Radiofrequency Ablation

What is radiofrequency ablation?

Radiofrequency ablation is an advanced pain management technique that can treat a variety of pain syndromes. The most common use of radiofrequency ablation is in the cervical spine and lumbar spine where the procedure is employed to reduce pain from arthritic joints. Radiofrequency ablation is a technique that employs heat to disable the pain-transmitting nerves in the spine. The procedure is very safe and is only used on sensory nerves that transmit pain impulses. There is no risk of paralysis or weakness from the procedure. There is also another type of radiofrequency ablation called “pulsed” radiofrequency ablation. This procedure does not use heat to disable the nerve, and is appropriate for treating a wide variety of pain problems that originate in sensory nerves.

How does radiofrequency ablation relieve my pain?

Radiofrequency ablation uses heat to disable the pain-transmitting nerves in the spine. The process is analogous to microwave ovens that use microwave energy to heat food. Radiofrequency energy is transmitted to the tip of a needle where it is converted to heat, which is applied directly to the nerve fibers. Once the nerves undergo this heat treatment, they slowly stop transmitting pain.

What can I expect during the procedure?

After checking in at the Surgery Center, you will be interviewed by the admission nurse who will take a full history and start an IV. You will also be seen by the medical staff of Arizona Pain Specialists prior to the procedure, at which time you will have the opportunity to have any additional questions answered. After being placed on the treatment table, intravenous sedation will be administered to make the procedure as comfortable as possible. Local anesthetics will be used during the procedure to further ensure your comfort. Following the procedure, you will be allowed to rest for approximately 30 minutes in the recovery area prior to discharge. You must have a responsible adult take you home.

When will I begin to feel pain relief and how long will it last?

Since this is a different procedure than simply injecting local anesthetics at the site of pain, and it involves heat to injure and disable the nerve, it may take longer for the pain-reducing effects of the procedure to occur. We typically expect that pain reduction may not begin for one to two weeks. By four weeks, you should have a good estimate of how much pain relief will be achieved.

What is the anticipated recovery from the procedure?

Most patients have minimal difficulties with the procedure. However, a very small percentage of patients may develop a “neuralgia” at the procedure site (especially in the cervical spine.) These symptoms usually resolve. If you continue to have symptoms, please refer to Surgery Center discharge instructions. You also may call Arizona Pain Specialists if there are any concerns.

More on Radiofrequency Ablation:

Radiofrequency ablation of nerves has been used for over 25 years to treat a variety of severe, chronic pain problems. Lately, there have been notable improvements in the equipment and technique. Several recent medical publications strongly support the use of radiofrequency for treatment of chronic neck and back pain. Radiofrequency techniques are also being developed for treatment of occipital headaches, thoracic spine pain and certain types of sympathetic pain syndromes.

The technique itself is rather simple, and can be thought as analogous to the use of micro-waves to heat food. Radio-frequency current at 500,000 Hz is used to generate heat at the tip of an insulated needle placed at the location of the nerve. This energy passes to adjacent tissue heating it to about 80 C and stopping transmission of painful impulses. The period of time in which the nerve does not conduct pain impulses lasts anywhere from 6 months to several years. The procedure usually is performed on an outpatient basis, with light sedation. Use of fluoroscopy is mandatory to ensure correct placement of micro-electrodes.

Chronic neck and back pain are some of the most common problems seen in modern pain clinics. This pain can develop from degenerative changes or trauma.

Whiplash is one of the more common problems that can cause long-term neck pain (See previous issues of The Pain Management Letter, or our Website for a discussion of the evaluation and treatment of this particular medical problem.)

For most people with acute neck or low back pain, the problem will resolve spontaneously without specific intervention, other than symptomatic treatment. If the pain lasts longer than 3 to 6 months, then an investigation into the causes should be initiated.

In chronic neck pain, the most likely sources are the intervertebral discs or the facet joints. For chronic low back, the most likely sources are the intervertebral discs, the facet joints or the sacroiliac joints. The key to successful treatment of these chronic pain problems is correct diagnosis. To make the picture more complicated, the chronic pain may represent a combination of these causes.

Facet joint pain is the most widely treated pain syndrome with radiofrequency. This is due to the discrete and well-defined innervation of these particular joints. The innervation of the intervertebral discs and the sacroiliac joint is more complicated and less understood.

Patients with suspected spine pain due to facet joint problems should undergo a detailed history and physical examination. If the facet joints are still thought to be the source of pain, then diagnostic nerve blocks are the next step in the treatment protocol. Although plain films and MRI studies may implicate the facet joints, the only reliable diagnostic test is blocking of the nerve with local anesthetics. If the results of the diagnostic test indicate 50% or greater relief of pain, then the patient may be an appropriate candidate for radiofrequency ablation of the spine nerves.

Radiofrequency treatments are performed on an outpatient basis with light sedation. Some patients will have an exacerbation of their pain that could last several weeks following the procedure. Typically, multiple sensory branches are treated since innervation of the facet joints is from several different nerves.

Once the electrode is properly placed with fluoroscopic guidance, electrical stimulation is conducted in order to ensure correct placement. The first step is 50 Hz stimulation which may reproduce the patient’s pain. Next, 2 Hz stimulation is conducted in order to ensure that there is no unwanted motor activity. If all of these test indicate proper placement, then the electrode is turned on for 60 seconds. Several lesions at each level are performed in order to increase the effectiveness of the procedure.

A review of the medical literature shows that this technique is very effective for treatment of chronic spine pain caused by facet joint problems. Long term pain relief can be obtained and very few complications have been noted. Additionally, relief of chronic spine pain has been associated with resolution of psychological distress, reduced use of oral medications, lessened disability and an improved return to usual lifestyle activities.

We are eager to help you manage your chronic pain and appreciate your trust in us. You can learn more about our practice and the conditions we treat at www.ArizonaPain.com. To schedule an appointment please call 480-563-6400 or fax at 480-563-8009.