Chronic neck and back pain can interfere with everyday life. Medications and other noninvasive treatments may help some patients manage their pain, but other patients may need further treatment to manage their neck and back pain. If patients do not find relief from noninvasive treatments, then radiofrequency ablation could relieve their pain. Radiofrequency ablation is a procedure designed to decrease pain signals from the nerves where the back pain originates.
Who is a good candidate to have radiofrequency ablation?
Radiofrequency ablation is a treatment option for patients who have experienced successful pain relief after a diagnostic nerve/pain receptor block injection.
These treatments are an option for most people. The only people who cannot have radiofrequency ablation are people with an active infection, pregnant women, or those with a history of bleeding problems.
When Radiofrequency Ablation is Recommended
Radiofrequency ablation may be an option for patients with chronic neck or back pain caused by arthritis in the spine. There are two types of joints in the spine: facet joints and sacroiliac joints. Facet joints are the tiny joints at the back of the spine that stabilize the vertebrae. Sacroiliac joints are located at the bottom of the spine, between the base of the spine and the pelvic bone. These joints can be subjected to degenerative changes from arthritis, which puts pressure on the spinal nerves, leading to neck or back pain.
The goal of radiofrequency ablation is to eliminate or reduce pain signals caused by this compression of the spinal nerves. Although it is a safe procedure with few associated complications, radiofrequency ablation may not be recommended for some patients. Radiofrequency ablation is not suitable for patients with active infections or bleeding disorders. Dr. Trujillo examines patients prior to the procedure to determine whether or not radiofrequency ablation is an option.
What are the advantages to having radiofrequency ablation done?
There are numerous advantages to using these treatments for chronic back pain. First, the patient can avoid surgery, which presents far more risk and longer recovery times. Recovery from radiofrequency ablation itself is short, with most patients returning to their normal activities in just 1-3 days after the procedure. These treatments allow patients to dramatically decrease their reliance on pain medication. They allow the patient to improve movement and function, which improves their quality of life. Radiofrequency ablation can also be repeated if the nerve regenerates after ablation, which typically happens from 6 months to 2 years.
Preparing For Radiofrequency Ablation
A doctor performs a thorough medical history review to include imaging studies to ensure radiofrequency ablation is an appropriate technique to address pain.
If a patient takes aspirin or other blood-thinning medication, they will need to stop or switch their usage several days before radiofrequency ablation. Medication must never be stopped without first consulting with a primary healthcare provider.
Diabetic patients may need to adjust the dosage of insulin on the day of their procedure. A primary healthcare provider can assist with this. Diabetes medication can be brought to the appointment and taken soon after the ablation procedure.
Patients need to arrange for someone to drive them to and from the office or outpatient treatment center on the day of their procedure.
Radiofrequency Ablation Procedure
Patients are typically administered IV sedation prior to the radiofrequency ablation procedure. Local anesthetic is also administered in the area where the procedure will be done. Patients are typically awake during this procedure so that they can provide feedback.
Once anesthesia has been administered, Dr. Trujillo will use x-ray guidance to insert the radiofrequency needle into the correct area, alongside the nerves causing pain. A mild electrical current is then passed through the needle to verify correct placement. If placed correctly, the electrical current will briefly create a tingling sensation and may cause a muscle twitch in the neck or back. Once the target nerves are located, local anesthesia may be administered to minimize pain during the procedure.
Radiofrequency currents are then passed through the needle, creating a lesion on the nerve. This lesion disrupts the pain signals sent to the brain. Dr. Trujillo will repeat this process for additional nerves as needed. The procedure typically lasts between 30 and 90 minutes.
How long does it take radiofrequency ablation to provide pain relief?
Pain relief after these treatments is typically experienced 1 to 3 weeks after the injection.
What To Expect After Radiofrequency Ablation
Patients are able to return home the day of the procedure, but will need to make arrangements to have someone drive them home. The treatment area may be sore for the first few days after the procedure. Patients may experience muscle spasms and irritation for about one to two weeks after the procedure. Side effects and complications are rare with radiofrequency ablation, but may include:
- Burning pain and hypersensitivity of the treatment area for one to two weeks
- Numbness of the skin over the treatment area
- Leg numbness due to local anesthesia (this should subside after a few hours)
- Permanent nerve pain
What Is The Success Rate Of Radiofrequency Ablation?
Patients report varying degrees of pain relief following radiofrequency ablation. Studies suggest that this has to do with the location and cause of pain. In many cases, pain relief lasts six to 12 months. Some patients’ pain remains absent or very mild for years. Research indicates that radiofrequency ablation is 70 to 80% successful with only one treatment. If needed, the procedure can be repeated.
Recovery From Back Pain Treatment
Patients may apply ice to the back to help with soreness. While there are no absolute activity restrictions after radiofrequency ablation, patients should avoid painful activities and make sure that they are getting enough rest while recovering. The degree and longevity of pain relief can vary from patient to patient. Most patients experience full pain relief two to three weeks after the procedure.
For many patients, this pain relief can last for 6 to 12 months. The nerves regenerate over time, causing the recurrence of pain. In other cases, pain relief can last for years or may never recur at all.
When can I resume my normal activities after radiofrequency ablation?
Most patients can walk around immediately after the procedure. You may experience pain from the procedure for up to 14 days, but this is simply due to the residual effects of the nerve ablation or muscle spasms. Patients can usually return to work and other normal activities in just 1 to 3 days after their procedure.
Driving After a Radiofrequency Ablation
There are a few restrictions immediately following radiofrequency ablation. Driving is one of them.
- Patients should not drive for 24 hours after their procedure.
- Strenuous activity should be avoided for 24 hours.
- Showering is acceptable, but baths should be avoided for 1 to 2 days.
Is Radiofrequency Ablation Painful?
Patients receive a local anesthetic into the area being treated, as well as IV anesthesia that works on the central nervous system. Although patients are awake for the procedure, they feel very little if any discomfort.
Side Effects Of Radiofrequency Ablation
Radiofrequency ablation is a proven procedure that is both safe and effective in the treatment of various forms of pain. The procedure is generally well-tolerated by patients and incurs few side effects. As a procedure that involves the insertion of a needle, RFA does carry a slight risk of bleeding and infection.
After receiving radiofrequency ablation, patients can expect discomfort from nerve modification to last for a few days. Many patients are back to work within 1 to 3 days after their procedure, with pain improving significantly by day 10. Side effects from RFA are typically limited to this mild pain. Some patients do not experience this at all, while others may feel discomfort for up to three weeks.
Can radiofrequency ablation be repeated on the same area of the back?
For most patients, the pain will return. This is especially true in the sacroiliac joints as compared with the facet joints. These treatments are considered successful if the patient’s pain has decreased. This pain relief typically is from 6 months to 2 years, but it can last longer.
If the pain returns, Dr. Trujillo can perform a repeat radiofrequency ablation on the same area. This second treatment usually increases the success rates. There is no specific limitation on repeating this procedure, but it is never meant to be the go-to treatment option. Often Dr. Trujillo uses radiofrequency ablation to allow the patient to reduce his or her pain and the use of pain medications, and to improve the patient’s range of motion so they can continue to strengthen the area with physical therapy.
What are the limitations of radiofrequency ablation?
These are effective treatments with little risk. They can also be repeated. But there are limitations. The main limitation is that the procedure isn’t sure to provide the pain relief intended. In radiofrequency ablation for facet joints, the success rates (meaning the patient’s pain is reduced) are 45 to 60 percent. In the sacroiliac joint, pain relief occurs in from 75 to 86 percent of patients.
Also, the ablated nerve can regenerate and begin sending pain signals once again. This usually occurs from 6 months to 2 years after treatment, although there are some examples of pain relief for up to 3 years. Although this is a limitation, the earlier success means the impacted nerve will likely respond to ablation again in a repeat procedure.