Radio frequency ablation (RFA), also called rhizotomy, is a relatively new treatment to control chronic pain. It is a non-surgical procedure that utilizes the thermal energy or heat produced by radio frequency waves to destroy nerve tissue and disrupt the pain signals they send to the brain. The radio frequency is sent through a needle that’s inserted directly into the effected nerve. It’s not a cure, but it can significantly reduce pain. 70-90% of patients reported initial relief with only 15-20% reporting recurrent pain at 12 months. It can be done in an office setting in just a half hour for each nerve treated.
What can radio frequency ablation do?
- Eliminate or decrease pain
- Reduce pain medication use
- Avoid more invasive procedures
- Improve daily activities
RFA can treat a variety of pain syndromes
- Facet joint pain. Every vertebral body in our spinal column has a pair of these small joints. They give us flexibility and motion e.g. bending and twisting. The median branch nerves attached to the facet joints send pain signals to the brain when it hurts to move at this site.
- Sacroiliac joints are the large triangular looking bone in our lower back just above the tailbone. Here, lateral branch nerves carry pain signals away from the spine to the brain.
- Spinal stenosis is a narrowing of the canals where the spinal cord or peripheral nerves exist. This allows less space for proper movement which can lead to pressure on the cord or exiting nerve, creating pain. This most often occurs from wear and tear in the neck and lower back.
- Trigeminal neuralgia is a condition that causes facial pain. In this syndrome a focused beam of radio frequency waves is targeted at the root of the trigeminal nerve in order to prevent the transmission of pain signals to the brain.
- Cancer. Radio frequency ablation can be used to kill cancer cells in hard to reach areas, those that are too close to blood vessels, aren’t amenable to surgery, or are causing pain.
- Neuropathic pain occurs when one or more nerve is damaged or not functioning normally. It can occur at any level e.g. the spinal cord or brain – together known as the central nervous system- or from peripheral nerves that innervate organs and the extremities. Damaged nerves due to diabetes, shingles, nerve impact from a herniated disc, alcoholism, chemotherapy, send the wrong signals to pain centers resulting in chronic pain disorders.
- Heart arrhythmias. Cardiac ablation uses the energy from radio frequency ablation to create tiny scars in the heart to block irregular electrical signal that cause arrhythmias such as atrial fibrillation.
- Chronic venous insufficiency in the legs. Blood pools in our lower legs causing edema and pain when the valves can’t function properly and pump the blood against gravity back up to our heart. This leads to chronic lower extremity pain. RFA can “seal off” the damaged vein, forcing blood flow into healthier, more appropriate veins to improve circulation and relieve pooling.
- Thyroid nodules. In benign nodules, radio frequency ablation can reduce their size. But since they aren’t excised, annual ultrasounds are still required to ensure they don’t regrow in size.
Who is a candidate?
- Those who have pain relief after a test nerve block injection confirms a particular nerve is causing your pain.
- Chronic pain that doesn’t respond to conservative treatments e.g. rest, ice, medications, physical therapy.
Not recommended if you are:
- Have a bleeding disorder
- Have an infection
Although relatively safe every procedure has a risk:
- Temporary increase in pain
- Increased sensitivity to touch or Hyperesthesia
- Damage to nerves or blood vessels
- Minimally invasive
- Can be performed in an office or out patient setting
- Takes only 5-30 minutes for each nerve treated
- Minimal recovery time
- Majority of patients see quick results
Is it effective?
Although there might be residual pain for days to a few weeks after the procedure, most studies show 70-90% get rapid relief after a successful nerve block. It can last months, and in some patients, even years. Less than 30 % of patients reported no benefit.
A treated nerve can regrow in 6-12 months. If the pain reoccurs another treatment can be performed.
Radio frequency ablation requires little down time and is minimally invasive. It is a simple intervention taking an hour in an office setting. No strenuous activity is recommended the day of the procedure. The next day 50% of normal, the second day after the procedure 75% and by the third day you can resume normal activity.
Talk to your provider and see if this may be a way to treat your chronic pain.