Radiofrequency Ablation: How It Works for Pain Relief
Radiofrequency Ablation (also called RFA, radiofrequency neurotomy, radiofrequency nerve lesioning, or facet rhizotomy) is a great treatment option for certain types of back pain, neck pain, whiplash pain, and even headache. It is a minimally-invasive procedure that takes only minutes but provides months to years of lasting pain relief. Instead of using short-lasting medication, radiofrequency ablation works by thermal energy, creating a long-lasting block of chronic pain from some painful regions of the spine. For safety reasons, this treatment option is only offered by pain management doctors with extensive training in the use of real-time X-rays (fluoroscopy) for safe placement of radiofrequency probes near the spine. X-rays allow me to precisely guide thin needles onto specific nerves, enabling me to target radiofrequency energy to pain generators without affecting nearby nerves or other parts of the spine. These procedures are done comfortably with local anesthetic to numb the skin and nerves before treatment, and most patients require little to no sedation.
Radiofrequency Ablation for Back Pain
RFA is a proven and effective treatment for a specific kind of back pain called “facet joint pain.” The medical term for these joints is zygapophysial joints, but most doctors call them facet joints because it is easier to pronounce and spell! Each level of the spine has two facet joints, left and right, which connect the vertebrae to each other on the back side of the spine. In some cases of chronic low back pain, inflammation in these joints is the underlying cause. Some people describe this pain as an aching band that spreads across the low back. Sometimes it is more severe on one side than the other, and it can even mimic sciatica pain by radiating down a leg. Many doctors have difficulty making the diagnosis of facet joint pain, and although X-rays and MRI scans can give clues, they are not enough to pinpoint facet joint pain. For this reason, when I suspect that low back pain or sciatica pain symptoms are coming from an inflamed facet joint, I do a procedure called a Medial Branch Block, where I numb the nerves from specific facet joints with local anesthetic, to see if this blocks the pain temporarily. This is the gold standard for diagnosing facet joint pain, and like RFA, requires special training to perform.
Many patients ask me if there are any good permanent treatments for facet joint problems. Unfortunately, surgery is generally not an option for this kind of pain. In some cases I can inject steroid medication into these joints, but this only provides 2-3 months of relief in most cases. Fortunately, radiofrequency ablation works well, is minimally invasive, and usually lasts for at least 6 to 12 months. In the case of low back pain, I target medial branch nerves of the lumbar spine with radiofrequency energy. For mid to upper back pain, I can target similar nerves of the thoracic spine. If pain returns, the procedure can be safely repeated many times, on an as-needed basis.
Besides facet joint pain, RFA can also be an effective treatment for difficult sacroiliac pain, which is a different cause of low back pain and buttock pain. Like facet pain, sacroiliac pain can also mimic sciatica. Although sacroiliac joint pain often responds well to steroid injections, another option is to use RFA to treat the nerves that transmit sacroiliac pain. Like facet joint RFA, it can last for months to years.
Radiofrequency Ablation for Neck Pain and Headache
Just as facet joints are a common source of back pain, they are often an underlying cause of neck pain. After whiplash from a car accident, it is common to see neck pain stemming from irritation of these joints. However, it is also common in people without a history of trauma. In the neck I take great care when I perform these procedures, using generous local anesthetic and special radiofrequency needles that are as thin as those used for IVs in babies. Radiofrequency ablation for neck pain and whiplash pain has been such a breakthrough that the first study proving its effectiveness was published in the New England Journal of Medicine, which is the most prestigious journal in medicine. It is very rare for any pain treatment to be considered important enough for publication in this journal, which limits itself to the most important discoveries in all medical specialties.
Sometimes a cervical facet joint can also cause severe headaches. These are called cervicogenic headaches, meaning that the headaches originate in the neck. Again, it is a common cause of whiplash related headaches, although it also happens without whiplash. The reason why facet joints can cause severe headaches is that there is a nerve called the Third Occipital Nerve which goes to the C2-C3 cervical facet joint, but also travels high up to the head. You have two of these nerves, one on each side. I have highlighted in green on this diagram from Gray’s Anatomy of the upper neck and back of the head how the nerve wraps around the facet joint before shooting up to the head. Radiofrequency ablation is the best treatment option because I can directly treat this irritated nerve for long-lasting headache relief.
Will RFA Help Me?
As mentioned above, radiofrequency ablation only works for low back pain or neck pain if the cause of the pain is facet joints, sacroiliac joints, or the third occipital nerve. This diagnosis is difficult to make, but as a pain management doctor I am very experienced at identifying these underlying problems. Radiofrequency ablation has changed many lives and I hope to be able to offer it to you.