Radiofrequency Ablation (RFA) is a minimally invasive out-patient procedure and treatment for a range of conditions and pain syndromes. This cutting-edge procedure uses a specialized device that uses radiofrequency heat energy to stop nerve signals from transmitting pain to the brain.
RFA is often used in pain management to treat chronic back pain, neck pain and muscle pain. During RFA, a radiofrequency probe is inserted through a small needle into the skin. Controlled and targeted heat is delivered through the probe. RFA may be used to destroy the irritated nerve through targeted heat, eliminating pain signals. Pulsed-RFA is used to interrupt painful nerve impulses.
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).
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 RFA:
- Peripheral Neuropathies
- Sympathetically Mediated Pain
- Complex Regional Pain Syndrome
- Trigeminal Neuralgia
- Headaches
- Neck pain
- Back pain
- Some Stroke Related Pain
- Other RFA Techniques
- IDET
- Disc Dennervation
Procedure
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.
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.
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 – This is similar to thermo-coagulation RFA, except that 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 RFA.
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 in this study 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).
RFA 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
Risks
RFA 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.
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 RFA 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 RFA 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).
For more information about RFA, or other items mentioned, please see your pain physician.
Resources
- 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