by Nicole Berardoni M.D, Tory McJunkin M.D, and Paul Lynch M.D
Radiofrequency Ablation (RFA) is a very exciting procedure in pain medicine that uses a specialized device to disrupt nerve conduction. This pain relief technique can be used by those with back pain, neck pain, muscle pain and multiple other pain syndromes. A probe is inserted through a needle and controlled delivery of heat is placed along a painful nerve. RFA causes nerve destruction through heat. Pulsed-RFA does not cause nerve destruction, but instead is used to stun painful nerves.
The anatomy and physiological function of the spine is the key in evaluating a person with spine related pain. The bony spine is positioned so that individual vertebrae (bones of the spine) provide a flexible support structure while also protecting the spinal cord. The facet joints of the spine are a moveable connection that connects one vertebra to another. Facets are innervated by the medial branch nerve, which provide sensation to the joint. The joints may become arthritic or damaged causing extreme pain with activity. Medial branch nerves are small nerve branches that communicate pain to the brain caused by the facet joints in the spine. The nerve is located at the junction of the transverse process and superior articular process of the facet joint. Medial branch radiofrequency ablation is a minimally invasive outpatient procedure that reduces back pain by interrupting the nerve supply from painful facet joints in the neck or back (Murtagh 2006).
A ganglion is a bundle of nerves. The sphenopalatine ganglion provides innervation to the face and head region. Often times face pain or headaches can be successfully treated with sphenopalatine ganglion blockade or ablation. A recent article showed that the ganglion can be targeted with radiofrequency for chronic headaches or other conditions causing atypical facial pain (Bayer 2005).
Other RFA Treatment
- Peripheral Neuropathies
- Sympathetically Mediated Pain
- Complex Regional Pain Syndrome
- Trigeminal Neuralgia
- Neck pain
- Back pain
- Some Stroke Related Pain
- Disc Dennervation
Radiofrequency Ablation is a procedure which creates a nerve lesion produced by localized heat. When the lesion is placed over a painful nerve, pain signals are interrupted and pain perception by the brain is decreased. The procedure is performed in an outpatient setting. The treatment is done with local anesthesia along with IV sedation when needed. Before the procedure begins your physician starts by cleaning the skin over the injection site and injecting a local anesthetic to numb your skin. Another needle is placed through the numb tissue and the entire procedure is performed using fluoroscopic (X-ray) guidance. When the needle is in the correct location, an electrode is introduced into the center of the needle. Stimulation is initiated first with sensory stimulation and then with motor stimulation. When the correct needle position is verified, local anesthetic and sometimes a steroid medication are injected. Radiofrequency thermo-coagulation – The electrode is heated to 50-80°C and kept at that temperature for several minutes. Electro-thermal heat is generated, which allows for destruction of surrounding pain fibers, thereby decreasing your pain. Pulsed Radiofrequency – This technique is similar to thermo-coagulation RFA, but differs by a lower level of heat produced. This does not destroy the nerve tissue, but instead stuns the nerve. This method is less uncomfortable and in general only a mild pulsating sensation is felt. After a brief recovery period, you are able to go home after the procedure. You may have some discomfort when the local anesthetic wears off.
In a recent clinical research study for patients treated with radiofrequency therapy, 21% had complete pain relief, and 65% reported mild to moderate pain relief. The majority of the respondents reported reduction in the use of pain medications. None of the patients developed significant infection, bleeding, hematoma formation, or numbness as complications to their therapy (Bayer 2005). RFA has been used for many years, and the technique continues to improve with better efficacy and fewer risks. Patients can experience significant pain relief with a minimally invasive procedure that does not require a long hospital stay.
As with any medical procedure, there are risks and potential complications. Although complications rarely occur, patients need to know what complications can occur. In general, the risks are low and complications are rare. Potential complications that may occur include: bleeding, infection, worsening of pain symptoms, discomfort at the point of injection, and rarely motor nerve damage. Radiofrequency therapy averages three to six months relief.
Radiofrequency treatment is an extremely safe well-tolerated method selected to treat many causes of chronic pain (Menno). If your pain responds well to an initial treatment a follow-up treatment may be helpful. There is strong clinical evidence that RFA has “an important role in the management of trigeminal neuralgia, nerve root and spinal pain” (Lord 2002). In a large study, 92.5% achieved excellent or good pain-relieve by radiofrequency thermo-coagulation for the symptoms of trigeminal neuralgia (Chen 2001). A series of one hundred patients suffering from trigeminal neuralgia were treated by radiofrequency thermo-coagulation. The study concluded that RFA is the treatment of choice for trigeminal neuralgia when medical treatment is no longer effective or the side-effects of medications contraindicate their usage (Motta). Another study evaluated thirty nine patients with trigeminal neuralgia and 92.3% received satisfactory pain relief (Sengupta). A large evidence-based practice guideline for the management of chronic spinal pain was developed by the American Society of Interventional Pain Physicians to provide recommendations for clinicians. It states “for medial branch blocks, repeated injections at defined intervals provided long-term pain relief. For medial branch radiofrequency neurotomy, short-term pain relief was defined as relief lasting less than 3 months and long-term relief as lasting 3 months or longer. The evidence for pain relief with radiofrequency neurotomy of cervical and lumbar medial branch nerves is moderate for short and long-term pain relief.” (Boswell 2007). If you are suffering from back, neck, facial or other painful conditions contact Arizona Pain Specialists to see if you can benefit from this state of the art treatment. We are happy to offer this treatment to the Phoenix area.
Radiofrequency ablation in the management of spinal pain Menno E. Sluijter MD, PhD Institute for Anesthesiology and Pain Treatment, Swiss Paraplegic Center, Nottwil, Switzerland Lord SM, Bogduk N. Radiofrequency procedures in chronic pain. Best Pract Res Clin Anaesthesiol. 2002 Dec;16(4):597- 617. Clinical significance of trigeminal neuralgia treated using radiofrequency thermocoagulation (RFT) with different approaches Chen Z, Zhao Z, Li M, Yang Y. Hua Xi Kou Qiang Yi Xue Za Zhi. 2001 Aug;19(4):240-2. Radiofrequency-thermocoagulation in the treatment of trigeminal neuralgia: analysis of 100 cases Motta P, de Souza MT, Sengupta RP. Arq Neuropsiquiatr. 1980 Mar;38(1):33-44 Radiofrequency thermocoagulation of Gasserian ganglion and its rootlets for trigeminal neuralgia.Sengupta RP, Stunden RJ. Br Med J. Jan 15;1(6054):142-3. A systematic review of therapeutic facet joint interventions in chronic spinal pain. Boswell MV, Colson JD, Sehgal N, Dunbar EE, Epter R. Pain Physician. 2007 Jan;10(1):229-53. Radiofrequency neurotomy for lumbar pain. Murtagh J, Foerster V. Issues Emerg Health Technol. 2006 May;(83):1-4 Sphenopalatine ganglion pulsed radiofrequency treatment in 30 patients suffering from chronic face and head pain. Bayer E, Racz GB, Miles D, Heavner J. Pain Pract. 2005 Sep;5(3):223-7