Radiofrequency ablation for pain

Overview

A radiofrequency ablation is a minimally invasive procedure that destroys the nerve fibers carrying pain signals to the brain. It can provide lasting relief for people with chronic pain, especially in the lower back, neck and arthritic joints. If you suffer recurrent pain and you’ve experienced good relief with a nerve block injection, you may be a candidate for a radiofrequency ablation.

What is radiofrequency ablation?

Radiofrequency ablation, also called rhizotomy, is a nonsurgical, minimally invasive procedure that uses heat to reduce or stop the transmission of pain. Radiofrequency waves ablate, or "burn", the nerve that is causing the pain, essentially eliminating the transmission of pain signals to the brain.

This procedure is most commonly used to treat chronic pain and conditions such as arthritis of the spine (spondylosis) and sacroilitis. It is also used to treat neck, back, knee, pelvic and peripheral nerve pain. The benefits of radiofrequency ablation include: avoiding surgery, immediate pain relief, little to no recovery time, decreased need for pain medication, improved function, and a quicker return to work and other activities.

Who is a candidate?

Radiofrequency ablation is a treatment option for patients who have experienced successful pain relief after a diagnostic nerve/pain receptor block injection.

Radiofrequency ablation is done using fluoroscopic (x-ray) guidance and should NOT be performed on people who have an infection, are pregnant, or have bleeding problems.

Who performs the procedure?

The types of physicians who performradiofrequency ablation include physiatrists (PM&R), radiologists, anesthesiologists, neurologists, and surgeons.

What happens before treatment?

The doctor who will perform the procedure reviews your medical history and previous imaging studies to plan the best location for the ablation. Be prepared to ask any questions you may have at this appointment.

Patients who are take aspirin or a blood thinning medication may need to stop taking it several days before the procedure. Discuss any medications with your doctors, including the one who prescribed the medication and the doctor who will perform the injection.

The procedure is usually performed in an outpatient special procedure suite that has access to fluoroscopy. Make arrangements to have someone drive you to and from the office or outpatient center the day of the ablation.

What happens during treatment?

At the time of the procedure, you will be asked to sign consent forms, list medications you are presently taking, and if you have any allergies to medication. The brief procedure may last 15-45 minutes, followed by a recovery period.

Step 1: prepare the patient

The patient lies on an x-ray table. Local anesthetic is used to numb the treatment area. 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.

Step 2: insert the needle

The technique for nerve ablation is similar to that used for diagnostic blocks. With the aid of a fluoroscope (a special x-ray), the doctor directs a thin hollow needle into the region responsible for the pain. Fluoroscopy allows the doctor to watch the needle in real-time on the fluoroscope monitor to make sure that the needle goes to the desired location. Contrast may be injected to confirm correct needle location. Some discomfort occurs, but patients typically feel more pressure than pain.

Figure 1. A heating current is passed through an electrode to destroy the medial branch of the sensory nerve to block the transmission of pain signals.

Step 3: deliver heating current

Once the needle is in place, the patient receives a numbing medication. Then a radiofrequency current is passed through the hollow needle to create a small and precise burn, called a lesion, about the size of a cotton swab tip (Fig 1). The current destroys the portion of the nerve that transmits pain and disrupts the pain-producing signal. The burn takes approximately 90 seconds for each site, and multiple nerves can be burned at the same time.

What happens after treatment?

Most patients can walk around immediately after the procedure. After being monitored for a short time, you can usually leave the office or suite. Someone must drive you home.

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.

Patients should schedule a follow-up appointment with the referring or treating physician after the procedure to document the efficacy and address any concerns the patient may have for future treatments and expectations.

What are the results?

Pain relief may last from 9 months to more than 2 years. It is possible the nerve will regrow through the burned lesion that was created by radiofrequency ablation. If the nerve regrows, it is usually 6-12 months after the procedure. Radiofrequency ablation is 70-80% effective in people who have successful nerve blocks. The procedure can be repeated if needed.

What are the risks?

Radiofrequency nerve ablation is relatively safe procedure with minimal risk of complications. The complications reported in the literature include: temporary increase in nerve pain, neuritis, neuroma, localized numbness, infection, allergic reaction to medications used during the procedure, and/or lack of pain relief (in less than 30% of patients).

                                                                                                              PRE-PROCEDURE INSTRUCTIONS 

1. Please arrive 15 minutes before your procedure time.

2. If you are having a procedure in the head, neck or upper back, please DO NOT eat for 6 hours before the injection. You may have clear liquids up to 3 hours before the procedure (Clear liquids include: water, apple/ cranberry juice, ginger ale, black coffee, or black tea but no milk, sugar, citrus juices, gum, or mints). If you are having a low back, trigger point, or joint injection, you may have a light meal prior to the procedure.

3. Do not wear any skin lotion prior to any proπcedure.

4. You may be asked to change into a gown. Please dress in comfortable, loose clothing and flat rubber soled shoes (please no heels or flip-flops).

5. You may take your medications as usual on the day of the procedure, except for: ______see attached form for guidance on stopping blood thinning medications___________

6. Please notify us if you become ill or develop an active infection. If you develop a bacterial infection, you must have completed antibiotic treatment and be free of infection for 2 days before a procedure can be done.

7. You should arrange for a ride home after the procedure. You may not drive or operate machinery for 24 hours after a spinal procedure.

8. Expect to stay at least 15-30 minutes after the procedure, so that we may monitor you. If you are undergoing a Radiofrequency Lesioning procedure, please expect to stay ONE HOUR after the procedure for recovery. You will be requested to remain in a wheelchair until we determine that it is safe for you to walk.

9. After discharge, you will be asked to rest at home and place ice on the injection site. Please plan accordingly.

10. DO NOT stop any blood thinner unless your cardiologist or primary care physician (PCP) approves it.

11. If you are a diabetic and are having a steroid injection, you will need to follow your blood sugars closely for up to 3 weeks after the procedure. Contact your PCP if your blood sugars are elevated after the procedure.

12. If you will be taking a sedative for premedication, please arrive 30 minutes prior to your procedure. 

Alprazolam as directed (Take 1 tablet 1 hour prior to procedure, then take 1 tablet as needed 30 min prior to procedure). Do not drive, operate machinery or make any legal decisions for 24 hours after taking the sedative. If you have any questions, please call our office at 0705250101.

Your procedure is scheduled for _________________________ am/pm on _________________

PLEASE SIGN BELOW THAT YOU UNDERSTAND YOUR PREPROCEDURE INSTRUCTIONS.

PATIENT’S NAME (PRINT): ....................................................................................................................

SIGNATURE: ..................................................................................... DATE: .........................................

                                                                                                                                                                                                                                                                                                                                                                                                                 POST--PROCEDURE INSTRUCTION

 1. Today, you have received an injection for the management of your pain. Please expect some discomfort for the next 2--3 days following your procedure. Use of ice to the injeciton site for increments of 20 minutes at a time every hour may be helpful in reducing any discomfort.

2. Go home and rest today. Limit your activities today.

3. If significant redness, swelling , warmth or severe pain occurs at the injection site , please call our facility.

4. If you develop a fever and/or chills or bowel or bladder problems, please call our facility.

5. It is not uncommon to develop numbness or weakness in an extremity after a spine or lower extremity nerve injection. Please use great care with weight-bearing activities, as you may be prone to falling. Have someone assist you with walking, if necessary. It is advised that you remain off your feet until the numbness and/or weakness subsides, usually within 2--4 hours. If the numbness or weakness persists beyond the day of the procedure, please call our facility.

6. Do not drive or operate machinery for the next 24 hours, unless instructed otherwise.

7. If you have been taken oral sedating medication, it is advised that you do not operate machinery, drive or make legal decisions for the next 24 hours.

8. If you experience a headache, continue resting, lie flat on your back, elevate your legs and drink extra caffeinated fluids. If your headache lasts greater than 24 hours, please call our facility.

9. Keep the injection site and Bandage clean and dry on the day of the procedure. In the morning, following the procedure, remove the Bandage and cleanse the area thoroughly with soap and water. You may then resume normal activities.

10. If you stopped a blood thinning medication for your procedure, restart it 24 hours after your procedure.

11. If you are a diabetic and received a steroid injection today, please follow your blood sugars closely over the next 3 weeks. If your blood sugars, are high, contact your PCP immediately to help you control your blood sugars.

Your follow--up appointment is scheduled for ………………………… am/pm on .....................................................

PLEASE SIGN BELOW THAT YOU UNDERSTAND THE ABOVE INSTRUCTIONS

PATIENT’S NAME (PRINT): . .................................................................................................................................

SIGNATURE: .................................................................................. DATE: ......................................................