Understanding Radiofrequency Ablation For Chronic Pain Management
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Since radiofrequency ablation (RFA) became widely used in the late 1990s, it has been used for managing chronic neck pain in some patients. While this procedure has shown reliable results for neck pain relief, its effectiveness for low back pain has been inconsistent.
One possible explanation for this inconsistency is that RFA disrupts nerves that play a role in stabilizing the spine. This occurs because RFA uses controlled heat to disrupt nerve function. Some refer to it as a “nerve-burning” procedure for the lower back, as it reduces signals from pain-associated nerves.
However, recent research further questions the suitability of RFA for low back pain, suggesting it may not be an ideal approach for long-term relief.
What Is RFA?
While the term “radiofrequency ablation,” also known as radiofrequency denervation, may sound like an advanced, high-tech procedure, it has been used for pain management for several decades. The terminology “radiofrequency ablation” may seem innocuous and elegant; however, this procedure involves a relatively straightforward and intense approach to pain management.
At its core, RFA converts electromagnetic signals into heat energy. This heat is directed to the target tissue through a tool such as a probe or needle. The term “ablation” refers to destroying tissue by applying high temperatures or chemicals.
During an RFA procedure for back pain, the targeted nerves and surrounding tissue are intentionally disrupted. The alternate term, “radiofrequency denervation” (where “de-” means “to remove” and “nervation” refers to nerves), further illustrates the nerve-targeting intent of the procedure.
Before recent advancements in regenerative medicine, RFA was seen as a promising option, offering short-term relief that could sometimes extend over longer periods—an alternative to options like pain medications and spinal fusions. However, as newer research emerges, questions arise about the efficacy and long-term benefits of RFA for chronic back pain.
The Uses Of RFA Across Various Body Areas
Although RFA is commonly used to manage chronic back pain, it can also be effective in addressing pain in other areas, providing relief in cases where other treatments may have been less effective. Below are some of the main areas where RFA is commonly utilized:
Spine
In the spine, RFA targets nerves around the facet joints, which are small joints located along the back of the vertebrae. These nerves can become sources of pain due to degeneration or injury. RFA is used to target nerves involved in pain signaling.
Knees
RFA is sometimes used to manage chronic knee pain, often in patients with arthritis or who have not responded well to other conservative treatments. By targeting nerves around the knee, RFA is used in some cases to help manage pain, which may contribute to improved mobility.
Hips
In cases of hip pain that may stem from conditions like osteoarthritis, RFA targets the sensory nerves around the hip joint. This can sometimes provide temporary relief for those not candidates for, or wish to avoid, hip replacement surgery.
Shoulders
RFA can help manage chronic shoulder pain, which often stems from conditions like rotator cuff injuries or arthritis in the joint. By targeting specific sensory nerves around the shoulder, RFA interrupts the transmission of pain signals, which can lead to temporary relief.
Sacroiliac Joints
In the sacroiliac (SI) joints at the base of the spine where the sacrum meets the pelvis, RFA is often employed to manage persistent pain that hasn’t responded to other treatments. By targeting the nerves around the SI joints, RFA aims to interrupt pain signals traveling from this area to the brain, potentially offering relief for individuals with chronic pain.
Peripheral Nerves
RFA is occasionally used on peripheral nerves to manage localized pain in areas beyond the central joints, such as the arms, legs, or specific muscle groups. This application targets sensory nerves that carry pain signals from particular body regions to the brain.
Conditions Treated With RFA
Radiofrequency ablation (RFA) is commonly used to manage spine-related pain, particularly conditions affecting the facet joints. It primarily targets arthritis-related discomfort by disrupting pain signals from irritated nerves. Conditions RFA may help address include:
- Degenerative Disc Disease: RFA may help manage symptoms associated with degenerative disc disease by targeting nerves near the affected spinal segments. This technique aims to provide temporary pain relief by interrupting pain signals, though it does not treat the underlying disc degeneration.
- Facet Cyst: A facet cyst is a fluid-filled sac that develops in the spine’s facet joint, often due to degeneration. Depending on size and location, it may cause localized back pain, nerve compression, or radiating symptoms such as numbness or weakness. Read More About Facet Cyst.
- Sacroiliac Joint Dysfunction: The sacroiliac (SI) joint connects the spine to the pelvis and helps transfer weight between the upper body and legs. Dysfunction or inflammation in this joint may cause lower back pain, hip discomfort, and stiffness, often worsening with movement or prolonged sitting. Read More About Sacroiliac Joint Dysfunction.
- Spondylolysis: Spondylolysis is a stress fracture or defect in the vertebra, most commonly in the lower back. It may cause localized pain, stiffness, and, in some cases, nerve irritation, often worsening with activity or prolonged standing. Read More About Spondylolysis.
- Torn Discs: A torn disc, or annular tear, occurs when the outer layer of a spinal disc is damaged, potentially causing pain, inflammation, or nerve irritation. Symptoms may include localized back pain or radiating discomfort if the tear affects nearby nerves. Read More About Torn Disc.
RFA Vs. Exercise For Low Back Pain
A 2017 study sought to evaluate how effective radiofrequency ablation (RFA) is for chronic low back pain compared to standard exercise programs. In this three-month study, 681 participants across three randomized control trials were assigned either to a test group (RFA combined with exercise) or a control group (exercise alone).
Out of these participants, 521 completed a one-year follow-up. All subjects experienced chronic low back pain due to issues in the facet joints, sacroiliac joints, discs, or a combination of these and had previously not responded to other treatments.
The findings indicated that compared to the exercise-only group, those who received RFA in addition to exercise showed no clinically significant improvement. This suggests that combining RFA with exercise was no more effective than exercise alone for managing chronic low back pain.
Risks Involved In Burning Nerves With RFA
While RFA may offer temporary pain relief by disrupting nerves, the procedure has potential risks, especially when applied to different body areas. Targeting nerves with RFA may have effects beyond pain management, including possible impacts on surrounding tissues. Below are some potential complications associated with RFA in various body regions.
Disc Degeneration From Nerve Ablation
In the long term, using RFA to destroy nerves in the lower back discs for pain treatment may be problematic. Nerves play essential roles in the body, including within spinal discs, where they help manage forces on the disc, promoting natural healing. Altering nerve function through RFA may impact natural healing processes, and some research suggests it may be associated with disc degeneration in certain cases.
Masking Pain Without Addressing Root Cause
Nerves transmit pain signals from joints and other tissues to alert the body to underlying issues. While RFA may temporarily reduce pain by disrupting these signals, the pain typically indicates an underlying problem, such as arthritis, that remains unaddressed.
When the root cause isn’t treated, additional joint damage may occur, since the body’s natural warning system has been impaired.
Instability Due To Multifidus Muscle Damage
A possible side effect of RFA for chronic lower back pain is damage to the multifidus muscle, a key stabilizer in the lower back. Disruption of this muscle can lead to spinal instability, allowing for increased movement in the lower back, which may accelerate wear and tear on discs, joints, and ligaments.
One method used to assess the effectiveness of an RFA procedure—ensuring that all targeted nerves are disrupted—involves inserting an EMG electrode into the multifidus to confirm the extent of nerve impact.
Long-Term Nerve Damage
Using heat to disable nerves through RFA can result in lasting impairment of nerve function beyond just pain signaling. This damage may extend to nearby tissues, potentially compromising mobility or stability in areas such as the spine or joints. In some cases, the reduced nerve function may also affect sensation, limiting a person’s ability to detect changes in temperature or pressure in the treated area.
Potential Nerve Regeneration And Increased Sensitivity
Following RFA, nerves may regenerate, sometimes leading to increased sensitivity or heightened pain in the treated area. When nerves regrow after ablation, they may develop altered sensitivity, resulting in neuropathic pain—a condition where heightened nerve sensitivity causes a more intense or widespread pain response.
This outcome can be challenging to manage and may necessitate further treatments to address the new or intensified symptoms.
Are There Safer Alternatives To Nerve Ablation For Pain Management?
Physicians in the licensed Regenexx network offer interventional orthobiologic procedures that may provide a non-surgical option for managing pain without disrupting nerve function. Unlike nerve ablation, which temporarily blocks pain signals by altering nerve activity, these procedures aim to support the body’s natural repair processes.
Interventional orthobiologic approaches, such as platelet-rich plasma (PRP) or bone marrow concentrate (BMC) injectates, use a patient’s own biologics to help support tissue health and joint stability. These image-guided procedures are designed to target areas of discomfort with the goal of reducing inflammation and promoting function.
By focusing on joint and tissue health rather than disrupting nerve function, these procedures may be an alternative option for individuals exploring ways to manage pain while maintaining mobility. Consulting a physician in the licensed Regenexx network can help determine if these approaches align with their condition and treatment goals.
Target Nerve Pain At Its Source With Procedures Using Regenexx Injectates
Maintaining nerve integrity is crucial for mobility and joint function. While some pain management procedures work by disrupting nerve signals, nerves also play a key role in supporting coordination, muscle strength, and joint stability.
Physicians in the licensed Regenexx network offer interventional orthobiologic procedures that focus on joint and tissue health. These procedures use Regenexx lab-processed injectates, such as platelet-rich plasma (PRP) and bone marrow concentrate (BMC), to help support the body’s natural repair processes.
Image-guided procedures may target areas of tissue dysfunction, such as worn cartilage, inflamed tendons, or weakened ligaments, to help promote function and mobility.
By addressing underlying joint and tissue concerns, these approaches may provide an alternative option for individuals exploring non-surgical pain management while maintaining nerve function. To determine if this approach aligns with your treatment goals, consult with a physician in the licensed Regenexx network.
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