Radiofrequency Ablation

Radiofrequency ablation is an exciting technique used in interventional pain management.  In this post, I am going to explain how it works, what it is used for, and what you might expect from a radiofrequency ablation or RFA.

Nerve blocks are common procedures for pain management, and they involve targeting a nerve with a needle, and then injecting numbing medication to the area. Sometimes we will use steroid along with the numbing medication to try to prolong the numbing effects, but unfortunately, even with the steroid, many times the results are temporary and limited.  A technique that can make the pain relief last longer is called radiofrequency ablation.

The idea behind radiofrequency ablation is that instead of using numbing medication, we use special needles that are capable of putting out heat. In conventional radiofrequency ablation, high frequency current  is used to semi-permanently destroy a nerve. Pulsed radiofrequency uses short high frequency bursts of current to modulate how the nerves fire, rather than destroying them.

Everyone is different in terms of how long the treatments last, but on average, conventional radiofrequency treatment lasts somewhere between 6 months to two years.  Much longer than numbing medicine that lasts only hours!

Radiofrequency ablation can be used for a variety of pain conditions, including arthritis in the neck/back, arthritis in the knees and peripheral nerve pain in various locations. Often times, when a pain management doctor is deciding whether or not a patient is a candidate for RFA, they will perform a diagnostic block first.  This is essentially a nerve block like I was discussing before, but it is used to see if blocking the nerve really is helpful in alleviating the pain. Think of it like test driving a car- it gives you a chance to try out what it would feel like after the RFA on a temporary basis.

Generally, the protocol for radiofrequency treatment involves one or two test blocks, and then the RFA treatment.  Whether one or two test blocks is required depends completely on the insurance company. I know- it’s frustrating to me too when insurance companies dictate care.

During the procedure, a pain physician will first use an ultrasound or an x-ray machine to localize the target area. Then, a small needle is used to numb the area. The special RFA needle is inserted after the area is fairly numb. Next, stimulation is used to ensure that the needle is in the correct location. This involves sensory stimulation to confirm the target reproduces the patient’s pain, and motor stimulation to confirm that the needle is not close to a motor nerve (which we never want to damage with RFA).  After confirmation, more numbing medicine is applied, and then the treatment begins.

It is normal to have more pain in the area after the procedure.  This usually tends to subside in the following days, and some physicians will put a little bit of steroid into the area at the time of the RFA to try to prevent this.  

If you are wondering if you might be a candidate for RFA, the best thing to do is see a pain management doctor in person! And don’t forget to subscribe to my blog here, so you never miss a post.