FAQ’s on Radiofrequency Ablation
What is a Radiofrequency Ablation?
A radiofrequency procedure in pain management is when the doctor uses thermal electromagnetic energy to produce pain relief. This energy heats up nerve endings that provide sensation, and hence pain, to spinal joints along with areas of the body like the pelvis, sacroiliac joint, and more.
The procedure goes by numerous names, such as radiofrequency neurotomy, medial branch neurotomy, radiofrequency lesioning, RFA and more. Whatever the procedure is called, it represents a revolutionary advancement in pain management of the 21st Century.
RFA procedures often provide six to eighteen months of pain relief for various conditions, which is truly amazing. While the procedure does not cure the condition it treats, the fact it often provides such long term relief makes it a “godsend” for chronic pain patients with difficult conditions.
Keep in mind that radiofrequency procedures do not involve actual nerve roots, but only nerve endings or peripheral nerves that only supply a sensory role (like the occipital nerve).
For what conditions does it benefit?
Radiofrequency ablation offers pain relief for quite a few conditions, and the list is continually growing. Here are some of the pain problems that benefit from RFA:
- Cervical facet arthritis
- Thoracic facet arthritis
- Lumbar facet arthritis
- Sacroiliac Joint Arthritis
- Headaches – with occipital nerve RFA
- Pelvic Pain – with Superior Hypogastric Plexus RFA
- Abdominal Pain – with Celiac Plexus RFA
- Reflex Sympathetic Dystrophy (RSD) – with sympathetic nerve RFA
- Complex Regional Pain Syndrome (CRPS) – with sympathetic nerve RFA
- Coccydynia – with Ganglion Impar RFA
How is an RFA performed?
Radiofrequency procedures are performed as an outpatient. IV sedation may be used, but it is not mandatory. For those with claustrophia, anxiety, or previous good experience with sedation, it may be very helpful. Or a patient may simply take a Valium by mouth a half hour prior.
Patients are usually placed prone (on abdomen) on an x-ray friendly table. The vast majority of pain management doctors use fluoroscopy for these procedures, which is a real time form of x-ray. The pain doctor will numb up the skin and soft tissues down to the area for the procedure.
Pain doctors will then inject contrast usually to ensure accurate needle placement. Once satisfied, the radiofrequency needles are slightly stimulated to make sure they are not close to an actual nerve root. If an arm or leg jumps, the needle is re-situated and tested again. Numbing medicine is injected along with the contrast medicine.
The RFA procedure itself involves heating up the needles to approximately 80 degrees Celsius for about 90 seconds. The heat and time will vary depending on the anatomic area being treated. Also, there are areas in the body where continuous heat is not used, but a pulsed RFA is the norm.
The latest RFA machines allow multiple spinal joints to be treated simultaneously. The procedure overall takes 20 to 45 minutes. The patient is then monitored in the recovery room for a while to ensure vital signs are stable and no allergic reaction occurs.
What are the outcomes?
Radiofrequency ablation has been one of the most successful procedures in all of pain management. The procedure has been extensively studied and provides pain relief for low back pain averaging 60 to 85% pain relief for anywhere from 6 to 24 months (Roy et al, J Vasc Interv Radiol. 2012 Dec;23(12):1659-64.)
For chronic neck pain, the results are also impressive, with pain relief often lasting 7 to 9 months at over 50% pain reduction. If the pain relief wears off for either a lumbar or cervical procedure, studies have shown a repeat procedure usually works just as well (Smuck et al, Pain Physician. 2010 Sep-Oct;13(5):437-50).
Recent studies have shown that RFA procedures for occipital neuralgia work exceptionally well with very low complications (Choi et al, J Korean Neurosurg Soc. 2012 May;51(5):281-5). In addition, RFA for SI joint pain has shown excellent results with over 50% pain reduction for 3 to 6 months (AAPM presentation 2012).
Pulsed radiofrequency ablation for whiplash may help considerably. It can prevent the acute neck pain from becoming chronic, which unfortunately occurs in over 15% of individuals.
What are the risks of radiofrequency procedures?
Thankfully, the risk profile of these procedures is very low. There is a risk of infection, bleeding and allergic reaction to medicines used. If blood thinner medication is being taken, this should be ceased 5 to 7 days prior. Your pain doctor will specify the exact time frame.
Nerve injury is uncommon but can happen. If the RFA needle is placed too close to an actual nerve root, damage can occur with resulting sensory and/or motor abnormality. A more common occurrence with RFA is a patient may have some muscle spasms afterwards which typically resolve within a few weeks.
Rarely, patients may actually have increased pain after the procedure due to spasms. This usually subsides within a couple weeks, but patients should be made aware of it beforehand so it’s not a big surprise should it happen.
The Bottom Line
Overall, RFA procedures have been an impressive breakthrough for pain management. The procedures have an impressive success rate, and often provide over 6 to 12 months of relief. This allows patients to increase function, get back to work, play with their kids, and decrease the amount of pain medication necessary to be comfortable. If you are suffering from chronic pain, headaches, pelvic/abdominal pain, let a pain management doctor work with you.