What is Radiofrequency Ablation?
Radiofrequency Ablation (RFA) is a minimally invasive out-patient procedure and treatment for a range of conditions and pain syndromes. This innovative procedure uses a specialized device that uses radiofrequency heat energy to stop nerve signals from transmitting pain to the brain.
Radiofrequency Ablation is often used in pain management to treat chronic back pain, neck pain and muscle pain. A radiofrequency probe is inserted through a small needle into the skin. Controlled and targeted heat is delivered through the probe. Radiofrequency Ablation may be used to destroy the irritated nerve through targeted heat, eliminating pain signals; or Pulsed-Radiofrequency Ablation is used to interrupt painful nerve impulses.
Radiofrequency Ablation, begins by your pain physician administering local anesthetic to numb your skin. Using fluoroscopic (X-ray) guidance, the proper placement of a needle is determined by sensory and motor stimulation. When it has been confirmed that the needle is in the correct position, a local anesthetic is injected. An electrode is threaded into the needle, and is heated to 50-80 degrees Celsius. That temperature is maintained for several minutes, destructing the surrounding pain fibers, which results in the interruption of the pain signals to the brain. Radiofrequency ablation is extremely safe, has high success rates and is performed in our in-house procedure center daily.
Most patients feel mild to no discomfort following the procedure and typically experience a dramatic decrease in pain. Rarely, however, post-operative inflammation of the nerve (neuritis) may occur, and the patient will experience pain similar to a bad sunburn on their skin. This only affects 20% of patients following Radiofrequency Ablation, and should resolve in approximately four to six weeks. If post-operative pain is moderate to severe, we recommend that you schedule an office visit.
Pain relief from a Radiofrequency Ablation typically lasts a little under a year, however in our experience, we have seen pain relief last anywhere from six months to six years.
Radiofrequency Ablation Anatomy
An understanding of spine anatomy and its physiological function is a critical piece in the evaluation of a person with spine-related pain.
The spine consists of individual vertebrae (spinal bones). The vertebrae create a flexible support structure and protect the spinal cord. Facet joints are on the top and bottom of each vertebra and connect the vertebrae to one another. Facet joints hold the spine together and assist with spinal stability. The facet joint structure has lubricating fluids, which allows for ease in a range of back movement. Each vertebra has two facet joints.
Facets are supplied by the medial branch nerve, small nerves which branch out from the vertebra, at the facet joint. They provide sensations to the joints. The facet joints may become arthritic, damaged or irritated causing severe pain with movement.
When the facet joints are compromised, the medial branch nerves send pain signals to the brain. The nerve is located at the junction of the transverse process and superior articular process of the facet joint.
A recent study found that 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).
Radiofrequency Ablation and Sphenopalatine Ganglion
A ganglion is a structure containing a bundle of nerve cell bodies. The sphenopalatine ganglion provides sensations to the face and head region. It’s located at the back of the nose. Often times face pain or headaches are treated successfully with a 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).
Pain conditions commonly treated with Radiofrequency Ablation
- Peripheral Neuropathies
- Sympathetically Mediated Pain
- Complex Regional Pain Syndrome
- Trigeminal Neuralgia
- Neck pain
- Back pain
- Some Stroke Related Pain
Other Radiofrequency Ablation Techniques
- Disc Dennervation
The radiofrequency probe produces a lesion created by localized and targeted heat. When the lesion is created over a painful nerve, pain signals are interrupted to the brain.
The skin area is sterilized and a local-numbing agent is administered through a needle. IV sedation is available and administered if needed. Another needle is placed through the numb tissue and the entire procedure is performed using an imaging device such as a fluoroscopic (X-ray) to guide the needle placement.
To ensure proper needle placement, an electrode is passed into the center of the needle. First stimulation is verified with sensory stimulation and then with motor stimulation. When the needle position is correct, 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. The generated electro-thermal heat allows for destruction of surrounding nerve tissue, thus eliminating or decreasing pain.
Pulsed Radiofrequency – Similar to thermo-coagulation Radiofrequency Ablation; but the electrode is heated at a lower temperature. This lower temperature doesn’t destroy the nerve tissue, but instead stuns the nerve. During the procedure, this technique is generally more comfortable, with often only a mild-pulsating sensation.
After a brief recovery period, patients are typically allowed to go home. Patients may experience mild discomfort following the Radiofrequency Ablation.
Radiofrequency Ablation Benefits
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 patients reported reductions in their pain medication usage. None of the patients developed significant infection, bleeding, hematoma formation, or numbness as complications from the procedure. (Bayer 2005).
Radiofrequency Ablation has been used for many years, and continues to evolve with better results and fewer risks. It offers patients a long-term and significant pain relief treatment, with a minimally invasive out-patient procedure
Radio Frequency Ablation Risks
Radiofrequency Ablation is considered a safe minimally invasive option for many patients who have chronic pain. However, like any procedure there are possible complications and risks.
Potential complications 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 pain relief.
RadioFrequency Ablation Outcomes
Radiofrequency treatment is an extremely safe and widely accepted technique to treat many chronic pain causes (Menno). If a patient has pain relief from an initial treatment, a second treatment may be beneficial. There is strong clinical evidence that Radiofrequency Ablation has “an important role in the management of trigeminal neuralgia, nerve root and spinal pain” (Lord 2002).
In a large study, 92.5% of the participants reported excellent or good pain relief with radiofrequency thermo-coagulation for the symptoms of trigeminal neuralgia (Chen 2001).
A group of 100 patients suffering from trigeminal neuralgia were treated by radiofrequency thermo-coagulation. The study concluded that Radiofrequency Ablation is the treatment of choice for trigeminal neuralgia when other medical treatments are no longer effective, or the side-effects of medications contraindicate their usage (Motta).
Another study evaluated 39 patients with trigeminal neuralgia and 92.3% received satisfactory pain relief (Sengupta).
A large evidence-based practice guideline (developed by the American Society of Interventional Pain Physicians) provided recommendations to clinicians and patients in the United States.
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 three months and long-term relief as lasting three 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).
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