Radiofrequency ablation for pain management

Overview

Radiofrequency ablation (RFA) is a medical procedure frequently utilized for long-term relief from chronic pain, particularly in areas such as the neck, lower back, and arthritic joints, when other treatments have proven ineffective. This procedure uses heat generated by radio waves to destroy nerve tissue, thereby preventing pain signals from reaching the brain.

The goals of radiofrequency ablation are to alleviate pain, enhance function, decrease reliance on pain medications, and avoid or postpone surgery.

Reasons for undergoing the procedure

Radiofrequency ablation is typically recommended for individuals who experience pain relief after a nerve block injection, indicating the specific nerve responsible for their pain, or for those whose chronic pain has not responded to other treatments such as medication and physical therapy.

Conditions that may be treated with radiofrequency ablation include:

• Pain in the back, knee, and neck
• Chronic pain brought on by ailments such as sacroiliac joint pain and spondylosis, an arthritis of the spine
• Pain from cancer
• Trigeminal neuralgia causing pain in the face
• Peripheral nerve pain
• Abnormal heart rhythms
• Tumors

Risks

During the procedure, some pain or burning may be felt, which can last for a week or two afterward. Applying an ice pack can help relieve this pain. Temporary numbness at the needle site is also possible.

The risk of complications from radiofrequency ablation (RFA) is very low. However, uncommon risks associated with RFA include:

• Permanent nerve damage
• Bleeding at the needle site
• Infection
• Worsening pain

Procedure

Radiofrequency ablation (RFA) involves inserting a small needle into the affected nerve. An electrode is placed inside the needle to deliver the radio waves. The heat creates a small lesion on the nerve, which blocks pain signals, providing relief without harming nearby healthy nerves.

Generally, the procedure uses heat from radio waves to target and damage nerves that are causing pain, stopping them from sending pain signals to the brain.

RFA is commonly used to manage pain from joints, such as the knee, and spinal pain, particularly in the neck and lower back. In the spine, nerves branch off from the spinal cord to the facet joints and sacroiliac joints.

Facet joints are small joints between vertebrae that allow for spinal flexibility. Medial branch nerves connected to these joints transmit pain signals to the brain. Similarly, sacroiliac joints, located above the tailbone, have lateral branch nerves that send pain signals from the spine.

RFA targets the medial branch nerve in the facet joints or the lateral branch nerve in the sacroiliac joints, effectively reducing pain signals sent to the brain.

Before the procedure

To prepare for radiofrequency ablation, these may be required:

• Diagnostic block: This procedure may be performed to help predict the potential level of pain relief. If the diagnostic block does not significantly alleviate the pain, radiofrequency ablation (RFA) may not be a suitable treatment. However, if the block provides substantial relief, the provider may recommend RFA to help manage the patient’s pain.
  A diagnostic block involves injecting a local anesthetic near the painful area to confirm the source and intensity of the one’s pain.
• Review of medical history: The healthcare provider will conduct a comprehensive review of one’s medical and medication history and inquire about their pain symptoms. If they are taking aspirin or other blood-thinning medications, discontinuation may be required for a few days prior to the procedure.
• Imaging tests: X-rays or other imaging tests may are ordered to assess one’s anatomy, evaluate the extent of arthritis or spine injury, and rule out other possible causes of pain.

During the procedure

The duration of the radiofrequency ablation varies from 15 minutes to two hours, depending on the treatment location and the number of treatments performed. If necessary, multiple nerves can be treated during the procedure.

During the procedure, the patient lies on their stomach on an X-ray table while the healthcare provider monitors their condition. The patient remains awake to answer any questions, although optional medications can be administered to help them relax. Usually, a local anesthetic is applied to numb the skin where the needle will be inserted.

The procedure is done as follows:

• A thinneedle is introduced into the area experiencing pain.
• The needle’s placement is monitored using a type of real-time continuous X-ray called fluoroscopy.
• After positioning the needle correctly, the healthcare provider will conduct a test to ensure accuracy. This involves inserting a microelectrode through the needle and checking if a tingling sensation, discomfort, or a muscle twitch is experienced, indicating the proper location for treatment.
• A local anesthetic is then injected through the needle to numb the targeted area.
• A radiofrequency current is passed through the needle to heat the specific nerve segment.
• This current destroys the nerve segment, preventing it from transmitting pain signals to the brain.

After the procedure

One can go home shortly after the procedure but must have someone drive them.

People who undergone the procedure should rest and avoid driving or engaging in strenuous activities for 24 hours. They can usually resume normal activities, including bathing, after a day or two. Soreness, pain, or muscle spasms at the treatment site may occur for a few days, and pain medication or ice packs may help.

Physical therapy might be recommended, and a follow-up appointment will be scheduled to monitor progress and address any questions after a radiofrequency ablation.

Outcome

Overall, the benefits of radiofrequency ablation include effective pain relief without surgery, minimal recovery time, reduced reliance on pain medications, improved function, and a quick return to regular activities.

The pain relief from radiofrequency ablation can last anywhere from six months to a year, with some individuals enjoying relief for several years. However, the treated nerve may regenerate within 6 to 12 months, and the procedure can be repeated if necessary. It’s recommended to consult a healthcare provider to discuss how long relief may last based on your specific condition.

Monitoring your overall health after the procedure is crucial. Contact a healthcare provider if you experience any of the following:

• Increased weakness or numbness in an arm or leg
• Severe pain, redness, or swelling at the injection site