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Radiofrequency Ablation (RFA)

If you suffer from neck pain, mid-back pain, low back pain, neuropathy, headaches or joint pain, this truly revolutionary treatment can help you.

What is RFA?

Radiofrequency ablation uses a special type of needle to apply radio waves to a painful nerve, in turn “stunning” it and relieving the pain. The procedure is referred to by many names: RF, RFA, rhizotomy, and neurotomy. There are several different types of Radiofrequency Ablation:

  • Thermal or Conventional RFA: A radiofrequency current is created which causes energy to pool in the tissue. This energy converts into heat which creates a small lesion on the nerve rendering it unable to transmit painful signals.
  • Pulsed RFA: Similar to thermal, however, a higher voltage is used in a pulsing fashion, allowing the energy to dissipate more easily and less heat to generate. This particular type of RFA leaves the nerve intact, while selectively “shocking” the A-delta and C fiber (pain conductors).
  • Water-Cooled or Cooled RFA: Using a multi-channel electrode that is actively cooled by a continuous flow of water, the radiofrequency current is prevented from reaching temperatures as high as thermal/conventional. This effectively creates a larger and more complete lesion.[1]

    The Ainsworth Institute is unique in that we offer all three types of Radiofrequency Ablation and are one of only a handful of practices in the Tri-State area offering the groundbreaking Cooled RF technology.

RFA has been used to treat pain since the 1970’s.[2]  The pain relief from RFA can be life changing. In many cases, patients are able to successfully avoid or prolong the need for surgery. The goal of the RFA procedure is to interrupt communication of pain to the brain.

Indications

Radiofrequency Ablation (RFA) is a viable option for chronic pain of many kinds. This procedure can be used to treat a variety of types of conditions throughout the body.

Learn More About the Facet Joints of the Spine

The most common application for Radiofrequency Ablation (RFA) is to treat neck and back pain. Typically, neck (cervical spine) and the low back (lumbar spine) pain is generated by the facet joint. The target in these cases is a small nerve called medial branch of the posterior ramus. This nerve communicates pain from the facet joint to the brain. When RFA is performed on the medial branches, facet joint pain and related symptoms in the neck and back will resolve.

Radiofrequency Ablation RFA IconBefore proceeding with RFA, your pain-generator needs to be identified. This is typically accomplished by performing a diagnostic block – your physician will inject a small amount of local anesthetic into the suspected area. If the correct nerve and/or area are injected, the pain signals will be blocked and there will be a period of relief. Shortly after, the medication will wear off and the pain will return. Now that the pain-generator has been identified, your physician can plan a RFA treatment of the area.

In the case of neck and low back pain, the diagnostic injection will be a facet joint or medial branch block. Since the medial branch nerves do not control neck or low back muscles, it is not harmful to disrupt or turn off their ability to send signals to the brain.

How Many Treatments Will I Need?

In most cases, a single treatment with Radiofrequency Ablation will last anywhere from 8 to 12 months.

When Will I Feel Better?

The positive effects of Radiofrequency Ablation can be felt in as soon as 2 to 3 days after the treatment.

Is Radiofrequency Ablation Right for Me?

Radiofrequency therapy is a targeted procedure of precision that works by using radiofrequency technology (mild electrical current) to prevent nerves from transmitting painful signals. This remarkable procedure has been proven to treat pain of all kinds, ranging from neck and back pain to cancer and neuropathic pain. The relief from pain and related symptoms may last a year or longer.  

Discussing Radiofrequency AblationBecause the procedure relies on fluoroscopy, a type of video X-ray that projects X-ray images onto monitors in the procedure room, our doctors can extensively visualize structures under the skin without making a single incision. In fact, many surgeons will refer patients for RFA before considering surgery due to the fact that the results are comparable to surgical intervention while avoiding the potential complications of an open procedure.

The procedure can also be performed at several areas at the same time or within just a few days of each other. As it pertains to the neck and back, RFA can be done at 2-3 spinal levels in one appointment.

The advantages of RFA are rooted in the premise that your physician can treat a painful area of the body and render it painless with out a single incision. The overall benefits of RFA include:

Avoid surgery
Immediate pain relief
Little to no recovery time
Decreased need for pain medications
Improved function
Quicker return to work and other activities

Contact the Ainsworth Institute to set up an initial evaluation to find out if you are a candidate for Radiofrequency Ablation.

Procedure - Patient Details

Once the appropriate pain generator has been identified, your doctor will schedule you for RFA. This treatment can be done as an outpatient right in your doctor’s office. The treatment is typically performed under local anesthesia, although IV sedation can be given if needed.

Before starting, your skin will be thoroughly cleaned with sterile soap to minimize the risk of infection. The skin and the underlying tissue are then anesthetized for comfort. Once everything is numb, a small, thin needle is inserted through the skin toward the target, under radiographic guidance. In most cases, your physician will use Fluoroscopy (a real time X-ray that will your physician to see the needle the entire way under the skin) to place the needle, although Ultrasound can also be used.

Once the needle tip is in the correct position, a hair-thin electrode will be placed within the needle. To further confirm the needle is in the correct position, your physician will “test” the electrode by stimulating the nerves and muscles in the immediate area.

 Sensory Testing: A special signal that will selectively stimulate sensory nerves to make sure there are no nerves nearby that transmit sensation in the arms or legs.

•  Motor Testing: A completely different signal that will selectively stimulate motor nerves to make sure there are no nerves nearby that are responsible for moving the arms or legs.

Once the testing is finished and your doctor has made sure the needle is safely away from any sensory or motor nerves, local anesthetic will be injected through the needle to make the area completely numb. Shortly thereafter, the electrode will be activated and radio waves will be transmitted. This portion takes about 1–2 minutes to complete.

Once the radio waves are finished, the needle and electrode are both removed and a small Band-Aid is placed. The whole procedure will take approximately 10–20 minutes.

Your physician’s office will typically call you 24 to 48 hours after the procedure to check up and see how you are doing. In some cases, you may be asked to keep a pain journal with your symptoms and activities. Such journals can be of great value in fine-tuning therapy if they describe symptoms in relationship to the injection site.

Risk Factors

RFA, like any other medical procedure, carries with it certain inherent risks. There is a rare but potential risk of bleeding or infection. Most patients tolerate the procedure without complaint, however some report some mild soreness and/or spasm in the area of the procedure; these are both easily controlled with medication which your doctor will likely prescribe to you upon discharge as a precaution. There is also a theoretical risk of numbness or weakness – these would be the result of a misplaced needle. By using radiographic guidance and performing sensory/motor testing before commencing application of the radio waves, our doctors can ensure proper placement and safe distance from major nerves to avoid these possibilities.

Neuritis is another rare but potential side effect whereby the skin near the area of the procedure becomes irritated and overly sensitive for a short period of time. Recent studies have suggested this can be effectively treated or even avoided with small doses of gabapentin. Low blood pressure, headache and allergic reaction are also possible risks.

To discuss the risks and benefits relating to your specific case, schedule and appointment to speak with one of our doctors in person.

Evidence of Performance

Radiofrequency therapy is an extraordinary treatment option that has been around for decades. There is no shortage of evidence supporting its application to a variety of different types of pain throughout the body.

Back Pain: For all intents and purposes, the most common diagnosis seen with the use of RFA is back pain, and as a result it is the most widely studied application for this unique therapy. There are an abundance of studies reporting an overwhelming amount of success when used properly for the treatment of back pain. The culprit in most cases is the facet joint (facet-mediated pain or facet syndrome).[3] Fortunately, the nerve responsible for transmitting pain from a facet joint (medial branch of the posterior ramus) is easily accessible for treatment with RFA.[4] Your physician will first elect to perform a diagnostic block of the medial branch (lumbar medial branch block) to confirm that the facet is cause of the pain and to further determine which facet(s) is/are responsible.

In a study by Van Kleef and colleagues in 1999, 31 patients with positive responses to diagnostic medial branch blocks in the lumbar spine where randomized into 2 groups: RFA and sham treatments. The patients who received RFA as the treatment reported greater than 50% reduction in their low back pain at 12 months.[5]  In a more recent study in 2007, 60 patients were treated with thermal RFA, pulsed RFA, and sham. The patients were evaluated at 6 and 12 months. Those treated with RFA showed significant pain relief and functional improvement.[6]

Most studies show the relief from RFA for back pain will range from 6 months to 1 year.[7]

Neck Pain: The second most common reason for RFA is neck pain. Much like back pain, the widespread prevalence of this diagnosis and subsequent treatment with RFA has lead to a great deal of research on the topic. As in back pain, facets are typically the cause and the medial branches are also subsequent target. A diagnostic cervical medial branch block will precede cervical RFA to determine which facets are the cause. In a study by Lord in 1996, patients with facet-mediated pain in the neck were treated with RF neurotomy and reported significant pain relief up to 27 months after.[6]

Knee Pain: Using RFA for knee pain (Genicular Neurotomy) is currently one of the hottest topics in Pain Management and Orthopedics. Currently, RFA is being used for pain after knee replacements and on patients with chronic knee pain who are not candidates for surgery. In 2011, Choi et al published the results of a double-blind randomized controlled trial on the use of radiofrequency treatment on chronic knee osteoarthritis pain.[8] Those receiving RF reported greater than 50% pain relief after treatment at 12 weeks along with improved function.

Headaches and Occipital Neuralgia: Despite the wide prevalence of headaches, many patients and their physicians still struggle to find adequate treatments to treat the pain and decrease the frequency. Studies have shown a great number of headaches originate from the neck (cervicogenic headaches)[9] and/or a nerve originating at the base of the skull called the Greater Occipital Nerve (Occipital Neuralgia).[10] By utilizing RFA, your physician can decrease the pain and frequency of these types of headaches in just a handful of visits.[11],[12]  In a study by Stovner in 2004, patients with headaches suspected to originate from the neck and the greater occipital nerve were treated with RFA. Those treated with RFA reported significant relief at 3 months.[13]

Facial Pain and Trigeminal Neuralgia: RFA can be safely used on the trigeminal ganglion, gausserian ganglion, sphenopalatine ganglion and the stellate ganglion to treat chronic facial pain and trigeminal neuralgia (tic douloureux). In a study by Chen in 2001, patients with trigeminal neuralgia were treated with RF thermo-coagulation. The authors reported 92.5% of the patients had good to excellent pain relief.[14]

Sciatica: In rare cases, sciatica will fail to respond to conventional treatment and injections. In these instances, RFA (more specifically pulsed RFA) can offer a safe alternative to surgery. In study published in 2008, 76 patients lumbar radiculopathy were enrolled in a randomized controlled trial (RCT). Those treated with RFA reported significant improvement at 2 months post-procedure.[15]

Disc-related (Disogenic) Pain: The search for a proper treatment of discogenic pain dates back to the 1990’s. There have been several options which have come and gone in that time – all of which relied on some sort of radiofrequency technology. Fortunately, the most recently developed treatment option also appears to offer the most promising results – Biaculoplasty. Relying on intradiscal bipolar water-cooled radiofrequency technology (Cooled RF TransDiscal System Baylis Medical Company, Montreal, Canada), your physician can take a herniated disc or annular tear and render it completely painless. This procedure was extensively studied the Cleveland Clinic by some of the most esteemed names in the field. One such study reported pain relief of greater than 50% at 12 months with no complications.[16]

Sacroiliitis: Ferrante first reported the use of RF treatment on sacroiliac pain in 2001.[17] Since that time, there has been a considerable amount of data on the use of RFA for the treatment of sacroiliitis. By targeting the lateral branches of the primary dorsal rami, doctors have been able to decrease and even eliminate pain from the sacroiliac joint. Most studies report pain relief in over 60% of patients for at least 6 months post-procedure.[18]  Most recently, Cohen and colleagues studied the use of cooled RF technology for treating sacroiliitis using the Sinergy System™ (Kimberly Clark Health Care). The authors showed superior results (64% reporting pain relief) to conventional RFA methods as well as a decrease in overall procedural time.[19]

The Ainsworth Institute of Pain Management is proud to offer the Sinergy System™.

Pelvic Pain: The use of RF neurolysis on chronic pelvic pain has been poorly studied and there is a paucity of data regarding the subject. Anecdotally, our physicians have use pulsed RF on a handful of nerves known to contribute to pelvic pain (ganglion of impar, ilioinguinal nerve, iliohypogastric nerve and pudendal nerve) and our patients have reported good pain relief after the treatments.

The Ainsworth Institute is Here to Help

If you are suffering from chronic pain and would like to see if you may be a candidate for this exciting treatment option, contact the Ainsworth Institute of Pain Management today. Schedule an appointment with one of our Board Certified Physicians to learn more about radiofrequency therapy and see if you are a candidate for one of these state of the art treatments.

References

[1] Benzon, Honorio. Essentials of Pain Medicine. Philadelphia: Saunders Elsevier, 2011. Print

[2] Shealy CN: Percutaneous radiofrequency denervation of spinal facets. Treatment for chronic back pain and sciatica J Neurosurg. 1975; 43:448-451.

[3] Lord SM, Barnsley L, Wallis BJ, et al.: Chronic cervical zygapophysial joint pain after whiplash. A placebo-controlled prevalence study. Spine. 21:1737-1744 1996 discussion 1744–1745.

[4] Brummett CM, Cohen SP: Facet blocks, facet joint injections, medial branch blocks, rhizotomy. Benzon HT Rathmell JP Wu CL Turk DC Argoff CE Raj’s Practical Management of Pain. ed 4 2006 Mosby New York 1003-1037

[5] van Kleef M, Barendse GA, Kessels A, et al.: Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine. 1999; 24:1937-1942.

[6] Tekin I, Mirzai H, Ok G, et al.: A comparison of conventional and pulsed radiofrequency denervation in the treatment of chronic facet joint pain. Clin J Pain. 2007; 23 (6):524-529.

[7] Lord SM, Barnsley L, Wallis BJ, et al.: Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med. 1996; 335:1721-1726.

[8] Choi WJ, Hwang SJ, Song JG, et al. Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial. Pain. 2011; 152: 481-7.

[9] van Suijlekom JA, Weber WE, van Kleef M: Cervicogenic headache. techniques of diagnostic nerve blocks Clin Exp Rheumatol. 2000; 18:S39-S44.

[10] Anthony M: Headache and the greater occipital nerve. Clin Neurol Neurosurg. 1992; 94:297-301.

[11] Silverman SB: Cervicogenic headache. interventional, anesthetic, and ablative treatment Curr Pain Headache Rep. 2002; 6:308-314.

[12] Bovim G, Fredriksen TA, Stolt-Nielsen A, Sjaastad O: Neurolysis of the greater occipital nerve in cervicogenic headache. A follow-up study. Headache. 1992; 32:175-179.

[13] Stovner LJ, Kolstad F, Helde G: Radiofrequency denervation of facet joints C2–C6 in cervicogenic headache. a randomized, double-blind, sham-controlled study Cephalalgia. 2004; 24:821-830.

[14] Chen Z, Zhao Z, Li M, et al. Clinical significance of trigeminal neuralgia treated using radiofrequency thermocoagulation (RFT) with different approaches [Article in Chinese] 2001 Aug;19(4):240-2.

[15] Simopoulos TT, Kraemer J, Nagda JV, et al.: Response to pulsed and continuous radiofrequency lesioning of the dorsal root ganglion and segmental nerves in patients with chronic lumbar radicular pain. Pain Physician. 2008; 11:137-144.

[16] Kapural L: Letter to editor intervertebral disk cooled bipolar radiofrequency (intradiscal biacuplasty) for the treatment of lumbar diskogenic pain. a 12-month follow-up of the pilot study Pain Medicine. 2008; 9:407-408.

[17] Ferrante FM, King LF, Roche EA, et al.: Radiofrequency sacroiliac joint denervation for sacroiliac syndrome. Reg Anesth Pain Med. 2001; 26:137-142.

[18] Cohen SP, Abdi S: Lateral branch blocks as a treatment for sacroiliac joint pain. a pilot study Reg Anesth Pain Med. 2003; 28:113-119.

[19] Cohen, S., Hurley, R., Buckenmaier, C., Kurihara, C., Morlando, B., Dragovich, A., Randomized placebo-controlled study evaluating lateral branch radiofrequency denervation for sacroiliac joint pain. Anesthesiology, 2008; 109: 279-287.

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