Radiofrequency Ablation for Back and Neck Pain
What is radiofrequency ablation?
Radiofrequency ablation (RFA), also known as radiofrequency neurotomy or radiofrequency rhizotomy, is a minimally invasive procedure that uses localized heat generated by radiofrequency waves to target specific tissues within the body. An RFA procedure is commonly used to target and disrupt the small medial branch nerves responsible for transmitting pain signals from facet joints, which are connections between bones in the spine. (This is sometimes referred to as nerve ablation.) It is performed to manage and reduce chronic neck or back pain arising from the cervical (neck) or lumbar (lower back) facet joints.
Is radiofrequency ablation the same as a nerve block?
RFA and nerve blocks are two distinct interventional pain management procedures used to alleviate chronic pain. They are both performed using needles and image guidance, but they differ in their mechanism and duration of relief.
RFA uses heat to disrupt a nerve’s ability to transmit pain signals. RFA is typically used for longer-lasting pain relief in cases where other treatments, such as medications, physical therapy, or nerve blocks, have been less effective.
Nerve blocks involve the injection of anesthetic or anti-inflammatory medications directly into or near the specific nerves responsible for transmitting pain signals which temporarily blocks the nerve's ability to send pain signals. Nerve blocks are typically used for diagnostic or short-term pain relief purposes. They help confirm the source of pain (diagnostic blocks) and provide temporary relief from conditions like acute pain, surgery-related pain, or flare-ups of chronic pain. The effect of a nerve block is often temporary.
The choice between RFA and nerve blocks depends on the specific pain condition, the expected duration of relief needed, and the diagnostic or therapeutic goals of the intervention. Healthcare providers can determine which approach is most suitable for a patient's individual case.
How does radiofrequency ablation work?
RFA uses energy from radiofrequency waves to create localized heat at the target nerve or tissue within the body. The elevated temperature generated by the radiofrequency energy is precisely controlled to target a specific area and avoid overheating surrounding healthy tissues.
This energy heats the target and and causes coagulation of the cells in the target area. In the case of pain management procedures, such as facet RFA, the heat disrupts the nerves responsible for transmitting pain signals. This disruption interrupts the pain signals and provides sustained relief to the patient.
Types of radiofrequency ablation
RFA can be categorized into different types based on the specific approach or energy delivery method used during the procedure. Three common variations of RFA are thermal RFA, cooled RF (cool RF), and pulsed RF. For pain management procedures including facet RFA, the primary approach used is thermal RFA. Cooled RF and Pulsed RF are not commonly used and are currently considered experimental in most cases.
Each type has unique characteristics and applications:
- Thermal radiofrequency ablation (thermal RFA) generates heat to create localized coagulative necrosis (cell death) in the target tissue. It involves the application of radiofrequency energy to heat the target tissue at a temperature of up to 80 degrees Celsius.
- Cooled radiofrequency ablation (cool RF) involves the use of a specialized electrode with cooling technology to prevent excessive tissue charring during the procedure. It still generates heat, but the cooling effect helps protect nearby tissues and allows for larger lesion sizes.
- Pulsed radiofrequency (pulse RF) delivers intermittent bursts or pulses of radiofrequency energy, rather than continuous heat. This approach aims to modulate pain signals without causing tissue damage or coagulative necrosis. It is considered "non-destructive." It is commonly used in pain management for trigeminal neuralgia, complex regional pain syndrome (CRPS), and neuropathic pain.
Each type of RFA has specific advantages and limitations, and the choice of which type to use depends on the medical condition being treated and the intended outcome. The decision is typically made by the healthcare provider or specialist based on the patient's needs and the potential benefits of each technique for a particular case.
What conditions does radiofrequency ablation treat?
Facet radiofrequency ablation is commonly used to treat chronic pain in your neck, back, or spine that is believed to originate from the facet joints. The facet joints are small, paired joints located on the back of the spinal column, and they can become a source of pain due to conditions such as arthritis, injury, or degenerative changes. Spine arthritis is medically known as spondylosis or facet arthropathy. Facet RFA can provide long-lasting pain relief when other treatments like medication, physical therapy, or injections have been less effective.
Who is a good candidate for radiofrequency ablation?
Facet RFA is an appropriate treatment option for patients experiencing persistent and chronic pain who have not adequately responded to at least three months of conservative treatments like medications, physical therapy, or other non-invasive interventions.
Candidates for facet RFA must undergo diagnostic tests, such as facet joint injections or medial branch blocks, to confirm that the facet joints are the source of their pain. If two separate diagnostic injections provide temporary relief, it suggests that facet RFA may be an effective treatment.
Facet RFA is a minimally invasive alternative to spine surgery. Patients who may not be good candidates for surgery due to underlying medical conditions, age, or other factors can often benefit from this procedure.
It's essential for patients to have a comprehensive discussion with their healthcare provider, including a pain specialist, to determine if facet RFA is a suitable treatment option for their specific condition. The decision to undergo RFA should be made in consultation with a healthcare team and consider an individual’s medical history and needs.
(Find a doctor at HSS who performs radiofrequency ablation.)
How is radiofrequency ablation performed?
RFA is a minimally invasive procedure, meaning that it is typically performed using needles via punctures in the skin, which results in less pain, shorter recovery times, and reduced risk compared to traditional open surgery.
During the procedure, you will be positioned on an examination table. Your vitals including your pulse, blood pressure, and electrocardiogram may be monitored to ensure your safety. Additionally, grounding pads are an essential component to ensure patient safety and prevent electrical burns or shocks during the procedure.
To precisely locate the target tissue and guide the procedure, imaging techniques such as ultrasound, X-ray, or fluoroscopy are often used. These imaging tools provide real-time visualization, ensuring that the procedure is accurately directed to the intended area.
The physician will use a local anesthetic to numb the area where the procedure will be performed. A specialized needle is then guided into the target area. Once in position, a radiofrequency electrode is inserted through the needle. At this time, the electrode can be used for nerve stimulation/testing to ensure the correct target is reached and increase safety of the procedure. Then, using the same electrode, radiofrequency energy is applied to disrupt the nerves responsible for pain signals.
Throughout the procedure, the healthcare provider closely monitors the temperature and progress to ensure that the treatment is effective and safe.
How do I prepare for a facet RFA procedure?
Your healthcare provider will provide specific instructions for your procedure depending on the specific treatment plan.
In general, you may be asked to stop taking certain medications and avoid food and drink for a specified period before the procedure. While usually not required, if you are having anxiolysis (minimal sedation which will leave you awake but very relaxed) or sedation for the procedure, you may be asked to arrange for someone to drive you home afterward.
You should wear comfortable clothing on the day of the procedure. Loose-fitting clothing that is easy to put on and take off is advisable, as you may be asked to change into a hospital gown.
It's important to maintain good hygiene before the procedure. Shower or bathe as usual, but avoid applying creams, lotions, or perfumes to the procedure area. Clean, dry skin is essential for aseptic technique during the procedure.
How painful is radiofrequency ablation? How long does it take? Will I be sedated?
The procedure itself is not painful and typically is completed in less than an hour. Local anesthesia is commonly used to numb the target area and sedation is not required in most cases.
Oral relaxation medications can be administered prior to the procedure for anxiolysis and your comfort. In some cases when significant anxiety or discomfort is anticipated, sedation may be used to keep you comfortable and relaxed. Requirement for sedation should be discussed with your doctor prior to the procedure.
Overall, you may feel some mild discomfort or pressure during the procedure, but it should not be painful. You may have some discomfort during the testing and stimulation part of the procedure.
What is the success rate of radiofrequency ablation?
Generally, facet RFA is considered a very effective treatment for many patients with facet joint-related pain. Since diagnostic blocks (medial branch blocks) are completed prior to RFA procedures to confirm the cause and location of pain generator, facet RFA procedures typically have high success rates.
The success rate of facet radiofrequency ablation (facet RFA) can vary depending on several factors, including the patient's specific condition, the healthcare provider's expertise, and the individual patient's response to the procedure.
Success may also depend on the patient's adherence to post-procedure care, rehabilitation, and follow-up appointments. These factors can affect the longevity of pain relief.
How long does pain relief from radiofrequency ablation last?
The duration of pain relief from radiofrequency ablation varies from person to person, but many patients experience relief that lasts for several months to a year or more. Some individuals may need periodic repeat procedures to maintain pain relief.
How long does it take to recover from radiofrequency ablation? When can I return to exercise?
After facet RFA, you may experience some mild discomfort or soreness at the injection site for a few days. You can usually return to your normal activities within a day or two. Pain relief may not be immediate and can take a week or more to become noticeable as the nerves need time to heal and stop transmitting pain signals.
What are the side effects and potential risks of radiofrequency ablation?
Facet RFA is generally considered safe, but, like any medical procedure, it carries some risks. Potential side effects include temporary discomfort, bruising, or infection at the injection site. More serious complications are rare but may include nerve damage or allergic reactions.
How often can you have radiofrequency ablation?
In most cases, the minimum recommended time interval between facet RFA procedures to allow for the healing of nerves and tissues is usually six months.
The frequency of facet RFA may be determined by the duration of pain relief achieved after each procedure. The need for repeat procedures is typically based on when the pain returns or becomes problematic again. Some patients may find that a single RFA procedure provides long-term relief for several years.
Are there alternatives to facet RFA for pain management?
Yes, there are alternative treatments for pain management, such as physical therapy, medications, and other interventional procedures, such as facet blocks, peripheral nerve stimulation, and spinal fusion surgery. Your healthcare provider will help determine the most appropriate treatment plan based on your condition and medical history.
How can I know if facet RFA is right for me?
Your healthcare provider will evaluate your condition, conduct diagnostic tests, and discuss your medical history with you to determine if facet RFA is a suitable option. It's essential to have a thorough discussion with your healthcare team to make an informed decision about your pain management.
What type of doctor performs radiofrequency ablation?
Facet radiofrequency ablation (facet RFA) is typically performed by medical specialists who are trained in interventional pain management including:
When seeking a healthcare provider to perform facet RFA, it is essential to ensure that they have the necessary training, experience, and credentials to perform the procedure safely and effectively. You may be referred to a pain management specialist or interventional pain physician by your primary care physician, orthopedic specialist, or other healthcare providers when facet RFA is considered an appropriate treatment for chronic pain related to the facet joints.
If you’re ready to get help for your painful injury or condition, book an appointment with one of our pain management physicians.
Posted: 12/11/2023
Authors
Assistant Attending Anesthesiologist, Hospital for Special Surgery
Clinical Instructor in Anesthesiology, Weill Cornell Medical College