Radiofrequency Ablation for Pain Management
A radiofrequency ablation (RFA) uses heat to destroy and deactivate nerve tissue. For pain management, radio waves are sent through a precisely placed needle to heat an area of the nerve. This prevents and deactivates pain signals from being sent back to your brain. RFA can be used as a long-term, semi-permanent solution for chronic pain conditions, especially of the neck, lower back or arthritic joints that haven’t been successfully treated with other methods.
Why is radiofrequency ablation (RFA) done?
The goals of radiofrequency ablation are to:
- Increase range of motion
- Stop or reduce pain
- Improve function and activity
- Avoid the need of NSAIDs or other pain medications
- Avoid or delay surgery
Which pain conditions can be treated with radiofrequency ablation?
Radiofrequency ablation is used to treat:
- Chronic pain caused by conditions including arthritis of the spine and sacroiliac joint
- Pain in your neck, back and knee.
- Peripheral nerve pain.
How does radiofrequency ablation work?
Radiofrequency ablation uses heat produced from radio waves to target and deactivate nerve tissue, preventing pain signals.
During a radiofrequency ablation procedure, a small hollow needle is inserted into the targeted nerve that is causing pain. An electrode is inserted into the top of the needle, which sends the radio waves through the needle to the targeted nerve. The heat causes a lesion that prevents and deactivates the nerve from sending pain signals to your brain. Nearby healthy nerves are not damaged during the procedure.
Pain management within your spine
Radiofrequency ablation is often used to manage pain originating from joints (such as your knee) and oftentimes related to pain from your spine, especially your neck and lower back.
Within your spine, nerves branch off from your spinal cord and travel to the facet joints and sacroiliac joints.
Facet joints are pairs of small joints between the vertebrae in your spine. These joints give your spine flexibility and allow movement of your back, such as twisting and bending. Two small nerves, called medial branch nerves, are connected to the facet joints and send a signal to your brain that there is pain coming from these joints.
Sacroiliac joints are found near the bottom of your spine, right above your tailbone. Lateral branch nerves that are connected to these joints send pain signals from the spine to your brain.
Using radiofrequency ablation to treat the targeted medial branch nerve in the facet joints or the lateral branch nerve in the sacroiliac joints decreases pain signals from reaching your brain.
Who is a candidate for radiofrequency ablation (RFA)?
Radiofrequency ablation (RFA) may be right for you if have:
- Significant arthritis or arthropathy in your spine or joints
PROCEDURE DETAILS
What happens before a radiofrequency ablation (RFA) procedure?
Your healthcare provider will review your medical and medication history and ask you questions about your pain.
Your provider will perform a diagnostic block to confirm the source and level of your pain. The block consists of an injection of a local anesthetic (numbing medication) near the area of pain. If you have a favorable response to the diagnostic block, another confirmatory block will then be performed. If you receive greater than 80% relief from both blocks, then your provider may recommend you pursue the RFA as a treatment to ease your pain.
What happens during a radiofrequency ablation procedure?
First, you’ll lie on your stomach on a special X-ray table.
Your doctor will use a local anesthetic to numb the area of your skin where a needle will be inserted. Then:
- A thin needle is inserted into the area where you feel pain.
- Needle placement is guided by a special kind of real-time continuous fluoroscopic xray machine
- A local anesthetic is injected through the needle to numb the target area.
- A radiofrequency current is sent through the needle to heat the identified portion of the nerve.
- The current destroys and deactivates that area of the nerve, stopping it from sending pain signals to your brain.
- More than one nerve can be treated during the procedure (if needed).
How long is the radiofrequency ablation procedure?
Radiofrequency ablation takes 10 – 15 minutes to complete, depending on the treatment location and number of treatments performed.
What happens after a radiofrequency ablation procedure?
After your radiofrequency ablation procedure:
- You’ll go home shortly after your procedure
- If you feel dizzy or weak, you may be asked to stay in patient room or lobby until you have fully recovered.
- Rest when you get home and avoid anything strenuous for 24 hours after the procedure.
- You may still feel soreness, pain or muscle spasms at the treatment site for a few days. You can also apply an ice pack to the injection site, off and on for 20 minutes a few times during the first day of your recovery at home.
Your provider may have also recommended physical therapy to regain strength and flexibility. You’ll also have a follow-up appointment to check on your progress and to have any questions you may have answered.
RISKS / BENEFITS
What are the advantages of radiofrequency ablation?
Advantages of radiofrequency ablation include:
- Pain relief.
- No surgery.
- Little to no recovery time.
- Decreased need for pain medications.
- Improved function, activity, and range of motion.
- Return to regular activities after a day or two of rest.
What are the side effects and risks of radiofrequency ablation (RFA)?
During the procedure, you may experience some pain or burning sensation at the site, similar to what you experienced before the procedure. The pain may last for a week or two after the procedure. Applying an ice pack at the site, 20 minutes off and on, may help relieve the pain.
You may feel some temporary numbness where the needle entered your skin.
The risk of complications from RFA is very low. On occasion, permanent nerve damage or pain can occur. In some people, their original pain may get worse. Other complications, including infection and bleeding at the needle insertion site, are uncommon.
RECOVERY AND OUTLOOK
How effective is radiofrequency ablation?
Most people have some pain relief after radiofrequency ablation, but the amount varies by cause of pain and location. Pain relief can be immediate in some people, occur within 10 days in other people or may take up to three weeks in others.
Pain relief can last from six months to 12 months. For some people, the relief lasts a few years. Others may have only limited pain relief.
The treated nerve can regrow. If this happens, it usually happens about six to 12 months after the procedure. Radiofrequency ablation can be repeated if needed.
