Radiofrequency Ablation

For patients who are experiencing chronic pain and are looking for a more permanent, long-term solution that is both safe and effective, radiofrequency ablation could be the answer. Using heat to stop affected nerves from sending pain signals to the brain, radiofrequency ablation is becoming an increasingly popular option for patients who have yet to find pain relief from other treatment options. The California Pain Consultants team in the Escondido, El Centro, La Mesa, San Diego, Chula Vista areas can help to finally provide you with the relief you need. 

What is Radiofrequency Ablation? 

Radiofrequency ablation (RFA) is a minimally-invasive procedure that uses radio waves to create a current that heats a small area of nerve tissue. The heat that is applied to the nerve tissues impairs or destroys the nerve itself, which allows for a semi-permanent disruption of the feeling of pain sent to the brain. 

First used in 1931 to treat a patient suffering from trigeminal neuralgia, which is a type of chronic pain disorder that involves sudden, severe facial pain, radiofrequency is now used to treat a myriad of chronic pain conditions. 

The goal of radiofrequency is most often to: 

• Stop or reduce chronic pain
• Improve function and mobility
• Reducing the dependency or need for pain medications
• Delaying or avoiding surgical treatment

Benefits include greater decreases in spinal pain when compared to conventional treatment options, with pain relief maintained for six months and up to a year after the procedure is performed. Due to the fact that radiofrequency ablation is performed in an outpatient setting and an imaging machine is used to expertly guide the needle to the exact nerve, the risks and side effects are low. It is also safe to be repeated, if needed, so that the patient can continue to experience pain relief. 

Radiofrequency is a great option for patients who are experiencing chronic pain in their neck or back, muscle pain, or a variety of other pain symptoms, and who have yet to find relief. It is most often used in conjunction with a medial branch block to identify the exact nerve that is causing the pain signals, so the success rate is very high. 

There are two main types of radiofrequency ablation: radiofrequency thermal-coagulation and pulsed radiofrequency. The type used depends on the patient’s level and location of pain, or medical condition. 

For radiofrequency thermo-coagulation, also known as continuous radiofrequency ablation, an electrode is heated to 122 and 176 degrees Fahrenheit and kept at that temperature for about 90 seconds. This is the amount of time required for the electro-thermal heat to nerve damage, which decreases or stops the ability of the nerve to send pain signals, thus decreasing the feeling of pain. 

Pulsed radiofrequency, on the other hand, uses a lower left of heat, around 104 to 108 degrees Farenheit, and delivers the heat in pulses. This stuns the nerve instead of destroying it. The pulsing pattern is also maintained for a longer period of time, and can range anywhere from two to eight minutes, depending on the location of the nerves and the quantity of nerves being treated. It is important to note that since pulsed radiofrequency does not completely destroy the nerve, there is a possibility the nerve will regenerate, requiring additional ablation treatment if and when pain is felt. 

How Does Radiofrequency Ablation Work?

Radiofrequency ablation is currently a treatment method for pain that originates from joints as well as related to pain from the spine, generally in the neck and lower back. 

Looking at the anatomy of the spine, nerves branch off from the spinal cord and travel to the facet joints and sacroiliac joints. Facet joints are located in the spinal column and connect each vertebrae together. Within these facet joints are networks of medial branch nerves, which are responsible for the actual transmission of pain signals to the brain. When the nerves become inflamed or damaged, either due to injury or a medical condition, they alert the brain of the pain. When the pain becomes chronic, or the nerve malfunctions and constantly sends a signal of pain when no pain is felt, radiofrequency ablation is used to destroy the nerve with the goal to completely eliminate the feeling of pain being felt by the brain. 

During the procedure, a small hollow needle is inserted into the targeted nerve that is causing pain. The best way to determine the targeted nerve is to first perform a medial branch block. Once the needle is at the precise location in the spine, an electrode is inserted into the top of the needle, which sends the radio waves through the needle and into the nerve. The heat ablates, or burns, the nerve, preventing it from sending pain signals to the brain. Because the needle targets only the precise nerve causing pain, no other healthy, surrounding nerves are damaged. 

Radiofrequency ablation has also been used as an effective tool for treating low back pain, cervical facet joint pain, and arthritis pain. 

Who Can Get Radiofrequency Ablation?

Good candidates for radiofrequency ablation are patients who are suffering from chronic back pain and haven’t found relief with other treatment options, and those who have found relief from a medial branch block. Radiofrequency is an attractive treatment option to help patients who are suffering from the following chronic pain conditions: 

• Neck and back pain
• Peripheral neuropathies (usually causes weakness, numbness and pain, usually in the hands and feet)
• Complex regional pain syndrome (chronic arm or leg pain)
• Stroke-related pain
• Sympathetically mediated pain (when pain signals are inexplicably sent to the brain)
• Headaches
• Arthritis of the spine

While radiofrequency ablation is most often used to treat chronic pain symptoms, it has also been an effective treatment options for: 

• Cancer tumors (to kill cells)
• Cardiac arrhythmia 
• Dermatology
• Barrett’s esophagus
• Varicose veins
• Obstructive sleep apnea (helps to reduce the size of the tongue base)

What are the Benefits of Radiofrequency Ablation?

Due to the fact that radiofrequency ablation is a minimally-invasive treatment with minimal risks, it is a safe and effective way to provide chronic pain relief. The major advantages include: 

• Immediate and long-term pain relief
• Reduces, removes or delays the need for surgery
• Very short and mild recovery period
• Decreased or no need for pain medications
• Improved function, mobility and quality of life
• Ability to enjoy daily activities after a day or two of rest
• Opportunity for repeat ablation treatment

After receiving radiofrequency ablation, roughly one in five patients reported complete pain relief, and more than half reported mild to moderate pain relief. Additionally, the majority of all patients reported a significant reduction in pain medication usage. 

While radiofrequency ablation is a popular treatment option for most patients who are experiencing chronic pain, there are some patients who are not candidates for the treatment because they have the following conditions:

• Uncontrolled diabetes
• Issue with blood clots (or ability of blood to clot)
• Pregnant
• Infection
• Steroid use
• Weigh 250 pounds or more

While these conditions don’t make the treatment unsafe, they just increase the risk of complications. It’s important to speak with your medical provider to learn more about the risks of radiofrequency ablation and discuss all possible treatment options. 

Radiofrequency Ablation Diagnosis Methods

Patients who suffer from chronic pain and who haven’t been able to find pain relief from physical therapy, anti-inflammatory medications, conservative therapy, steroid and/or epidural injections and more, might need to seek more minimally-invasive options. Typically, pain management specialists might recommend and administer corticosteroid injections for a few months to see if their chronic pain could benefit from focusing on low back pain or facet joint pain. If these injections fail to provide pain relief, the next step is a medial branch block. If the medial branch block does provide relief, then a minimum of two diagnostic medial branch blocks will be administered to confirm both the nerves being treated are in fact the nerves causing chronic pain, and also that radiofrequency ablation is the next best solution for providing long-term pain relief. 

Most patients receive, especially by this stage of treatment, X-rays, MRIs and CT scans, which gives the specialist a clear picture of the inner-body happenings and malfunctions and more insight into whether the ablation process will resolve the patient’s pain. If the specialist notices any abnormalities that might prove that the patient isn’t a candidate for ablation, then other treatment options will be addressed at this time. If no abnormalities are noted, then the medial branch block and subsequent radiofrequency ablation treatments are administered. 

Overall, pain management specialists use a complete range of diagnostic tools to help determine the best treatment plan for the patient. The goal is to provide as few treatment options as possible with each treatment yielding the highest amount of relief for the longest period of time. 

What Does Radiofrequency Ablation Treatment Involve?

Radiofrequency is an outpatient procedure that is performed in your pain management specialist’s office. While most patients are given a local anesthetic, your provider might also opt for a mild general anesthetic if you are nervous or uncomfortable. 

You will first lie on your side or your back, depending on the location of the nerve being targeted, and your provider will sterilize the skin at the injection site. A topical anesthetic will be used to numb the skin before a local anesthetic is injected into the skin, which should feel like a little prick. The entire procedure should be pain free, but be sure to notify your provider if you do feel any sensation. 

Once the targeted area is numb, your provider will place another needle with the help of fluoroscopic guidance, which helps to target the precise nerve that is causing the pain. Then a small microelectrode is placed through the needle, stopping near the targeted nerve tissue. A mild electrical current is then delivered to make sure the correct nerve is targeted. If so, a numbing agent is applied to the nerve before the heat-generating electrical current is delivered, which is the “ablation” part of the treatment. Depending on which specific ablation method your provider is using, the heat will either be administered in one stream or in pulses. 

The entire procedure takes anywhere from 30 minutes to 90 minutes. You should expect to rest for the rest of the day. You might experience some soreness at the injection site, so ice packs and over-the-counter medications (as prescribed) can help. While recovery time should be quick and symptomless, avoid swimming and strenuous activities for a few days after treatment. 

Pain relief is immediate in most people, but it could take up to 10 days to feel relief, or even up to a few weeks. Most patients experience relief that lasts up to several months, which is standard, or even a year. If pain persists, a second treatment might be needed, so please reach out to your pain care specialist to discuss options. 

What are the Risks for Radiofrequency Ablation?

Radiofrequency ablation is considered a minimally-invasive procedure, not surgery. Like other minimally-invasive procedures, this means that there is a low risk of infections and complications, a reduction in the length (if needed) of a hospital stay, a lower amount of pain experienced, and a shortened period of recovery. 

However, because it is still a medical procedure, there are risks involved. These are generally low and mild, and could include bleeding and infection at the injection site, discomfort at the injection site, as well as the possibility for worsening of pain symptoms. If you experience swelling, pain or fever, contact your medical professional immediately. Additional, but very rare, risks include motor nerve damage, paralysis, muscle weakness and severe pain. 

If you have questions about radiofrequency ablation, would like more information, or would like to know if you are a candidate, please reach out to the California Pain Consultants team in the Escondido, El Centro, La Mesa, San Diego, Chula Vista areas today. Our team of expert medical professionals is dedicated to helping their family of patients manage their chronic pain so they can enjoy a more mobile and pain-free life.