With over two million patients treated each year, lower back pain is the second leading cause for a patients visit to a pain management specialist. Imagine a procedure that could treat your back pain, potentially as an outpatient, and allow you to return quickly to your normal activities. All of this is possible using Radiofrequency technology.
Radiofrequency (RF) lesioning is a safe proven means of interrupting pain signals. Radiofrequency current is used to heat up a small volume of nerve tissue, thereby interrupting pain signals from that specific area. Clinical data shows the Radiofrequency Lesioning can effectively provide lasting pain relief.
A Typical Procedure An RF lesioning procedure is performed by a physician in an operating room setting. Both local anesthesia and a mild sedative may be used to reduce any discomfort during the procedure. You will need to be awake and alert during both the sensory and motor stimulation process to aid in properly pinpointing the placement of the lesioning electrode. During the procedure you will be lying either your stomach or back, depending on the approach your doctor will take. After the local anesthesia has been administered, you doctor will insert a small needle into the general area where you are experiencing pain.
Under the guidance of x-ray, the doctor will then guide the to the exact target area. A micro-electrode is then inserted through the needle to begin the stimulation process. During this process, you will be asked by your doctor if you are able to feel a tingling sensation. The object of the stimulation process is to help you doctor determine if the electrode is in the optimal area for treatment, this producing the most relief.
Once the needle and electrode placement is verified, treatment is ready to begin. A small RF current will travel through the electrode into the surrounding tissue, causing the tissue to heat and eliminate the pain pathways.
Radiofrequency lesioning of nerves is a procedure that may be used to reduce certain kinds of chronic pain by preventing transmission of pain signals. It is a safe procedure in which a portion of nerve tissue is heated to cause a long-lasting interruption in pain signals and reduce pain in that area. This procedure is sometimes called radiofrequency ablation.
Dr. Robles will first identify the nerve or nerves that are sending pain signals to your brain. You may have X-rays to pinpoint where to direct the radiofrequency probe. After you receive a local anesthetic, the doctor places an instrument under your skin through which electrical stimulation heats the surrounding tissue. This may cause you to feel a buzzing or tingling sensation. The heat "stuns" your nerves, blocking them from sending pain signals to your brain.
Radiofrequency (RF) lesioning is a safe, proven means of treating chronic pain. Continuous radiofrequency current is used to heat a small volume of nerve tissue, thereby disrupting pain signals from that specific area. This procedure has a selective effect on nerve fibers, reducing pain in target areas, but leaving other sensory capabilities intact.
Radio Frequency Lesioning is a procedure using a specialized machine to interrupt nerve conduction on a semi-permanent basis. The nerves are usually blocked for 6-9 months (can be as short as 3 months or as long at 18 months).
Currently at TPM, Radio Frequency Lesioning is offered to patients with: RSD/CRPS/SMP involving upper or lower extremities Mechanical neck or low back pain due to facet joint disease Occipital neuralgia Abdominal (visceral) pain responsive to splanchnic nerve blocks. You must have responded well to local anesthetic blocks, to be a candidate for Radio Frequency Lesioning.
The procedure disrupts nerve conduction (such as conduction of pain signals), and it may in turn reduce pain, and other related symptoms. Approximately 70-80% of patients will get good block of the intended nerve. This should help relieve that part of the pain that the blocked nerve controls. Sometimes after a nerve is blocked, it becomes clear that there is pain from the other areas as well.
Depending upon the areas to be treated, the procedure can take from about twenty minutes to a couple of hours.
Since nerves cannot be seen on x-ray, the needles are positioned using bony landmarks that indicate where the nerves usually are. Fluoroscopy (x-ray) is used to identify those bony landmarks. A local anesthetic (like Novocaine) is injected to minimize the discomfort. After confirmation of the needle tip position, a special needle tip is inserted.
When the needle is in good position, as confirmed by x-ray, electrical stimulation is done before any lesioning. This stimulation may produce a buzzing or tingling or pressure sensation or may be like hitting your "funny bone". You may also feel your muscles jump. You need to be awake during this part of the procedure so you can report what you are feeling. The tissues surrounding the needle tip are then heated when electronic current is passed using the Radio Frequency machine, for a few seconds. This "numbs" the nerves semi-permanently.
Nerves are protected by layers of muscle and soft tissues. The procedure involves inserting a needle through skin and those layers of muscle and soft tissues, so there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the needle. There is some discomfort involved for a few weeks after.
No. This procedure is done under local anesthesia. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easier to tolerate. The amount of sedation given generally depends upon the patient tolerance. It is necessary for you to be awake enough to communicate easily during the procedure.
It is done either with the patient lying on the stomach when working on the facet joints, low back for lumbar sympathetic nerves, and in sitting position when lesioning the cervical (neck) area. The patients are monitored with EKG, blood pressure cuff, and blood oxygen-monitoring device. The skin on the back is cleaned with antiseptic solution and then the procedure is carried out. X-ray (fluoroscopy) is used to guide the needles.
Initially there will be muscle soreness for up to a week afterward. Ice packs will usually control this discomfort. After the first two weeks are over, your pain may be gone or quite less. Some patients may have some "deep sun-burn" type feeling. Some may develop hypersensitivity or burning pain or numb areas for a few weeks. After lesioning of the 3rd Occipital nerve (for headaches), some of the patients may develop dizziness or vertigo for a few days. The relief of pain is noticed in about 2 to 3 weeks, not right away.
You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform the activities as tolerated by you.
You should be able to return to your work the next day. Sometimes soreness at the injection site causes you to be off work for a day or two.
If successful, the effects of the procedure can last from 3-18 months, usually 6-9 months.
If the first procedure does not relieve your symptoms completely, you may be recommended to have a repeat procedure after re-evaluation. Because these are not permanent procedures, they may need to be repeated when the numbness wears off (often 6-12 months).
It is very difficult to predict if the procedure will indeed help you or not. Generally speaking, the patients who have responded to repeated local anesthetic blocks will have better results.
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and the possibility of complications. The risks and complications are dependent upon the sites that are lesioned. Any time there is an injection through the skin, there is a risk of infection. This is why sterile conditions are used for these blocks. The needles have to go through skin and soft tissues, which will cause soreness. The nerves to be lesioned may be near blood vessels or other nerves which can be potentially damaged. Great care is taken when placing the radiofrequency needles, but sometimes complications occur. Please discuss your specific concerns with your physician.
If you are on a blood thinning medication (e.g. Coumadin®, Plavix®), or if you have an active infection going on, you should not have the procedure. If you have not responded to local anesthetic blocks, you may not be a candidate for this procedure.