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Radiofrequency Ablation (RFA) is procedure used to disrupt or deaden nerves as a form of pain management. The radiofrequency refers to the heat produced by the electric currents (RF currents) and the ablation, in the medical sense, refers to a procedure that deadens live tissue such as nerves and tumors. Essentially, RFA is a procedure that uses a needle with an electrical current that generates extreme heat to create a lesion on a nerve, thereby disrupting the painful sensations from being acknowledged by the central nervous system. An RFA procedure generally produces long-term relief that will last for a few months to several years.
This minimally invasive procedure is typically used on patients suffering from neck, back or muscle pain and other pain disorders. The symptoms produced range from pain and burning to tingling and numbness.
RFA, also known as radiofrequency neurotomy, is often used to treat damaged nerves resulting from injury or systemic disorders. Candidates for RFA treatment are typically determined by a successful nerve block (Van Zundert et al, 2012). A nerve block is a procedure that effectively numbs the nerves — most commonly the occipital nerves — resulting in pain relief. If the pain relief is greater than or equal to 50 percent, then the patient will be a likely candidate to benefit from RFA.
Common disorders requiring radiofrequency are:
- Back and Neck Pain: The facet joints of the spine are often considered to be the source of chronic spinal pain, the pain will also often radiate to the head, neck and shoulders (Boswell et al, 2007). The medial branch nerve, located at the junction of the transverse and superior articular processes of the facet joints throughout the spine provide sensation to the facet joints in the spine. For this particular form of pain, a medial branch RFA is the best solution, as it impedes the delivery of the perceived pain in the facet joints (Murtagh, 2006). Typically this pain is caused by degenerative changes, trauma or postural abnormalities (Menno, 2009).
As a natural form of the degenerative processes, chronic lumbosacral (low back) pain is often a candidate for RFA. In a recent study to test the safety, success and length of pain relief of repeated RFA treatments, 98 patients afflicted with lumbosacral radicular pain received a series of two to five RFA treatments. On average, the patients experienced pain relief for roughly four and a half months (Nagda et al, 2011).
- Headaches and face pain. The sphenopalatine ganglion (a ganglion is a bundle of nerves) is often the culprit for facial pain and headaches. This group of nerves can effectively be targeted with RFA to help decrease pain (Bayer et al, 2005). In fact, clinical trials have proven that RFA treatments can help reduce the pain of cluster headaches caused by the sphenopalatine ganglion nerves (Narouze et al, 2009). Trigeminal neuralgia is a particular variety of facial pain, which makes activities such as chewing painful. In a recent study, 33 out of 39 patients reported “excellent” pain relief after receiving RFA for trigeminal neuralgia (Udupi et al, 2012).
Occipital Neuralgia, a painful headache caused by irritation to the three occipital nerves at the base of the skull, is also a condition that can be treated by RFA.
- Other types of conditions that are likely candidates for RFA are: Sacroiliac joint pain, Complex Regional Pain Syndrome (CRPS), Phantom Limb Pain, Post-herpetic neuralgia (PHN) and Coccygodynia.
RFA is a minimally invasive outpatient procedure and essentially comprised of a nerve lesion being created by localized heat to disable painful nerve impulses.
Once the cause of the pain has been accurately diagnosed (typically, by using a nerve block), the patient will receive a local anesthesia to the injection site and an IV sedation, if needed. Using fluoroscopic (X-ray) guidance, a needle is injected into the skin and guided to the correct location. When the correct location is verified by electrostimulation, a local anesthetic and often, steroid medication is injected (Menno, 2009). Then an electrode in the center of the needle is heated to 50-80°C and kept in place for several minutes. The heat will create a lesion either on the specified nerve or unmyelinated fibres resulting in an interruption of pain signals to the CNS (Menno, 2009).
Pulsed RFA (PRF) on the other hand, does not damage nerves, but instead temporarily stuns them. PRF is almost identical to RFA, except the electrode emits low heat, effectively keeping the heat below neurodestructive levels (Menno, 2009).
Typically, both procedures will take between 20 minutes and an hour to take effect.
In both instances, patients are subject to a brief recovery period, before being allowed to go home after the treatment.
This minimally invasive procedure provides patients relief who suffer from significant pain. In a recent study, 21% of patients who underwent RFA for head and face pain experienced complete pain relief, while 65% experienced mild to moderate pain relief and the majority reduced the use of pain medications (Bayer et al, 2005). RFA provides substantially longer pain relief compared to pharmacological therapies and epidural steroid injections (Arora, 2005).
RFA is safer than surgery as it has less risk of infection and it is just as effective as open surgery (Bogduk, 2004). RFA is a favorable treatment, especially in the instance that surgery isn’t an option (Kawaguchi et al, 2001).
RFA is considered a safe procedure, but as with all medical procedures there are associated risks, possible side effects and complications.
- Pain at Injection Site
- Damage to surrounding nerves and blood vessels at injection site (Bunch et al, 2008)
- Temporary numbness and weakness in extremities (Nagda et al, 2011).
In general, the success rates for RFA for pain management are very high. There are a number of forms of chronic pain that are treatable by RFA that result in decreased use of pain medications and a restored range of motion (Nath et al, 2008). The average success rate for RFA in the lumbar medial branch varies from 60-90 percent, RFA in the cervical region is roughly 71 percent and 80 percent in treating cervicogenic headaches (Menno, 2009). RFA has been proven as a reliable form of treatment for chronic pain, is minimally invasive, relatively safe and produces long term results.
- Arora R. (2005). Radiofrequency neuroablation in chronic low back pain. Practical Pain Management. March;18-20.
- Bayer E., Racz GB, Miles D., Heavner J. (2005). Sphenopalatine ganglion pulsed radiofrequency treatment in 30 patients suffering from chronic face and head pain. Pain Pract. 5(3):223-7.
- Bogduk N. (2004). Management of chronic low back pain. Med J Aust. 180(2):79-83.
- Boswell MV, Colson JD, Sehgal N, Dunbar EE, & Epter R. (2007). A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician. 10(1):229-53.
- Bunch TJ, Ellenbogen KA, Packer DL, & Asirvatham SJ. (2008). Vagus nerve injury after posterior atrial radiofrequency ablation. Heart Rhythm. 5(9):1327-30.
- Kawaguchi M, Hashizume K, Iwata T, & Furuya H. (2001). Percutaneous radiofrequency lesioning of sensory branches of the obturator and femoral nerves for the treatment of hip joint pain. Reg Anesth Pain Med. 26(6):576-81.
- Menno ES. (2009). Radiofrequency ablation in the management of spinal pain. Institute for Anesthesiology and Pain Treatment, Swiss Paraplegic Center. Retrieved May 20, 2012 from www.c2i2.org
- Murtagh J., Foerster V. (2006) Radiofrequency neurotomy for lumbar pain. Issues Emerg Health Technol. 83:1-4.
- Nagda JV, Davis CW, Bajwa ZH, & Simopoulos TT. (2011). Retrospective review of the efficacy and safety of repeated pulsed and continuous radiofrequency lesioning of the dorsal root ganglion/segmental nerve for lumbar radicular pain. Pain Physician. 14(4):371-6.
- Narouze S, Kapural L, Casanova J, & Mekhail N. (2009). Sphenopalatine ganglion radiofrequency ablation for the management of chronic cluster headache. Headache. 49(4):571-7.
- Soloman M, Mekhail MN, & Mekhail N. (2010). Radiofrequency treatment in chronic pain. Expert Rev Neurother. 10(3):469-74.
- Udupi BP, Chouhan RS, Dash HH, Bithal PK, & Prabhakar H. (2012). Comparative evaluation of percutaneous retrogasserian glycerol rhizolysis and radiofrequency thermocoagulation techniques in the management of trigeminal neuralgia. Neurosurgery. 70(2):407-12.
- Van Zundert J, Vanelderen P, Kessels A, & van Kleef M. (2012). Radiofrequency treatment of facet-related pain: evidence and controversies. Curr Pain Headache Rep. 16(1):19-25.