Has your doctor or pain specialist suggested radiofrequency ablation to help alleviate your lower back pain? Many pain specialists are recommending radiofrequency ablation for back pain due to its high success rate and measurable results. Here’s how it works, and why it could work for you.
What is radiofrequency ablation for back pain?
Before you schedule your appointment, it’s a good idea to understand the process and how it can really help you. First, what is radiofrequency ablation for back pain? To start, you may also hear it referred to as lumbar radiofrequency ablation, which simply refers to the fact that it targets the lumber (or lower back) area of your spine. Radiofrequency ablation is also known as radiofrequency neurotomy or RFA.
The procedure has a long history and has been used effectively since 1931. It is a non-surgical treatment that disrupts the nerve functions in the affected area to stop painful sensations. It’s a minimally-invasive procedure that’s done on an outpatient basis with only local anesthetic. It can reduce pain sensations for up to two years, for some patients.
The following video gives a brief overview of this chronic lower back pain procedure.
How does radiofrequency ablation for back pain work?
After you and your doctor have decided that radiofrequency ablation may be a good option for you, your doctor will find the nerves that are transmitting pain signals to your brain. They do this with a nerve block. Spine-Health explains:
“Before the radiofrequency ablation procedure, a lateral branch or medial branch nerve block will have already been performed to prove that the patient’s pain is being transmitted by those nerves. The medial branch or lateral branch block acts as a test run before the neurotomy procedure.”
This is an important first step. Studies have found that patients who have a successful nerve block before undergoing RFA have higher success rates and greater pain relief.
The radiofrequency ablation procedure
On the day of your procedure, your doctor will discuss everything with you in-depth and answer any final questions you have. You’ll be comfortably lying down on a table when the radiofrequency ablation procedure begins. Your doctor will administer local anesthetic to numb the treatment area. As Mayfield Clinic explains:
“The patient experiences minimal discomfort throughout the procedure. The patient remains awake and aware during the procedure to provide feedback to the physician. A low dose sedative, such as Valium or Versed, is usually the only medication given for this procedure.”
During the procedure, a pain specialist uses an electrical current to create a localized heat that deadens the targeted nerves that are causing you pain. To do this, your doctor inserts an electrode into the affected area with a small needle-like tube. The best pain specialists always use fluoroscopic (special X-ray) assistance to determine the right placement for this needle.
Once it is in place, your pain doctor will use a high-frequency electrical current to destroy the affected nerves. They’ll use a continuous current or with pulsed radiation for shorter bursts followed by breaks. Heat from the electrical impulse is what disrupts the nerve sensors in your lower back or other affected area to reduce pain. While pain relief may last longer with continuous current radiofrequency ablation (up to two years), the risk of complications increases. This is why many pain doctors prefer pulsed radiofrequency.
Is radiofrequency ablation painful?
Many patients worry that the radiofrequency ablation procedure itself will be painful. During most radiofrequency ablation procedures, you should not feel any pain.
It is important to have a comfort level about the procedure before you arrive. Talk with your pain specialist about the steps involved and what to expect and make a point to talk about your preferences for pain management. In some cases, you may feel some pressure or light pain during the procedure. However, your doctor should be working closely with you to reduce any pain from the injection itself. If you’re in pain, talk to your doctor and they’ll increase the amount of local anesthetic they’re using or can provide other pain relief options.
Radiofrequency ablation for back pain video
Often, it’s more helpful to see a procedure actually taking place. In the following video, Dr. Lynch performs a radiofrequency ablation for lower back pain on one of his patients.
What to expect after radiofrequency ablation for back pain
Radiofrequency ablation can be done in an outpatient setting. It takes approximately 90 seconds to damage each targeted nerve. For most patients, the procedure will take 30 to 90 minutes. Immediately following the procedure, the office staff will monitor you for possible side effects. You must have someone else drive you home due to the anesthesia.
Soreness and weakness are common so it is best to rest and recuperate fully before returning to normal activities. It may still take a few weeks, up to a month, for your affected nerves to completely die off. Many patients will experience pain relief just a few weeks after the procedure, and continue to experience pain relief for a year or more after the procedure.
This procedure is a very precise and repeatable process. If radiofrequency ablation worked for you, it is possible to repeat the procedure as needed. As Spine Dallas explains, “It is possible for the treated nerve(s) to regenerate, which could lead to recurrent pain. However, RF Lesioning is repeatable for nerve regeneration if it worked the first time around.”
However, radiofrequency ablation for back pain won’t work for all patients. If this procedure doesn’t work for you, talk to your doctor about other pain management treatment options.
Will I experience pain after radiofrequency ablation?
Even though your doctor will work hard to make sure this procedure is as minimally-invasive as possible, you may still experience some pain after radiofrequency ablation. You may experience pain or tenderness at the injection site, especially after your local anesthetic wears off. This pain should resolve within a few days after the procedure. You can use over-the-counter medications or hot/cold therapy to reduce pain, as advised by your doctor.
You may also experience some light pain in the weeks following the procedure. Mayfield Clinic explains:
“Patients may experience pain from the procedure for up to 14 days, but this is generally due to the residual effects of the nerve ablation or muscle spasm. Patients are often up and around and back to work 24 to 72 hours after the procedure. Pain relief is typically experienced within 10 days, although relief may be immediate for some patients and take up to three weeks for others.”
If you experience any pain during these periods, it is typically less severe than your initial lower back pain. If the procedure works, it will resolve quickly.
Are there radiofrequency ablation for back pain complications?
Radiofrequency ablation for back pain side effects are usually mild and include pain, numbness, or discomfort around the injection area.
Mayo Clinic notes that there can be some serious, but rare, complications from radiofrequency ablation for back pain. These include:
- Long-term numbness
- Nerve injury
To avoid these complications, work with a highly-qualified pain specialist who uses both nerve blocks before and fluoroscopy during the procedure. They’ll also check for any risk factors that could contribute to complications. You may want to avoid a radiofrequency ablation for lower back pain procedure if you:
- Are overweight
- Have an active infection
- Are pregnant
- Suffer from poorly-controlled diabetes or blood clotting issues
What is the lumbar radiofrequency ablation success rate?
Since radiofrequency ablation for back pain promises relief for the millions of patients who suffer from lower back pain, there has been a wealth of recent study into it. In 2014, the journal of Pain Research and Management did a systematic review of the randomized controlled trials out there for this procedure. They noted that more research was needed, especially for pain originating in the coccyx. However, they reported that:
“The evidence supports RFA as an efficacious treatment for lumbar facet joint and sacroiliac joint pain, with five of six and both of the RCTs demonstrating statistically significant pain reductions, respectively.”
But the more important question is — will radiofrequency ablation for back pain work for you? And that depends. Some patients find long-lasting pain relief with radiofrequency ablation. When a nerve block is done beforehand and successfully identifies the nerve causing pain, up to 80% of those patients will find pain relief. Otherwise, typically up to 50% of patients will experience significant pain relief, sometimes for up to two years. Others may find pain relief, but at lower rates or for shorter periods of time. And, if RFA worked once, it’s likely that repeat treatments will continue to provide the same level of pain relief.
However, some patients simply won’t experience any pain relief from this procedure. In these cases, you should work closely with your pain doctor to find pain treatments that could work for you. These may include epidural steroid injections, spinal cord stimulation, or surgery in more advanced cases.
Get started with radiofrequency ablation for back pain
Are you ready to find a life with less pain? Radiofrequency ablation is a minimally-invasive, outpatient procedure that can provide significant pain relief for many patients. Click the button below to find a pain doctor near you who specializes in interventional pain management.