If you’re suffering from chronic pain, chances are good you have looked at many different options for relief. One of the important parts of discussing potential pain-relieving procedures is making sure you understand what side effects might occur. Radiofrequency ablation is generally considered a safe procedure for managing pain, but if you are considering it these are 11 radiofrequency ablation side effects to be aware of (and what to do about them).
What is radiofrequency ablation?
Radiofrequency ablation is a chronic pain therapy first discovered in 1931 as a treatment for trigeminal neuralgia. Trigeminal neuralgia is a pain condition in which facial nerves send severe jolts of pain across the face and down the sides of the neck. Radiofrequency ablation delivers an electrical current into these nerves transmitting pain signals to the brain. This electrical pulse disrupts pain signals and can help relieve chronic pain.
These days, radiofrequency ablation is often associated with the treatment of chronic pain in and around the spine.
The 33 vertebrae of the spine are connected on both sides with facet joints that join the vertebrae. Together with the intervertebral discs, these facet joints aid in flexibility and movement of the vertebrae, gliding seamlessly in multiple directions. However, the facet joints and their function in the spine are vulnerable to injury, tissue damage, and inflammation. The most common condition treated by radiofrequency ablation is lower back facet joint pain where the medial branch nerves are located.
Radiofrequency ablation can also treat the following conditions:
- Arthritis pain
- Other types of lower back pain unrelated to the facet joint
- Sacroiliac joint pain
- Obstructive sleep apnea (OSA)
- Cardiac arrhythmia
- Bone, lung, liver, and kidney tumors
- Varicose veins and venous insufficiency
- Neck pain
How does radiofrequency ablation work?
There are two types of radiofrequency ablation:
- Continuous radiofrequency
- Pulsed radiofrequency
As their names suggest, continuous radiofrequency ablation delivers a mild electrical signal continuously, and a pulsed radiofrequency ablation sends intermittent pulses to the affected nerves.
For continuous radiofrequency ablation, the electrical current applied is gradually increased to a temperature of between 50° and 80°C (122° and 176° F). This temperature stays stable for 80 to 90 seconds. This is the approximate length of time required for the heat to cause nerve damage. This continuous pulse is applied to multiple nerve sites to increase the likelihood of pain relief.
Pulsed radiofrequency ablation uses different levels of electrical current at different intervals held for varying lengths of time. Brief intervals of high voltage current (20 milliseconds) are followed by longer intervals (489 milliseconds). The temperatures produced in these intervals range from 40° to 42°C (104° to 107.8°F). This pattern repeats for at least two minutes, up to eight minutes depending on the location and number of nerves.
What can I expect during a radiofrequency ablation procedure?
A radiofrequency ablation procedure is minimally invasive and begins with a local anesthetic and possibly a mild sedative delivered via intravenous (IV) line. When the area for the procedure is numb and you are comfortable, your doctor will insert a hollow needle into the area of the affected nerves. Your doctor will use X-ray or fluoroscopic guidance to ensure accuracy and proper needle placement.
Once the needle is in position, your doctor inserts a microelectrode through the needle and into the area near the nerve. A weak electrical current runs through the microelectrode while it is put into place to double check for proper placement. You may feel a tingling sensation but it should not be painful.
Because proper placement is so crucial, stronger electrical current is run through the electrode directly into the nerve. This may produce twitching or throbbing in the surrounding muscles, but it is a necessary step to ensure proper placement.
After ensuring proper placement, treatment begins. Before applying continuous or pulsed electrical currents, your doctor may also inject a corticosteroid to reduce potential inflammation that occurs during or after the procedure. You should not feel any pain, as the numbing agents and mild sedatives you received in the beginning will still be effective.
In the following video, you can watch a procedure take place.
Is radiofrequency ablation painful?
The radiofrequency ablation procedure itself should not be painful. When receiving an injection of numbing agents or during the insertion of an IV catheter for IV sedation, patients will generally feel a small pinch or sting. However, this should subside quickly as the medications begin their work. There may be pressure or tingling sensations, but that should be it.
During the procedure, your doctor will check in at each step to make sure you are comfortable. It is important to communicate with your doctor, letting them know how you are feeling each time they check in.
Some patients feel so much anxiety regarding radiofrequency ablation (or any other type of procedure) that deep sedation is their only option. It is important to talk with your doctor about your concerns before your procedure so that they can make it as comfortable as possible for you.
11 common radiofrequency ablation side effects
As with any treatment for chronic pain, radiofrequency ablation side effects are an important consideration. Although considered relatively low risk and minimally invasive, radiofrequency ablation does come with some side effects.
The most common radiofrequency ablation side effects include the following four minor side effects:
- Temporary numbness or burning
- Temporary pain at the procedure site
- Infection at the injection site
In very rare cases, the following seven serious complications may occur:
- Nerve damage
- Motor deficits
- Muscle weakness
- Severe pain
- Allergic reaction to medications
Working with a highly-qualified doctor can help you avoid many of these side effects.
Pain after the procedure may occur in the muscles surrounding the radiofrequency ablation. Muscle spasm may also increase temporarily in this area, causing pain.
2. Temporary numbness or burning
Patients may feel temporary numbness that gradually recedes, focused in and around the area of the procedure.
This numbness should subside as the injected corticosteroids and analgesics wear off. A burning sensation may proceed the numbness, but both should wear off in two weeks or less.
3. Temporary pain at the procedure site
Once the local anesthetic wears off, temporary pain at the injection site is normal and is usually a minor discomfort.
4. Infection at the injection site
Whenever the skin is punctured, infection is possible. This radiofrequency ablation side effect is so rare as to hardly warrant a mention, but it’s important to keep an eye on the injection site as it heals.
Your doctor will have a full list of signs and symptoms to watch for. If you see any signs of infection, contact your doctor.
Bleeding and the following conditions are more rare, but they are possible.
Whenever the skin is punctured, bleeding can occur. In rare cases, this bleeding can occur inside the body, necessitating further treatment.
6. Nerve damage
Nerve damage of the non-targeted nerve occurs as a result of improper placement of the electrode. Using fluoroscopy and X-ray ensures proper placement and reduces the risk of this radiofrequency ablation complication.
Working with a highly-trained doctor who has performed many RFA procedures is the best way to prevent this side effect.
7. Motor deficits
Motor deficits are also related to nerve damage that occurs during the procedure.
This challenge with motor skills is usually temporary, with control and strength returning with physical therapy and as the nerves regenerate.
In very rare and severe cases, paralysis can occur. The nerves being targeted run along the spine, and too much electrical current or improper placement may actually run into the spinal cord, resulting in paralysis that can be temporary or long-term.
This complication is exceedingly rare but is worth considering. Again, always work with a highly-trained doctor to help prevent this complication.
9. Muscle weakness
Muscle weakness is related to either improper placement of the needle or electrode or incorrect use of electrical current.
Most muscle weakness will correct itself over time as the nerves regrow, but in some cases physical therapy is necessary.
10. Severe pain
Severe pain after radiofrequency ablation is very rare. This may be due to improper needle placement or inadequate sedation that results in damage to other nerves.
11. Allergic reaction to medication
An allergic reaction to sedatives or other medications can be potentially life-threatening. Your doctor will take a complete medical history prior to sedative, and it is important to disclose any prior issues with sedation to prevent this complication.
What’s my risk for radiofrequency ablation side effects?
The risk of side effects for radiofrequency ablation is about 1%, with the vast majority of those complications being considered minor.
Patients can avoid most side effects and radiofrequency ablation complications by preparing themselves before the procedure and working with a highly-trained doctor. Talking with your doctor about any underlying health challenges, allergies, or other comorbid conditions can help them get a better idea as to whether radiofrequency ablation is the best choice for your chronic pain.
You can also increase your chances of success and decrease your chances of side effects by staying in the best health you can prior to your procedure and following your doctor’s instructions for recovery.
What to expect after radiofrequency ablation
Patients nervous about what to expect after radiofrequency ablation have tools to help ease them through their recovery. On the day of your procedure and for several days after, take it easy and allow your body to rest. Your doctor may prescribe anti-inflammatories or recommend over-the-counter anti-inflammatory medications to ease pain and swelling. Cold compresses can also offer relief at the site of the procedure.
Avoid bathing for 24 hours and baths for another 48. Avoid strenuous lifting or operating heavy machinery for at least the first 24 hours as well. Talk to your doctor about any other modifications you should do to your current routine.
Knowing what to expect after radiofrequency ablation goes beyond the side effects. Your pain relief may not be immediate, and it will most likely not be permanent.
How long will I have pain relief?
Because pain is so personal, reports of a pain relief timeline range from beginning immediately (separate from any painful side effects) and lasting for months or they take several weeks and offer only mild relief. In some cases, patients experience profound and lasting pain relief, while others may have residual pain that does not respond to this procedure. If no pain relief occurs, the proper nerves may not have been targeted, and the procedure can be repeated in two to three weeks.
For most patients, nerves damaged by radiofrequency ablation may regrow between six and 18 months. With proper physical therapy and exercise, it is possible that even if pain returns, the level may be more manageable than before as you handle any underlying conditions that have led to pain.
While the level of pain relief may depend partially on the patient, a doctor skilled in radiofrequency ablation offers the best chance for success. You can find a pain doctor in your area by clicking the button below or looking for one in your area by using the tips here: https://paindoctor.com/pain-management-doctors/.