Radiofrequency (RF) treatment is a minimally invasive procedure that can provide intermediate to long-term pain reduction from various types of chronic pain.
Radiofrequency neurotomy creates a heat lesion on certain nerves, with the goal of interrupting the pain signals to the brain, thereby eliminating pain. It provides longer lasting relief to those suffering from facet joint or sacroiliac joint pain compared to cortisone injection. If you have had pain relief with a test block, you may be a candidate for radiofrequency neurotomy.
Specialised equipment generates heat that is then focused onto specific nerves and temporarily interrupts their ability to transmit pain signals. This heat is delivered to the targeted nerves via needles inserted through the skin around your spine. The procedure is performed under sedation.
It is performed on any part of the spine that causes you pain. This includes:
- Cervical facet joints
- Lumbar facet joints
- Sacroiliac joints
- Thoracic facet joints
Pulsed radiofrequency (pRF)
Pulsed radiofrequency (pRF) is unique in that it provides pain relief without causing significant damage to nerve tissue.
Pulsed radiofrequency (pRF) uses slightly lower temperature of heat on more delicate nerves to provide long-lasting pain relief.
The procedure can be performed on any nerve that causes pain. These nerves includes:
- Dorsal root ganglion (DRG) for arm and leg pain
- Genicular nerves for knee pain
- Greater and lesser occipital nerves for occipital headache
- IIlioinguinal nerve for groin pain
- Intercostal nerve for chest pain
- Lumbar sympathetic for leg pain
- Sphenopalantine ganglion for facial pain or trigeminal neuralgia
- Stellate ganglion for facial and arm pain
- Splanchnic plexus for abdominal pain
- Suprascapular nerve for shoulder pain
Frequently asked questions about Radio Frequency (RF)
What is radiofrequency (RF) lesioning?
Radiofrequency (RF) lesioning is a procedure in which special needles are used to create lesions along selected nerves. The needles heat the nerve to 80°c (about the temperature of hot, not boiling, water). When this heat is applied to the nerve for about 2-3 minutes, the nerve stops carrying pain signals. The body tends to try to regrow nerves that are blocked in this manner but that process can take up to a year or longer.
Am I a candidate for radiofrequency (RF)?
Radiofrequency (RF) is offered to patients with certain types of low back or neck pain (predominantly pain from the facet joints). You must have responded well to diagnostic local anesthetic blocks to be a candidate for RF lesioning. The effectiveness of RF lesioning will depend on how well you respond to the “temporary” or diagnostic block.
What are the benefits of radiofrequency (RF)?
The procedure disrupts nerve conductions (such as conduction of pain signals) to reduce pain and other related symptoms. Approximately 70-80% of patients will get a good block of the intended nerve. This should help relieve that part of the pain that the blocked nerve controls. Sometimes after a nerve is blocked, it becomes clear that there is pain from other areas as well.
How long does the procedure take?
Depending on the areas to be treated, the procedure can take from about 30 minutes to an hour.
How is it actually performed?
Since nerves cannot be seen on x-ray, the needles are positioned using bony landmarks that indicate where the nerves usually are. Fluoroscopy (x-ray) is used to identify those bony landmarks. After needle placement, extremely low voltages are applied to the needle to test for proper placement. After confirmation of the needle tip position, a small amount of local anesthetic is injected. After the nerve is sufficiently numbed, higher radiofrequency (RF) voltages are applied and the nerve is heated to the desired temperature.
Will I “be asleep” for this procedure?
This choice is yours. You can choose to have the procedure done under local anesthetic only. Although the majority of procedures are usually performed under sedation; which can be more comfortable.
It can range from some drowsiness or you may have little or no memory of the procedure. Regardless of the amount of sedation, you must not eat or drink anything for 6 hours prior. However, during this time it is ok to take your medications as usual with a sip of water. When choosing sedation you must have someone drive you home.
What should I expect after the procedure?
After recovery from the sedation, you should have someone drive you home. There will be some muscle soreness that may persist for up to a week. Application of ice packs will help. Your doctor will also discuss with you any medications you can take to help with the post-procedure discomfort. Although most patients experience significant relief within a week, it can sometimes take up to 3-4 weeks.
Can I go to work to work the next day?
You should be able to return to work the next day. Soreness at the injection site may cause you to be off work for a day or two.
How long will the effects of the procedure last?
If successful, the effects of the procedure can last from 9-18 months.
How many procedures do I need to have?
Your doctor will evaluate this on subsequent visits. Keep in mind that although this is a “permanent” procedure, the body tends to re-grow these nerves over time. You may need to have it repeated in the future.
What are the risks and side effects?
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and the possibility of complications. The risks and complications are dependent upon the sites that are lesioned. Any time there is an injection through the skin, there is a risk of infection. This is why sterile conditions are used for these blocks. The needles have to go through skin and soft tissues, which will cause soreness. The nerves to be lesioned may be near blood vessels or other nerves which can be potentially damaged. Great care is taken when placing the radio frequency needles, but there is a rare risk of complications. Your doctor will discuss all of the risks prior to the procedure.
Who should not have this procedure?
The following patients should not have this injection: if you are allergic to any of the medications to be injected, if you are on a blood-thinning medication (e.g. warfarin, injectable heparin), or if you have an active infection going on. Your doctor may advise you to stop taking blood thinners like warfarin for 4-7 days beforehand. Anti-platelet drugs like plavix may have to be stopped for 5-10 days prior to the procedure.