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Radiofrequency ablation

One of the treatments we offer at Resolve Pain is radiofrequency ablation (RFA). Many people may have never heard of this procedure; however, it has been performed since the 1960s. It is a specialized procedure requiring specific training and equipment – which is why you may not have heard about it before.

The principle is simple – if you have a nerve in your body that is sending signals to your brain about chronic pain – and that signal is not helpful (e.g., your hand is not currently in a fire), then we would like to dampen or block that unhelpful signal. Sometimes pain stops us from moving normally or doing the exercises our physiotherapist has told us will help improve our pain, strength, and mobility – but we can’t do these because it is too painful. At other times, the pain is a burning or sharp pain from trauma or surgery, or it can be pain from a pinched nerve, such as in our neck, giving us headaches.

The best treatment would be to cure the pain. However, this is not often possible if you have had pain for more than three months. Some people think, why can’t we just cut these nerves? The problem is that the brain has a minor panic if it suddenly doesn’t get sensation/pain signals – and can create pain without the nerve being connected! A sad example is that some people who have had their legs amputated can still ‘feel’ severe pain in their feet. We call this phantom pain.

Radiofrequency ablation uses either electricity or heat to dampen the pain signals in a nerve. We would usually try and work out if a particular nerve is giving you trouble first – we call this a ‘diagnostic block’. We would often inject local anaesthetic – a brief pain blocker – the same as you get when you have a dental filling or stitches around the possible nerve target, and then see if this reduces your pain. If it does, we know we have found a spot that likely contributes to your pain.

Radiofrequency ablation

If we can confirm the right nerve, then we can use radiofrequency ablation to attempt to dampen the pain signal for you. We use two types. We place a small needle next to the affected nerve and use either heat or electrical activity to try and scramble the unhelpful pain signal in that nerve.

Pulsed radiofrequency ablation uses electricity over several minutes to dampen the pain. In heat radiofrequency ablation, we heat the tip of the needle to ~80 degrees for approximately a minute to gently burn the nerve. Pulsed radiofrequency ablation is newer, so it has had fewer research studies than heat RFA. It is slightly less likely to work than heat RFA and may last 6-9 months. However, the benefit is that it does not burn tissue, so your recovery is quicker and is less likely to have a flare of pain for a few weeks after the procedure.

We can also use pulsed RFA in more areas as it can be used for nerves that control muscles. People often see the full benefits of pulsed RFA between 4-6 weeks because the theory is that it takes some time forthe electrical activity to run along the nerve and affect the cells which control the pain signals. Heat RFA, otherwise known as a rhizolysis, can last 9-12 months for some patients and has a slightly increased chance of working.

However, the downsides are that it can cause a flare of pain for a few weeks after the procedure (because we are doing micro burns in an already sensitive area), and it cannot be used on nerves that control muscles.

Will these procedures take away my pain forever? No. And that is not the aim of these procedures. These simple procedures are designed to settle your pain to give you a window of opportunity to return to work, normalize life, perform rehabilitation exercises, and possibly get off or reduce medications. Some people never need these procedures repeated if they use the opportunity to address the cause of the pain. Other people prefer having a procedure performed once or twice a year to taking medications daily or being in pain.

Remember, if you have had to lie in a bed or spent a lot of time sitting down because of your pain, your muscles will have become weaker, your energy levels lower, and your mood often worsens. Even taking away your pain does not always reverse these changes. Because pain affects many parts of our lives, these procedures are only a part of your treatment. You still need to work with the pain physician, your GP, physiotherapist, psychologist etc., to try and reduce the impact your pain has had in other aspects of your life.

Will these procedures definitely work? Unfortunately no. We often say that if a diagnostic block is positive (takes away 50% of your pain or improves your function), then there is approximately a 70% chance of the RFA reducing your pain significantly.

Are there risks of having the procedure? Yes - there are always risks with any procedure - but this is a safe procedure and most side effects are mild and brief. The most common side effects and risks for radiofrequency ablation include a flare of your pain condition, bruising, and the procedure not working. Less common but possible risks include infection, allergy to medications, or temporary nerve irritation. Extremely rare but theoretically possible risks of almost any procedure include spinal cord injury, permanent nerve injury, and as with any medical procedure, death is theoretically possible however driving a car has a higher risk of death than these procedures.

How are the procedures done? We perform these procedures in rooms (if under ultrasound) or in theatre (if underX-ray). If performed in the hospital, you come in for a day case in the morning. You will be given a hospital gown and a bed to relax in while awaiting your procedure. An anaesthetist will talk to you before your procedure and usually place a small cannula in your arm. We will then take you into the procedure room, and the anaesthetist will give you medication to make you sleep. However, this is not a full anaesthetic, so that you will breathe comfortably on your own. We will perform the procedure, which usually takes between 30 and 60 minutes. We then wake you up afterwards and typically provide you with biscuits and tea and let you recover.

You cannot drive for 24 hrs after a sedation procedure, so you will need someone to pick you up the same day.

If you have further questions about the procedure, we are happy to discuss it further, and please contact our rooms.If you decide to go ahead, we will provide you with information regarding dates, times, and costs, and we will ask you to sign a consent form that you understand the above information and have had the opportunity to ask any questions you wish.

These videos below are not written by us - but explain the concepts in a simple way (this information is for general information only. We always use sedation for our procedures)

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