The Role of Radiofrequency Neurotomy in Pain Management

Radiofrequency neurotomy is a minimally invasive medical procedure aimed at reducing chronic pain. This type of pain relief technique involves the use of radiofrequency energy to interrupt or disrupt the function of specific nerves transmitting pain signals. The procedure is commonly used to help patients with chronic (long-term) neck or back pain, and patients who have not responded to more conservative treatments such as physical therapy or medications. 

How does radiofrequency neurotomy work? 

Radiofrequency neurotomy, also known as radiofrequency ablation, works by selectively destroying the portion of the nerve that carries pain signals to the brain. Here’s a step-by-step breakdown of how it typically works: 

• Placement of the Needle: Using a type of real-time X-ray called fluoroscopy, the physician guides a small, thin needle to the nerve believed to be transmitting the pain signals. 
• Confirmation of Needle Placement: A small amount of electrical current is often passed through the needle to ensure it’s at the correct nerve. The patient may feel a brief discomfort, similar to the pain they usually experience or a muscle twitch, both are a good indicator that the needle is at the right place. 
• Radiofrequency Ablation: Once the needle is correctly positioned, a radiofrequency current is passed through the needle. This generates heat at the needle tip. The heat creates a lesion or burn on the nerve, which disrupts its ability to send pain signals to the brain. 
• Post Procedure: The needles are removed, and the insertion area on the skin is covered with a bandage. The patient is then monitored for a while in a recovery area before being discharged. 

It’s important to note that while this procedure can provide substantial pain relief, it doesn’t always work for everyone. The nerves can regenerate over time, which means that the pain can return. If necessary, the procedure can be repeated. As always, it’s recommended to discuss the potential benefits and risks with your doctor. 

Treatment candidates: is it right for you? 

Radiofrequency neurotomy is often considered for patients who have chronic (long-term) pain, particularly those with pain that originates in the joints of the spine. However, not everyone with chronic pain is a suitable candidate. A good candidate for this procedure typically meets several of the following criteria: 

• Non-Responsive to Other Treatments: The patient’s pain hasn’t significantly improved with more conservative treatments like medications, physical therapy, or injection therapies. 
• Positive Medial Branch Block Test: The patient has had a positive response to a diagnostic procedure called a medial branch block. This is a type of nerve block where an anesthetic is injected near the nerves believed to be carrying the pain signals. If the patient experiences a significant reduction in pain following this procedure, it suggests those are indeed the nerves causing the pain and that a radiofrequency neurotomy may be beneficial. 
• Chronic Facet Joint or Sacroiliac Joint Pain: The patient has persistent pain originating from the facet joints (small joints at each segment of the spine that provide stability and guide motion) or the sacroiliac joints (joints in the lower back and buttocks region). 
• No Contraindications: The patient doesn’t have any health conditions that would make the procedure risky, such as active infections, bleeding disorders, or poorly controlled diabetes. They should also not be pregnant. 
• Realistic Expectations: The patient understands that while radiofrequency neurotomy can provide substantial pain relief, it may not eliminate all pain. The nerves treated can regenerate over time, which means that the pain can return, though this might take months or even years. 

As always, whether a person is a good candidate for a particular medical procedure should be determined by a qualified healthcare provider, who can consider the individual’s specific circumstances, overall health status, and personal preferences. 

Side effects to be aware of 

Radiofrequency neurotomy, like all medical procedures, does have potential side effects and risks. These can vary depending on the individual’s health and the specific area where the procedure is performed. The most common side effects include: 

• Temporary Pain or Discomfort: The site where the needles were inserted might be sore for a few days following the procedure. This is typically mild and can usually be managed with over-the-counter pain relievers. 
• Bleeding or Infection: As with any procedure that involves inserting a needle into the body, there is a small risk of bleeding or infection at the site of the needle insertion. 
• Nerve Damage: Although the goal of the procedure is to “turn off” the pain signals from specific nerves, there is a risk that other nerves could be unintentionally damaged during the procedure, which could lead to new pain or even loss of function. 
• Temporary Numbness or Weakness: Some patients may experience a temporary numbness or weakness in the area where the procedure was done due to the effects of the local anesthetic or the impact on the nerves. 
• Increased Pain: Some patients may experience an increase in pain after the procedure, although this is usually temporary. 
• Changes in Sensation: Some patients may experience changes in sensation in the treated area due to nerve disruption. 

How to prepare for a radiofrequency neurotomy 

If you’re scheduled to have a radiofrequency neurotomy, your doctor will give you specific instructions on how to prepare for the procedure. However, here are some general guidelines that might be included: 

• Discuss Medications: Inform your doctor about all the medications you’re currently taking, including over-the-counter drugs, herbal supplements, and vitamins. You may need to stop taking certain medications before the procedure. For instance, if you’re on blood thinners, you might need to stop them for a certain period to reduce the risk of bleeding during the procedure. 
• Eating and Drinking: You might be asked to fast (not eat or drink) for several hours before the procedure, especially if you’re going to be sedated. 
• Plan a Ride Home: If you’re going to be sedated, you’ll need someone to drive you home after the procedure. Even if you’re not sedated, it’s a good idea to have someone available to drive you home. 
• Wear Comfortable Clothing: Wear loose, comfortable clothing. You will likely need to change into a hospital gown for the procedure. 
• Discuss Allergies: Inform your doctor about any allergies, especially if you have had a reaction to any anesthetics in the past. 
• Discuss Health Changes: If there’s any chance you could be pregnant, or if there are changes in your health such as a recent fever or infection, let your doctor know. 

Remember, the specific instructions can vary depending on your health condition, the exact type of procedure, and your doctor’s practices. Always follow the advice given by your healthcare provider. 

What to expect during the procedure 

Radiofrequency neurotomy is usually performed as an outpatient procedure, meaning you can go home the same day. Here is a general outline of what to expect: 

• Preparation: After arriving at the clinic, you’ll change into a gown and lie on a procedure table. 
• Anesthesia: A local anesthetic is applied to numb the area where needles will be inserted. You may also receive a sedative. 
• Procedure: Guided by fluoroscopy (real-time X-ray), the doctor inserts a needle to the nerve causing the pain. A small electrical current ensures correct placement. 
• Ablation: A radiofrequency current is passed through the needle, heating and disrupting the nerve’s ability to send pain signals. 
• Recovery: Needles are removed, the area is bandaged, and you’re monitored in a recovery room. Once stable, you can go home. 

You should expect to feel some soreness at the site of the procedure for a few days. The full pain relief may take several weeks to become apparent as the targeted nerves slowly die from the heat lesion. 

Remember that the specifics can vary based on your situation and the doctor’s practices. Always follow the instructions and advice given by your healthcare provider. 

Recovery: What life looks like after the treatment 

After undergoing a radiofrequency neurotomy, you can generally expect the following: 

• Immediate Post-Procedure: You may feel some discomfort or slight pain at the site of the procedure. This can usually be managed with over-the-counter pain relievers. 
• First Few Days: You might experience some swelling and bruising at the needle insertion site. You’re usually advised to rest and avoid strenuous activity for the first few days. 
• Short-Term Recovery: Most people can return to their normal daily activities within a few days. You’ll likely have a follow-up appointment with your doctor to check on your progress and assess the effectiveness of the procedure. 
• Pain Relief: The full effect of the procedure is typically experienced a few weeks post-procedure. This is because it takes some time for the targeted nerves to lose their ability to transmit pain. 
• Long-Term Outlook: The pain relief from radiofrequency neurotomy can last several months or even longer. However, nerves can regenerate over time, and if this happens, the pain can return. If necessary, the procedure can be repeated. 

Remember, everyone’s recovery can be different and is influenced by various factors, including your overall health, the specific reason for the procedure, and your body’s response to the procedure. If you have any questions or are interested in radiofrequency neurotomy, contact us today to schedule an appointment.