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Radiofrequency ablation (RFA) is a minimally invasive procedure used to treat and reduce chronic pain. The procedure is done by using an electrical current that is produced by a radio wave to heat up and ‘burn’ an area of nerves or nerve fibers. With this, the pain signals from the specific area being carried to the brain will be reduced. This can provide long-lasting pain relief for people with chronic pain, especially in the lower back and neck or with conditions such as arthritis. Usually, patients suffering from chronic pain who had beneficial results from procedure such as nerve block injections, are good candidates for Radiofrequency ablation.
What is Radiofrequency Ablation?
Radiofrequency ablation, sometimes called neurotomy, is a minimally invasive procedure that stops the transmission of pain by means of radiofrequency energy in the form of heat. Radiofrequency waves ‘burn’ or ablate the nerve fibers responsible for transmitting pain. This would destroy the nerve and essentially inhibit the pain signals to travel from the source of the pain to your brain, interpreting it as pain.
Radiofrequency ablation or RFA is usually used in patients with chronic pain or chronic conditions causing pain. This includes conditions such as lower back pain, sciatica, arthritis, and sacroiliitis or degenerative conditions. It is also used to treat back, neck, knee, pelvic, elbow and foot pain.
Benefits of this procedure are plentiful because of its minimally invasive nature and include: immediate pain relief, fast recovery, a quick return to normal routine and activity, avoiding surgery, decreased need for pain medication (including their individual side effects), improved function and general quality of life.
Does Radiofrequency Ablation Work?
Generally, RFA will often provide pain relief lasting around 9 to 14 months and sometimes even longer. A significant proportion of patients undergoing radiofrequency ablation for lower back pain experience significant pain relief for as long as 2 years however individual responses vary. It is possible for the nerve to regrow through the ablated area usually 6 to 12 months after the procedure. The procedure can also be repeated multiple times.
Who is a Candidate for Radiofrequency Ablation?
RFA is commonly a treatment option in patients who have experienced beneficial and pain-relief outcomes after receiving nerve block injections. Radiofrequency ablation is performed under local anesthesia and mild sedation to ensure that the patient is relaxed during the procedure. As with most spinal injections, radiofrequency neurotomy is best performed with the use of fluoroscopy (live x-ray) to assist with accuracy and guidance.
Who Can Perform Radiofrequency Ablation?
Medical doctors that can perform radiofrequency ablation include physiatrists, radiologists, anesthesiologists, neurologists, and surgeons.
Before, During and After the Treatment.
What Happens Before the Procedure?
You will meet the doctor that will perform the procedure and he/she will review the risks and benefits of the procedure. The doctor will also discuss the possible side effects of the procedure such as infection, bleeding, spinal headache, temporary limb weakness or numbness. Your doctor will explain the procedure to you and will tell you in a step-by-step fashion what will happen. The physician who will perform the procedure will review your medical history and obtain information regarding your previous surgeries, previous complications that you might have had with anesthesia, other medical conditions such as bleeding disorders, cancer, infections, diabetes or glaucoma. They will also request previous imaging studies that you might have received such as x-rays or CT scans. You should also prepare some questions and concerns that you might have to ask during this time. Patients on certain medications such as blood thinners may be required to stop them several days before the procedure and a few days after.
2 Weeks Before the Procedure
Let your physician know if you have any bleeding disorders or if you are on any blood thinners like aspirin, warfarin (Coumadin®), heparin, clopidogrel (Plavix®), enoxaparin (Lovenox®) or NSAIDs (ibuprofen, naproxen, nabumetone, diclofenac, etodolac, indomethacin, oxaprozin or ketoprofen). These medications may increase your risk of bleeding complications during or after the procedure.
The day of the procedure
Usually, you will be fully awake during the procedure and sedation is only occasionally used. If you have diabetes, you will need to contact your physician regarding the management before and during the procedure. It is important that you continue to take all of your medications as you normally would. You need to make sure that the doctor doing the procedure is aware of all of the medications.
During the Procedure
You will have to sign a consent form, list all of your current medications and all of your known allergies. You will also fill in a checklist asking questions about recent symptoms such as fever, weight loss, nausea, fatigue, loss of appetite, coughing or pain. After all of the necessary documents are provided, you will be moved to the waiting room. The procedure will then take place in a dedicated area accompanied by trained staff to assist the doctor. Often an x-ray machine will be used to allow for accurate injection. Your blood pressure and pulse will be monitored before, during and after the procedure. The skin around the injection site will then be cleaned with an antiseptic solution which can feel very cold. Your doctor will then warn you of a small needle prick during which he/she will inject a local anesthetic agent that will numb your skin and surrounding tissues. This will allow for the procedure to be pain-free. Please note that even though you will not feel pain, sensations such as touch and pressure will still be present. Apart from slight discomfort, the procedure should be completely pain-free. The procedure usually takes 15-45 minutes for lower back pain and neck pain.
The technique used for nerve ablation is very similar to the one used for nerve blocks. Your doctor will insert a thin needle into the area responsible for the pain while using a fluoroscope (a type of x- ray). The fluoroscope will allow the doctor to watch the needle in real-time to make sure that the needle accurately reaches the desired location. Once the doctor is sure that the needle is in the correct place, a radiofrequency current is passed through to ‘burn’ the targeted nerve fibers. The current destroys the portion of the nerve responsible for transmitting pain, therefore, interrupting the pain-producing signal.
After the Procedure
You will be monitored after the procedure before you are allowed to go home. It is very important that someone drives you home.
Usually, patients resume their normal activity by the next day and apart from mild pain at the injection site, patients should not experience any other pain or side effects. It is important not to expect immediate results and allow some time for the injection to work. This may take a few days.
You should schedule a follow-up appointment with your doctor to address any concerns that you may have and also to document the efficacy of the procedure.
How Long Can I Expect Pain Relief?
The duration of pain relief from radiofrequency ablation will be different in every case. It usually depends on the severity of inflammation and the type of condition you have. Injections can bring pain relief for several weeks or months after which further treatment or another injection is needed. Other times, a single injection is sufficient enough and brings long-term pain relief.
What Are the Risks of Radiofrequency Ablation?
RFA is a generally a very safe procedure with minimal risks involved. According to research complications may include: infection, bleeding, allergic reaction to dyes (if used), lack of pain relief and temporary increase in pain relief. These, however, are reported in less than 30% of patients.
Treatment options for neck pain and lower back pain is best achieved through a combination of injection in conjunction with graded rehabilitative exercise. Individual programs may include a cortisone shot, regenerative medicine, PRP injection, PRP treatment or stem cell therapy which boosts the body’s natural ability to heal.
If your pain does not resolve after a brief period, contact us so that we may help diagnose the problem and treat the underlying cause. Do not let pain persist or else it may become chronic.