People who suffer from chronic low-back and neck pain related to joint degeneration from arthritis have another weapon, in addition to medications, to use in the fight against their constant discomfort.
Radiofrequency ablation (RFA) uses an electrical current produced by a radio wave to heat a small area of nerve tissue, which decreases pain signals from a specific nerve, says Audra Eason, MD, of Alabama Pain Physicians in Birmingham. “Generally, these interventions augment pain relief along with medications,” she says. “The procedure treats pain caused by facet joints. Medial branch nerves supply the facet joints and transmit the pain. RFA destroys these nerves and lessens the pain.”
In the past, steroid injections were made into the facet joints in the spine to alleviate facet pain, Eason says. “These injections failed to provide significant long-term relief. The procedure was a little more complicated because going directly into a joint can result in damage to the joint capsule. RFA targets the nerve that supplies the joint,” she says. “We now do a medial branch nerve block first to make sure the patient will get relief after the RFA and is, therefore, a candidate for the procedure.”
A huge advantage of RFA is that many patients can get relief from pain for six to 18 months or longer with a single injection. “The nerve will regenerate over time, but that doesn’t necessarily mean that the pain will return,” Eason says. “Most patients will get prolonged relief, and there is no limit to the number of injections one person can receive. I have some patients who get so much relief, they come in once a year for the procedure.”
RFA has proven to be a safe and effective treatment, and most patients tolerate the procedure well with few complications. “The RFA is done in a procedure room in our office. We use a fluoroscope to identify the target, and we use imaging guidance to place the specially designed radiofrequency needle in the appropriate location. We always test to make sure we are not close to the spinal nerve that controls leg movement and sensation,” Eason says.
Intravenous medicines and local anesthetics decrease the pain of the treatment. Specially designed insulated needles are placed near or on the facet joint nerve. The special RFA needle is heated and used to destroy the nerve that is transmitting the pain.
Following the procedure, the patient may feel local tenderness. “We give them medicines to help the pain, and we also inject local anesthetics and steroids into the site for post-procedure relief,” Eason says. “Most patients can go back to work the next day, but they may have increased pain for a few days. The patient should start to experience relief in the first week, but it may take four to six weeks to achieve the maximum effect of the denervation.”
Eason says that most people are eligible for this treatment as long as their initial exam and image findings are appropriate for facet mediated pain. However, patients with active infections or bleeding problems cannot have the RFA procedure. For those who undergo RFA for low back pain, success rates typically are about 50 percent for pain relief for as much as two years. Success may be higher with procedures in the cervical spine area.
Eason encourages physicians to refer patients who may benefit from this procedure. “We like for them to refer the patient for a medial branch nerve block to determine if the procedure would be successful,” she says. “If so, we should be able to help them.”
In addition to doing ablation on the facet joint nerves, Eason says they are beginning to branch out to other areas such as peripheral nerves and joints. “I see this technology being a mainstay for the future for treating spinal pain. It is a great treatment advancement with prolonged efficacy,” she says. “RFA is an exciting tool, and it is amazing to be able to give someone relief from pain for a year or so. I know it makes our patients happy.”
