This procedure may help your chronic pain

A treatment that uses radio waves might help relieve your chronic back or neck pain.

Radiofrequency ablation (RFA) is a medical procedure that uses medium-frequency alternating electrical current to destroy tissue – a technique known as ablation. In chronic pain management, doctors use it to interrupt the pain signals being sent from a troublesome nerve to the brain.

RFA is not appropriate for all chronic pain but it can help some patients, said Adam Brown, DO, the director of the Falmouth Hospital Pain Center. In some types of chronic pain, radiofrequency ablation can temporarily disable nerve fibers that are carrying the pain signal through the spinal cord to the brain, he said.

“In the right patients, about 70 percent of RFA procedures provide pain relief that lasts for six months to a year, or possibly longer,” he said. “The technique may be useful for some people living with chronic arthritis or degenerative back and neck pain that is caused by spine joint arthritis, as well as some types of nerve pain.”

Dr. Brown recently answered some questions about RFA and how it might help those with chronic pain. His replies have been edited for length.

Who might qualify for RFA treatment for chronic pain?

The basic gist is that the chronic pain needs to have been difficult to treat with other methods, such as physical therapy or over-the-counter medications, and is severe enough to negatively impact a person’s daily life.

Common uses for RFA would be for chronic pain related to spinal arthritis involving the neck and the mid- and lower-back.

It can also be used for pain stemming from nerves that run along our ribs, abdominal pain following abdominal surgery, and knee or hip arthritis. However, in the case of knee or hip pain from arthritis, orthopedic options such as joint replacement are far superior to RFA treatment. RFA is most often tried if the person either can’t have surgery or they have had joint replacement surgery and their pain relief was not sufficient.

The most common use of RFA for chronic pain is for pain stemming from spinal arthritis. In this situation, the patient first receives an initial diagnostic nerve block. If the patient gets significant pain reduction from that, they would undergo the RFA procedure at the same site in order to provide similar pain relief for a much longer period of time.

What’s the experience like for the patient?

The procedure is similar to a needle biopsy. It involves inserting a needle-like probe or electrode into the body using imaging guidance such as X-ray or ultrasound. Radiofrequency waves are sent out from the probe into the surrounding tissue, which causes the nearby cells to die.

Most often the procedure is performed under local anesthetic only, without sedation, although in some cases and with some providers, light sedation is sometimes used.

Depending upon the body part, the patient may be positioned face down, on their back, sitting up, or on their side. The patient only needs to get undressed enough to allow access to the treatment area. Usually, the site only requires small Band-Aids or bandages after the procedure.

RFA is most often performed in an outpatient surgery center or in a hospital. Most patients walk out of the procedure room, are evaluated and monitored by post-procedure nurses for 30 or so minutes, and then go home.

Is the RFA procedure painful?

Any procedure that involves needles is going to involve some degree of pain, but after having performed literally hundreds of RFA procedures, my experience is that the pain varies considerably from patient to patient.

Typically, the worst part of the RFA procedure is the numbing medication injections, using a local anesthetic medication such as Lidocaine. The pain from a Lidocaine injection lasts approximately 10 seconds, and then the region is mostly numb or desensitized.

After the numbing medicine wears off, patients can experience “heat” or other discomfort at the sites where needles were inserted. Ice and over-the-counter pain medications can help.

Is this RFA a one-time thing or does it require multiple visits for chronic pain?  

There is no procedure – and that includes surgery to address chronic pain – that is 100 percent successful. Even surgical chronic pain techniques might mean that a person would need further treatment.

The pain reduction from RFA is not typically 100 percent, but is often very significant (75 percent or more). However, it is not permanent. The relief from spinal RFA can last from six months to two years, although it’s usually eight to 12 months.

As long as it is effective in significantly reducing the patient’s chronic pain, and there are no reasons not to repeat, then RFA can be repeated multiple times.

What are the risks of RFA?

The RFA procedure is extremely safe, but like any medical procedure, there are some risks. These include bleeding, infection, worsened pain, and nerve damage. However, these complications are very rare, and the vast majority of people do not experience any problems after RFA.