What is Radiofrequency Ablation and how does it stop pain?
According to the CDC roughly 58% of adults experienced pain in the last 3 months. Of that 58% of patients, 39% of patients report pain being in the back and 36.5% report pain being in the lower limb. Back pain can be a challenging entity to treat because of the complexity of the anatomy of the back. The back is divided into several distinct regions when evaluating a patient. These regions are neck (cervical spine), midback (thoracic spine), low back (lumbar spine). What makes treatment of back pain so complex is the fact that each region has its own set of nerves, soft tissue including muscles and ligaments, and other supporting structures that can contribute to pain in each region. Due to this complexity, an evaluation by an expert is required to help define where the pain may be originating. Here at M.I.S.S. we are experts in both treatment and diagnosis of spine pain conditions. Evaluation can include X-ray, MRI, CT scan, or EMG in addition to clinical evaluation. If pain is deemed to be of bony origin, most cases the facet joints, then an algorithm of treatment is used to help the patient.
Facet joints are small joints found at each level of the spine, except the parts of the sacrum and coccyx. These joints can be likened to the knee joint as they have supporting ligaments and joint capsules. Just like the knee, these facet joints can be sources of pain once arthritis starts to affect the joint. Facet pain can be characterized by local tenderness over the area, with sharp or dull qualities. This pain can be worsened with movement such as turning the head, if there is cervical arthritis, or prolonged standing and walking, if there is lumbar arthritis. However, facet joint pain can also be felt further away from the joints. For example, upper cervical facet joint pain is well documented to be a cause of headaches, referred to as cervicogenic headaches. Other cervical facet joint pain can refer pain to the upper shoulder and around the shoulder blade. Low back pain can be felt not only in the back but can also sometimes cause leg pain or buttock pain. This variance of presentation is primary reason why expert evaluation is required.
Once a diagnosis of facet joint pain is given, the treatment begins. Treatment normally begins with conservative measures such as oral medications, (for example, anti-inflammatories), then followed by physical therapy, chiropractic care, massage therapy, or acupuncture. When these techniques fail to provide adequate pain relief, we at M.I.S.S. use our expertise in spine care to provide targeted treatment to the painful joints.
The gold standard approach to treating facet driven pain is by use of a technique known as radiofrequency ablation. This procedure has been in existence for nearly 50 years. (Shealy, 1975) This technique targets the small nerve fibers known as medial branches that run to the facet joints and take pain signals back to the spinal cord and brain. This technique uses energy to heat up molecules to burn the small nerve fibers that cause joint pain but is very precise and does not interfere with the function of the nerves that control strength and sensation. This technique is effective and provides longer pain relief (up to 1 year or more) than conventional treatments. (Lee, Chung, & Kim, 2017). This procedure is performed under X-ray guidance and utilizes no steroids.
In order to qualify for radiofrequency ablation, a patient must undergo a diagnostic medial branch block (DMBB) of the target nerves. This procedure is also done under X-ray guidance without steroid. The goal of this procedure is to ensure that the right area of pain is treated. During the course of this treatment a patient is injected with numbing agent at the target level and allowed to return to their daily activity to “test” how it would feel with the area treated for pain by a more permanent technique. By undergoing DMBB the patient and the physician both are assured that the correct procedure is performed for the right area of pain. With careful patient selection and expert procedural practice, M.I.S.S. is able to help decrease back pain and get patients moving in the right direction with radiofrequency ablation and many other spinal interventions.
Works cited:
CDC.gov. (2021, July). Back, Lower Limb, and Upper Limb Pain Among U.S. Adults, 2019. Retrieved from cdc.gov: https://www.cdc.gov/nchs/products/databriefs/db415.htm
Lee, C., Chung, C., & Kim, C. (2017). The efficacy of conventional radiofrequency denervation in patients with chronic low back pain originating from the facet joints: a meta analysis of randomized controlled trials. The Spine Journal, 1770-1780.
Shealy, C. (1975). Percutaneous radiofrequency denervation of spinal facets. Treatment of chronic back pain and sciatica. . Journal of Neurosurgery, 448-451.
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