Radiofrequency Nerve Treatment
Heat is used in radiofrequency ablation (RFA) to destroy tissue. Radio waves are transmitted through a carefully positioned needle to heat a nerve region for pain relief. This inhibits pain impulses from returning to your brain.
Radiofrequency ablation, also known as rhizotomy, is a non-surgical, minimally invasive surgery that use heat to diminish or eliminate pain transmission. Radiofrequency waves ablate, or "burn," the nerve that is generating the pain, effectively preventing pain impulses from reaching the brain.
alleviate pain in the neck, back, knees, pelvis, and peripheral nerves. Radiofrequency ablation has several advantages, including the avoidance of surgery, rapid pain relief, little to no recovery time, decreased need for pain medication, increased function, and a speedier return to work and other activities.
Radiofrequency neurotomy is not a long-term solution for back or neck pain. Treatment success studies have had mixed results. Some patients may get some pain alleviation in the short term, while others may feel better for several months. Sometimes the therapy has no effect on pain or function.
It is critical that the nerves targeted by the procedure be the same nerves responsible for your discomfort for the treatment to function and for you to feel better.
Goals of Radiofrequency Nerve Ablation
The goals of treating facet and sacroiliac joints with RFA are to:
- Reduce neck or back discomfort over extended periods of time, usually more than 6 months.
- Improve neck and back function to allow for wider range of motion, which may allow the patient to continue with physical therapy.
- Reduce your usage of pain relievers, which have substantial side effects or hazards when taken long-term.
- Avoid or postpone surgery, which may include additional risks and a lengthy recovery time.
- Even if the pain is not entirely relieved, RFA may give modest pain reduction and function restoration for everyday activities.
Is Radiofrequency Ablation a Surgery?
Radiofrequency ablation is not a surgical procedure. It is regarded as a minimally invasive technique. This implies that the process is carried out utilizing procedures that cause the least minimum of injury or disruption to your skin and tissues. In general, minimally invasive treatment procedures minimize the risk of infection and other problems, shorten hospital stays, reduce discomfort, and shorten recovery time.
How Does Radiofrequency Nerve Ablation Work?
Thermal energy is commonly used to treat chronic back and neck pain disorders by applying it near or on the peripheral nerve sources along the levels of the spinal cord. It has been used to treat facet joint discomfort by focusing on the medial branch of the major dorsal ramus. It has also been used to treat discogenic back pain by targeting the ramus communicans.
The dorsal root ganglia is another target for radicular back pain, and the lateral branch neve is another for sacroiliac illness. The research also shows effectiveness in facial pain syndromes, thoracic pain, and anterior/posterior pelvic pain syndromes on a less frequent basis.
Types of Radiofrequency Ablation
Three types or variations of RFA may be used to produce heat lesions on tissues and are discussed below.
1. Conventional Continuous Radiofrequency (CRF):
To create a heat lesion, a needle is used that provides a continuous high-voltage current. The needle's tip is heated to 140 to 176 degrees Fahrenheit.
Radiofrequency neurotomy is used to treat pain in any area of the spine. This includes the following:
- Lower back pain (lumbar facet joint pain)
- Middle back pain (thoracic facet joint pain)
- Neck pain (cervical facet joint pain)
- Sacroiliac joint pain (SI joint pain)
- Leg pain (lumbar sympathetic plexus)
- Abdominal pain (sympathetic ganglion)
- Pelvic pain (hypogastric plexus)
Radiofrequency neurotomy is more effective in some patients than in others for pain control. If necessary, this therapy can be repeated.
2. Pulsed Radiofrequency (PRF):
It employs a needle that provides brief bursts of high-voltage current, with silence periods in between when no current is transmitted. In PRF, the needle is heated to roughly 107 degrees Fahrenheit.
Any nerve that produces or creates your pain can be treated with pulsed radiofrequency. These are some examples:
- Facial pain (mandibular nerve, sphenopalantine ganglion, stellate ganglion, supraorbital nerve).
- Arm pain (spinal nerve roots or the dorsal root ganglion (DRG), stellate ganglion).
- Chest pain (intercostal nerves).
- Abdominal pain (splanchnic nerves, coeliac plexus).
- Hip pain (obturator and femoral nerves).
- Knee pain (genicular nerves).
- Leg pain (spinal nerve roots or the dorsal root ganglion (DRG), sympathetic ganglia).
- Neuromas (benign growth of nerve tissue).
- Occipital headache (greater and lesser occipital nerves).
- Shoulder pain (suprascapular nerve).
- Trigeminal neuralgia (mandibular nerve, sphenopalantine ganglion, supraorbital nerve).
- Pelvic pain (pudendal nerves, ganglion Impar nerves).
3. Water-Cooled Radiofrequency (WCRF):
It employs a unique needle that can be heated to 140 degrees Fahrenheit while also being cooled by a constant supply of water. The water provides for a controlled flow of current while also keeping the needle tip from being overheated.
CRF and PRF cause well-defined tiny lesions, but WCRF causes bigger lesions that include broader tissue regions. Facet and sacroiliac joint pain are treated with all three forms of RFA. The severity of the heat lesions is determined by the temperature and size of the needle, as well as the length of the process.
Conditions Treated with RFA
Radiofrequency ablation is used to treat:
- Spondylosis and SI joint pain: Spondylosis does not always result in symptoms. When symptoms do appear, they are usually in the form of neck or back discomfort or stiffness.
- You are experiencing neck, back, and knee pain.
- Cancer discomfort.
- Trigeminal neuralgia is a disorder characterized by pain emanating from the trigeminal nerve, which begins near the top of the ear and divides into three branches, leading to the eye, cheek, and jaw. Although we have two trigeminal nerves on each side of our face, trigeminal neuralgia pain usually affects just one side.
- Peripheral nerve pain.
- Heart rhythm problems.
- Tumors (to kill cells).
Radiofrequency ablation has just a few contraindications. Patient refusal, elevated intracranial pressure, and local infection are all absolute contraindications. Because numerous operations are performed close to the spinal column, strong clinical judgment and standard of care must be used when dealing with anticoagulant drugs and bleeding diathesis. ASRA (American Society of Regional Anesthesia and Pain Medicine) recommendations are often followed.
A brief review of when to stop common anticoagulation therapies includes aspirin for primary prophylaxis (6 days), clopidogrel (7 days), apixaban (3-5 days), rivaroxaban (3 days), warfarin (5 days), and intravenous heparin (4 hours). Coagulation studies also should be reviewed as appropriate. Relative contraindications include bacteremia and aberrant congenital or surgical anatomy. Because these are elective procedures, it is imperative to weigh risks and benefits and document patient agreement and understanding.
As with many operations, appropriate room is essential to support necessary material and staff. A procedure table/bed that will comfortably support the patient while limiting positioning harm, fluoroscopic imaging equipment, and a table to lay surgical tools sterilely are examples of large equipment.
Monitors should be utilized to check the patient's oxygenation, breathing, circulation, and temperature, especially if sedation is being considered. A qualified anesthesia professional must also be present if deep sedation or general anesthesia is necessary. Introducer needles, catheters with electrodes, and an equipment interface are utilized during the process. Supplemental oxygen, suction, and a code cart should be nearby and easily accessible.
Who Performs Radiofrequency Ablation?
Thermal nerve ablative methods should only be used by highly trained professionals who have prior expertise doing spinal surgeries under fluoroscopy. These are often board-certified, fellowship-trained pain medicine specialists with backgrounds in anesthesia, physical medicine and rehabilitation (PM&R), family medicine, neurology, emergency medicine, and psychiatry.
A circulating nurse is often present to assist with equipment and patient support, as is the case with many other operations. A radiology technician also aids with radiographic imaging.
What Happens During Treatment?
You will be asked to sign consent forms, identify drugs you are currently taking, and if you have any pharmaceutical allergies at the time of the treatment. The 15-45-minute operation is followed by a recovery period.
Step 1: prepare the patient
The patient is positioned on an x-ray table. To numb the treatment region, a local anesthetic is utilized. Throughout the process, the patient feels just minor pain. During the process, the patient stays awake and conscious in order to offer input to the clinician. For this surgery, a low-dose sedative, such as Valium or Versed, is generally the only medicine used.
Step 2: insert the needle
The nerve ablation procedure is similar to that used for diagnostic blocks. The doctor uses a fluoroscope (a special x-ray) to send a thin hollow needle into the area causing the discomfort. Fluoroscopy allows the doctor to monitor the needle in real time on the fluoroscope display to ensure that it is inserted into the correct area. To ensure the correct needle position, contrast may be injected. There is some discomfort, but patients usually experience more pressure than pain.
Step 3: deliver heating current
The patient is given numbing drug once the needle is in place. The hollow needle is then run through a radiofrequency current to generate a tiny and precise burn, known as a lesion, roughly the size of a cotton swab tip. The current damages the part of the nerve responsible for pain transmission and distorts the pain-producing signal. Each site takes around 90 seconds to burn, and numerous nerves can be treated at the same time.
What Happens After RFA?
Most patients are able to move about soon following the operation. You can normally leave the office or suite after being observed for a short period of time. You must be taken home.
Patients may suffer discomfort for up to 14 days following the surgery, although this is usually due to the residual effects of the nerve ablation or muscular spasm. Patients are frequently up and about and back to work within 24 to 72 hours following the treatment. Pain relief is usually felt within 10 days, while it may be instantaneous for some people and take up to three weeks for others.
After the procedure, patients should arrange a follow-up consultation with the referring or treating physician to document the efficacy and address any concerns they may have about future treatments and expectations.
Pain alleviation might continue anywhere from 9 months to over 2 years. It is possible that the nerve will regenerate through the burnt lesion caused by radiofrequency ablation. The nerve normally regrows 6-12 months after the procedure. Radiofrequency ablation is 70-80% effective in patients who have had successful nerve blocks. If necessary, the procedure can be repeated.
Radiofrequency Treatment Side Effects
Radiofrequency nerve ablation is a largely risk-free technique with few consequences. The following problems have been noted in the literature:
- Leg numbness: Walk solely with help if you have any leg numbness. This is related to the local anesthetic used during the treatment and should only last a few hours.
- Mild back discomfort: This normally lasts two or three days after the local anesthetic wears off. If the discomfort persists, apply ice to the region the day of the surgery and moist heat the day following. You can also take your regular pain killers. Temporary
- Neuritis: "Neuritis," or nerve irritation, following a radiofrequency operation is a fairly typical side effect of radiofrequency, but it is seldom an issue for most people. It appears to be more prevalent for cervical (neck) surgeries, and it appears to be slightly more common in women than males. This inflammation normally goes away after two months.
- Neuroma: A neuroma, commonly known as a "pinched nerve" or a nerve tumor, is a painful ailment. It is a benign nerve tissue development that is commonly observed between the third and fourth toes. It causes discomfort, tingling, or numbness between the toes and in the ball of the foot. The most common sign of a neuroma is discomfort between the toes when walking. Those suffering from the ailment frequently find comfort by pausing their stroll, removing their shoes, and massage the afflicted region. The patient may describe the pain as having a stone in his or her shoe at times. Women account for the great majority of neuromas.
- Localized numbness: Patients may use the term numbness to represent a change in feeling (ie, paresthesia or sensory loss), strength (ie, weakness), or coordination (ie, clumsiness). It's a frequent form of post-radiofrequency treatment.
- Infection: One of the most prevalent severe consequences following RF ablation is an abscess. The diagnosis of an abscess might often be delayed because fever following RF ablation is a common sign of both hepatic abscess and postablation syndrome. Fever is the second most prevalent symptom of postablation syndrome.
- Allergic reaction: Allergic responses can manifest as hives or a rash. They can potentially be fatal and limit breathing. Most allergic responses occur instantly while you are in the operation room, allowing you to receive immediate assistance. Most responses are handled and do not have long-term consequences.
Radiofrequency ablation, also known as rhizotomy, is a non-surgical, minimally invasive surgery that use heat to diminish or eliminate pain transmission. Radiofrequency waves ablate, or "burn" the nerve that is generating the pain, effectively preventing pain impulses from reaching the brain.
This treatment is most typically used to treat chronic pain and disorders such as spondylosis and sacroilitis of the spine. It is also used to alleviate pain in the neck, back, knees, pelvis, and peripheral nerves. Radiofrequency ablation has several advantages, including the avoidance of surgery, rapid pain relief, little to no recovery time, decreased need for pain medication, increased function, and a quicker return to work and other activities.
Radiofrequency ablation aims to stop or minimize discomfort, enhance function, reduce the amount of pain drugs used, and avoid or postpone surgery.
Radiofrequency ablation is used to treat chronic pain caused by disorders such as arthritis of the spine (spondylosis) and sacroiliac (SI) joint pain, neck, back, and knee pain, cancer pain, trigeminal neuralgia-related facial discomfort, and peripheral nerve pain.
If you experience pain alleviation after a nerve block injection, radiofrequency ablation (RFA) may be suitable for you. This informs your physician that that specific nerve is the source of your discomfort and is a good candidate for RFA. Chronic pain that is unresponsive to other treatments, such as pain medication and physical therapy If you are pregnant, have an infection or have a bleeding issue, you may not be a candidate for radiofrequency ablation.
Pain reduction, no surgery, little to no recovery time, reduced need for pain medications, improved function, and return to ordinary activities after a day or two of rest are all advantages of radiofrequency ablation.
Most patients have some pain alleviation following radiofrequency ablation, however, the amount varies depending on the origin of the pain and its location. Pain relief might be quick for some people, happen within 10 days for others, or take up to three weeks for others.
Pain alleviation might last six to twelve months. For some, the alleviation lasts several years. Others may only receive modest pain alleviation.
The nerve that has been treated can regenerate. If this occurs, it generally occurs six to twelve months following the treatment. If necessary, radiofrequency ablation can be repeated.