region responsible for the pain. Fluoroscopy allows the doctor to watch the needle in real-time on the fluoroscope monitor to make sure that the needle goes to the desired location. Some discomfort occurs, but patients typically describe it as pressure, especially during the Sensory and Motor tests, where pulsed electric current is used to provoke sensory and motor stimulation to further ensure correct placement of the electrodes.

Figure 1. A heating current is passed through an electrode to destroy the medial branch of the sensory nerve to block the transmission of pain signals.

Step 3: deliver heating current

Once the needle is in place, the patient receives a numbing medication. Then a radiofrequency current is passed through the needle to create a small and precise burn, called a lesion, about the size of a cotton swab tip (Fig 1). The current destroys the portion of the nerve that transmits pain and disrupts the pain-producing signal. The burn takes approximately 90 seconds for each site, and multiple nerves can be burned at the same time. As painful as all this sounds most patients describes this part of the procedure as mild to moderate pressure.

What happens after treatment?

Most patients can walk around immediately after the procedure. After being monitored for a short time, you can usually leave the office or suite however someone must drive you home.

Patients may experience pain from the procedure for up to 14 days, but this is generally due to the residual effects of the nerve ablation or muscle spasm. Patients are often up and around and back to work 24 to 72 hours after the procedure. Pain relief is typically experienced within 10 days, although relief may be immediate for some patients and take up to three weeks for others.

Patients should schedule a follow-up appointment with the referring or treating physician after the procedure to document the efficacy and address any concerns the patient may have for future treatments and expectations.

What are the results?

Pain relief may last from 6 months to more than 2 years. It is possible the nerve will regrow through the burned lesion that was created by radiofrequency ablation. If the nerve regrows, it is usually 6-12 months after the procedure. Radiofrequency ablation is 70-80% effective in people who have successful nerve blocks. The procedure can be repeated if needed.

What are the risks?

Radiofrequency nerve ablation is relatively safe procedure with minimal risk of complications. The complications reported in the literature include:

  • Temporary increase in nerve pain.
  • Neuritis.
  • Neuroma.
  • Localized Numbness.
  • Infection.
  • Allergic reaction to medications used during the procedure.
  • Lack of pain relief (in less than 30% of patients).

Conclusion

When contemplating long term pain relief, Radiofrequency Ablation is one of the many treatment options available for you at Lenchig Spine and Pain Institute. We hope you find this information is helpful, and if you have any further questions, we encourage you to call us at 954-493-5048 or Email me crodriguez@lechig.org