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By QI ZHANG, MD
A non-surgical procedure called radiofrequency ablation can be highly effective in reducing or eliminating chronic back and joint pain in patients. The procedure can provide long-term relief by blocking nerves along the spine from sending a pain signal to the brain. The minimally invasive procedure may be used when medications or physical therapy have been ineffective in reducing pain.
What is radiofrequency ablation?
The procedure uses heat generated by radio waves to target specific nerves and temporarily interfere with their ability to transmit pain signals. The radio waves are delivered to the targeted nerves via a thin, hollow needle by a physician who specializes in treating pain. Radiofrequency ablation, also called radiofrequency neurotomy, is an outpatient procedure and usually takes about an hour to complete so the patient returns home on the same day.
When is radiofrequency ablation recommended?
The procedure is used to treat neck, spine, hip and knee joint pain associated with arthritis, other degenerative joint conditions, or from injuries such as whiplash. For back pain, the procedure is often used when pain:
- Occurs on one or both sides of your lower back.
- Extends into the buttock region and thighs but not usually past the knee.
- Worsens if you twist or lift something.
- Improves when you're lying down.
Facet joint inflammation is one of the most common causes of persistent back pain treated at the Ithaca Center for Pain Management. The facets are the joints that sit between the vertebrae in the spine and connect them to each other, providing flexibility and smooth movement. If you engage in too much physical work (heavy lifting, active labor, construction work) or too much exaggerated or repetitive motion (as many athletes do when working out), you run the risk of inflaming the facet joints. This can lead to degeneration of the joint and back pain.
How is radiofrequency ablation performed?
Prior to having the procedure, a preliminary test is made to numb nerves in the precise spots where the radiofrequency needle will go. If the pain significantly lessens, radiofrequency treatment at those spots may significantly help the patient.
The radiofrequency ablation procedure usually involves starting an intravenous line in the patient so a sedative can be given. The patient lies face down on the procedure table, and the physician uses x-ray guidance, or fluoroscopy, to direct a special radiofrequency needle to the target nerve. A small electrical current is passed through the needle to assure it is next to the target nerve and a safe distance from other nerves.
The targeted nerve is numbed to minimize pain during the ablation. Radiofrequency waves are used to heat the tip of the needle and a heat lesion is created on the nerve to disrupt its ability to transmit pain signals. This process will be repeated for additional nerves to treat other areas of pain. On the day of the procedure, patients are advised to avoid driving and avoid doing any strenuous activities. Patients may continue to take any normal medications except aspirin, ibuprofen or any other blood-thinning medications, such as Coumadin.
What are the side effects?
The patient's neck or back will usually be sore for a few days after the procedure. This pain is usually caused by muscle spasms and irritability while the targeted nerves are dying from the heat lesion. Depending on the area treated, patients might develop a superficial burning pain with hypersensitivity, similar to a sunburn feeling. Medications or warm towels may be prescribed to alleviate discomfort, and ice mat be recommended if swelling or pain occurs at the treatment sites.
Patients usually rest for several days before returning to normal activities but should let pain levels be their guide for the first few days after treatment. Physical therapy may be prescribed to allow patients to increase their strength and activity tolerance in a safe manner.
What are the results?
Pain relief may last from nine months to more than two 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 six to 12 months after the procedure. Radiofrequency ablation is 70 to 80 percent effective in people who have successful nerve blocks. The procedure can be repeated if needed.
Dr. Qi Zhang is board certified in anesthesia and specializes in pain management. She serves on the medical staff of Cayuga Medical Center where she divides her time between anesthesia and the Ithaca Center for Pain Management. She can be reached at (607) 274-4327.