Radiofrequency Ablation for Back Pain Reviews: Is It a Good Idea?
On this page:
- What is radiofrequency ablation (RFA)?
- What are the pros and cons of RFA?
- Does radiofrequency ablation treat back pain?
Radiofrequency has recently resurfaced in the medical news, but are there any reliable radiofrequency ablation for back pain reviews? Many years ago, I learned how to use radiofrequency ablation (RFA).
The good news is that, for the first time, I could treat patients with chronic neck pain and they would get better for one to two years from a single treatment. The bad news is that I knew I was destroying tissue to do it and that this would eventually come back to haunt the patient.
Now a new low-back-disc RFA device has just received FDA approval, and that’s a problem as my patients will now be getting the same destructive procedure believing that this is helping their disc, when in fact the opposite is likely occurring.
What Is Radiofrequency Ablation (RFA)?
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Radiofrequency ablation isn’t new — in fact it’s been performed for many years in pain management. Basically, it uses energy in the radiofrequency spectrum to heat tissue and ablate (read “destroy”) tissue. This is one of those times in medicine when if we doctors named these devices for what they did, you as a patient would never sign up.
For example, who wants to be treated with a “radiofrequency destruction device”? So to fix that problem, we substituted another, more obtuse, word like “ablation.” Most patients aren’t quite sure what that means, and even if they do know what it means, it sounds oh so much more elegant than “destroy.”
What Are the Pros and Cons of RFA?
When I first learned how to use RFA to treat chronic neck pain due to damaged facet joints in the neck, it was a pretty neat tool to have. I could treat my patients’ neck pain once and they would get one to two years of relief. Of course the pain would come back with a vengeance, and they would need another treatment, but at the time, this was pretty revolutionary.
The downside of RFA is that we’re destroying tissue (1). In the case of the neck, that tissue is the little nerve that takes pain signals from the joint. We know from other areas of medicine that when you take away a nerve supply to a joint, bad things happen. Eventually, since the patient can’t feel the area and continues to place forces on the damaged area, the pace of arthritis of that joint quickens. This is called a Charcot joint.
Plus, one study found that RFA was no more effective than using exercise as a treatment protocol (2).
What’s fascinating in RFA is that, at least in the neck, I still can’t find a single study where someone has looked at this issue long-term (i.e., what happens to the neck joints of long-term-treated RFA patients). Maybe we as pain-medicine doctors just don’t want to know.
I can tell you that in my own patient population, I saw these joints get worse over time, but that’s just my observation. Given that almost all of our chronic spine patients who were getting RFA have now been switched to platelet or stem-cell-based treatments, it’s a question I’ll never be able to definitively answer.
Does Radiofrequency Ablation Treat Back Pain?
I recently read a press release about a new low-back-disc-pain RFA treatment (3). The orthopedic surgeon who participated in the study had glowing reviews of the technology, and a few patient successes were highlighted. The procedure received FDA approval, and as a result, I’m sure that I’ll begin seeing patients now at my clinic who have had the procedure.
The problem with radiofrequency for low-back discs is of course the same problem as the one I describe above — destroying the nerves in the disc is no safer in the long run than destroying the nerves that take pain from the neck or back joints. Those nerves serve a purpose. In the case of a painful disc, they help get weight and forces off the disc until it can heal.
So should we be nuking those nerves and likely causing faster degeneration of the disc, or should we be using treatments that might help the disc, like platelets and stem cells? You already know which one I’m going to offer my patients.
The upshot? Radiofrequency ablation for back pain reviews are not good. RFA was a great technology for its time that helped patients in the short run and likely hurt them in the long run. However, with all of the new platelet and stem-cell-based options for the spine, it seems like this new RFA disc treatment has arrived very late to the party. No thanks for me. I’ve stopped nuking important nerves in my patients to buy them some relief — gave it up for good!
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References
(1) Kanchiku T, Imajo Y, Suzuki H, Yoshida Y, Nishida N, Taguchi T. Percutaneous radiofrequency facet joint denervation with monitoring of compound muscle action potential of the multifidus muscle group for treating chronic low back pain: a preliminary report. J Spinal Disord Tech. 2014;27(7):E262-E267. doi:10.1097/BSD.0000000000000107
(2) Juch JNS, Maas ET, Ostelo RWJG, et al. Effect of Radiofrequency Denervation on Pain Intensity Among Patients With Chronic Low Back Pain: The Mint Randomized Clinical Trials [published correction appears in JAMA. 2017 Sep 26;318(12 ):1188]. JAMA. 2017;318(1):68-81. doi:10.1001/jama.2017.7918
(3) Cision PR Newswire. New treatment for low back pain: minimally invasive procedure receives FDA clearance. July 2016. https://www.prnewswire.com/news-releases/new-treatment-for-low-back-pain-minimally-invasive-procedure-receives-fda-clearance-300304795.html
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