Radiofrequency Treatment

How does it work?
When various conservative treatments have failed, invasive modalities may be considered for the treatment of chronic pain.

Prior to Radiofrequency (RF) treatment, a definitive diagnosis is attempted, usually by performing nerve blocks, which involves injection of local anesthetic medication around the suspicious nerve believed to be the pain generator.

During RF treatment a needle is introduced through the skin towards the targeted neural tissue. The needle is connected to a generator, having the ability to test motor and sensory feeling, thus showing the clinician the proximity of the needle to the desired nerve believed to be involved in the generation of the specific chronic pain syndrome. Electric current will flow through the needle producing heat at the very tip of the electrode, thus heating and destroying the targeted tissue. Once this has occurred, the pain signals will fail to reach the brain, and the pain sensation will cease. Care is taken during such a procedure to avoid the destruction of the vital motor nerves, which sometimes may course along the nerves needed to be ablated. This technique has been refined in early 1980, after the introduction of small insulated electrodes.

As an alternative to thermal destruction of the small nerves, the so-called "pulsed radiofrequency technique" is used. Here, lower temperatures are generated at the tip of the needle, therefore avoiding true nerve destruction and potential side effects such as postoperative pain. This technique seems to work by changing the electric field surrounding the nerve. This method applies short pulses of 20 ms at a high voltage to neural tissue. The heat is dissipating and the final temperature reaching the target is around 42 degrees Celsius, compared to 70 or 80 degrees used with the traditional method. This is used preferentially for pain syndromes involving the peripheral nerves. Further studies are needed to validate this new modality, although clinical results are very encouraging.

The majority of the best research studies available for RF involve the LUMBAR AND CERVICAL FACETS, thus dealing with pain from spinal origin. The efficacy of this method was validated by well-conducted prospective randomized studies. Clearly this technique should not be used alone, but rather in conjunction with a vigorous rehabilitation program to address the deconditioning of weak muscles.

Over the past years, indications for the use of this technique have been extended to many other conditions for the treatment of spinal, visceral, (pancreatic pain), cancer pain and headache syndromes.

The Thoracic Facets, Sacroiliac Joint, and Dorsal Root Ganglion can be targeted when treating spinal pain.

The Splanchnic Nerves are a well-known origin for abdominal pain.

The Spheno Palatine Ganglion, C2/ C3 Dorsal Root Ganglion, and Trigeminal Ganglion are well known, albeit frequently unrecognized pain generators for recalcitrant headaches.

Peripheral nerves, such as the Suprascapular Nerve (chronic shoulder pain) Tibial Posterior Nerve (leg pain) and Intercostal Nerve (chest wall pain,) can be treated with pulsed RF resulting in relatively long term pain relief.

RF of the Stellate Ganglion and Lumbar Sympathetic Plexus are used in the early treatment of chronic regional pain syndrome (formally known as RSD.) The rationale is to use this technique in order to obtain longer relief than with the traditional local anesthetic blocks.

What to expect during the procedure?
For optimal outcome, this procedure must be performed under fluoroscopic (X ray) guidance. The position of the patient varies according to each individual procedure. The appropriate area is prepped with an antiseptic solution and then a local anesthetic is used to numb the skin. A light sedative can be administered, but the patient remains awake, in order to enable communication with the physician during the electrical test stimulation which allows for the exact placement of the electrode at the target area. Under direct X-ray visualization the actual electrode is introduced towards the target area. A mild, temporary discomfort may be perceived at this time. A contrast material may be used to increase the accuracy of the procedure.

A mild local discomfort may persist at the site of the injection for a few days. This can be treated with ice or a mild pain medication. If successful, the patient will start feeling better three to seven days after the procedure.

Radiofrequency is a safe procedure. Potential side effects are rare and include: bleeding, infections and temporary worsening of the pain.

On the day of the procedure, the patient needs to be accompanied by a designated driver since after the procedure temporary residual numbness may be perceived. Further discharge instructions will be provided by our staff before leaving the surgical area. The following day the patient will be called by the nurse and the outcome will be reassessed. A follow up appointment will be set up in two to three weeks after the procedure with one of the physicians or nurse practitioners.