Facet Joint Radiofrequency Ablation (RFA)(Lumbar and Cervical and Thoracic)
People who experience chronic pain have tried many pain solutions before they come to Downtown Pain Physicians. This is why we meet patients where they are when they first come to see us. Every patient has a different experience with pain and their unique medical history. Our approach to treating pain begins with the patient. We evaluate them and begin to understand the solutions they’ve tried. The purpose of our pre-procedure evaluations and conversations with any patient is to determine why these other solutions either did not work or were not as effective as they hoped. Facet Joint Radiofrequency Ablation or RFA is a pain solution for patients who have already tried other solutions that have not relieved their chronic or intense pain sensations. The objective in performing any of the procedures that Downtown Pain Physicians performs is to provide patients with permanent or lasting pain relief from the condition that they suffer from.
The Purpose of the RFA and How Facet Joint Injury Occurs
The purpose of a facet joint radiofrequency ablation is to treat pain in the lumbar, thoracic, or lumbar facet joints. The facet joints also referred to as Zygapophysial joints, or Z-joints are pairs of bone structures located on the back of each spinal vertebra or spinal column bone. They work together to let movement occur between two vertebrae. A capsule surrounds the facet joints and keeps them bathed in lubricating fluid, similar to a knee or shoulder joint. When a joint is injured, pain from the joint travels along the medial branches or sensory nerves to the spine and then to the brain. Injuries to the joint can involve the capsule, ligaments around the joint, or the cartilage that covers the end of the bone. The injury can also cause muscle spasms. Depending on where the facet joint injury is, pain can radiate in the lower back, buttocks, neck, and it can cause pain in the back of the head as well as headaches. The facet joints are divided into three sections. The top part connects the patient’s skull to the torso. This is known as the cervical spine. The middle part attaches the ribs to the spine and is known as the thoracic spine. Where the spine connects to the pelvis is known as the lumbar spine. Cervical facet joint pain is quite literally a pain in the neck. When a patient experiences neck pain, the facet joints in that part of the spine are inflamed. Inflammation causes difficulty in moving the head from side to side or up and down. Pain from these facet joints can occur in your neck and extend all the way down to your shoulder depending on which facet is injured. Cervical radiofrequency ablation may be considered in this case. Thoracic facet joint pain can sometimes present as muscle tension or as severe pain. This can be caused by injured cartilage inside the joint or by connecting ligaments around the joints. Pain can occur in the shoulder, upper back, or the hips. Lumbar sacroiliac joint pain can cause nerve pain that travels into the buttocks or back of the upper leg. It can make it hard to sit for long periods and extremely difficult to ride in a car. The area where the pain is felt may also be sore and tender and bending backward may hurt. Symptoms may indicate that a lumbar radiofrequency ablation procedure is necessary. Radio frequency treatment for back pain is a common reason people receive treatment as is radiofrequency neck treatment. The nerves that run from each type of joint deliver pain signals to the brain. An RFA procedure is intended to help eliminate the delivery of pain signals to the spine and brain to help each patient find pain relief.
What are the Types of RFA Procedures?
There are three different types of RFA procedures. The purpose of the procedure is to produce heat lesions on the tissue. It delivers radiofrequency ablation waves that are electromagnetic and travel at 186,000 miles per second or the speed of light. Pulsed radiofrequency (PRF) ablation: A needle is heated to 107 degrees Fahrenheit and it delivers a high-voltage current in short bursts. In between the bursts, there is no current passed. Conventional continuous radiofrequency (CRF) ablation: A needle heated between 140 and 176 degrees Fahrenheit and it uses a continuous high-voltage current to produce a heat lesion. Water-cooled radio frequency (WCRF) ablation uses water and a specialized needle heated to 140 degrees Fahrenheit. The water helps to regulate the current flow and keeps the needle from being overheated. The first two types of ablations produce small lesions while WCRF produces bigger ones. When these procedures are used on nerve tissue, it can provide pain relief for people who haven’t achieved it by other means. When treating pain RFA targets two different areas:
- Medial branch ablation focuses on the nerves sending pain signals from the facet joints.
- Lateral branch ablation focuses on nerves carrying pain from the sacroiliac joints.
- These two procedures don’t target sensations in the arms or legs or any muscles.
What an RFA Procedure is Used For RFA procedures at Downtown Pain Physicians focus on providing long-term pain relief for patients who haven’t had lasting success with other types of treatments like nerve blocks and injections.
RFA treats conditions such as:
- Complex regional pain syndrome
- Nerve entrapment syndromes
- Past spinal surgery
- Spinal arthritis (spondylosis)
- Cervicogenic headache
- Occipital neuralgia
There are several goals of an RFA procedure:
- Reduce neck and back pain for a longer period.
- Improve back and neck function to allow people to regain function and participate in physical therapy.
- Reduce the amount of pain medication that a patient takes.
- Avoid or delay surgery.
Why Patients Choose an RFA Procedure
Before proceeding with an RFA back procedure, RFA for neck pain, or RFA lower back procedure, patients usually undergo a procedure to help identify their pain. The most common way to do this is by doing a diagnostic block. The doctor injects a tiny amount of local anesthetic into the area that is suspected to be the source of the pain. If the anesthetic is injected in the right place, it provides the patient with immediate temporary relief and the pain will return shortly after the block. Success with this procedure indicates that RFA will also be successful for patients. RFA pain management has many benefits when it is successful for patients. The main benefit is that it provides lasting pain relief for between 8 and 12 months. The procedure can be performed on multiple sites of pain on the same day if it is in more than one spinal level. Otherwise, the lag time between the procedures is only a few days. This minimally invasive procedure is performed in our office and patients will be able to return home the same day.
Preparing for the Procedure
Before your RFA procedure appointment, stop taking any aspirin or medicine that lists aspirin as an ingredient for at least 11 days. Consult your primary care doctor about stopping any medications like this and ask when they can be restarted. Don’t eat or drink anything for at least six hours before the procedures. Medications can be taken with a little water. Diabetics should hold off on taking their insulin or diabetes medication. Take a shower and wash with an antibacterial soap on the day of the procedure to reduce the risk of infection. Just before coming in, put on clothes that are easy to take off and put on. Don’t wear any jewelry. Because this is a procedure involving nerves, you shouldn’t drive. Make sure to arrange for someone to bring you to the office and bring you home after. Please notify our office if you are taking any blood thinners before your procedure or if you are allergic to any medication that will be injected during the procedure. If you are on blood thinners, you may be instructed to stop them 4-7 days before the procedure. If you are a patient who has a heart condition, poorly controlled diabetes, or those who EW on blood-thinning medications like Coumadin need to receive medical clearance from their doctor to discontinue their medications before the procedure. Diabetics will need to have their insulin dose adjusted on the day of the procedure. We cannot perform an RFA procedure on patients who:
- Have an active infection
- Are Pregnant
What Happens During the Procedure
RFA is a minimally invasive procedure and requires only mild sedation anesthesia. On the day of the procedure, you will lie on your stomach or your side for some procedures involving the neck. You may also receive a sedative through an IV to help relax you and to keep you more comfortable during the procedure. The skin over the area of treatment is cleaned to reduce the likelihood of infection. The doctor will numb an area of the spine using an anesthetic. Then he will insert a special radiofrequency needle with a probe in it into the numbed area. Using X-ray guidance, he will guide the needle along the nerves that are delivering the pain signals. Once the doctor is sure the needle is in the right place, he will pass a current through the probe beside the target nerve and away from the other nerves. After the needle position is confirmed, the doctor will administer more of the local anesthetic in the area where the RFA procedure will be performed to numb it. Then the doctor will proceed to create a heat lesion on the nerve using the method preferred for the injury or condition. He’ll repeat the same process for each nerve until the procedure is complete. From start to finish, the RFA procedure takes between 20-30 minutes.
How a Patient May Feel During The Procedure
During the RFA procedure, the numbing medication and any sedative will minimize the amount of discomfort you feel. When the doctor is testing to see if the needle and probe are in the right place, you may feel some kind of pain. It should feel similar to the pain you have experienced. Notify the doctor if you feel any type of pain. The doctor will numb the area even more after testing so that you don’t feel more pain as the heat lesions are applied. As the procedure goes on, you may feel a warm sensation or nothing at all.
What to Expect After The Procedure and After Care
After the RFA procedure is complete, you’ll recover for 15 minutes to 30 minutes in the procedure room or recovery room. During this time, your vital signs will be monitored to make sure they don’t dip or go up. How you feel immediately after the procedure depends on what areas were treated. Some patients feel like they have a sunburn due to burning pain. Others may feel like their skin is numb in the same area. Rest for the rest of the day. You may experience body aches over the first few days. This is to be expected. Have someone drive you home after the procedure. Do not drive, make any important decisions, or operate any heavy machinery if you had sedation or any pain medication. You may also experience numbness in your lower extremities after the procedure. Ask for assistance moving around after the procedure is over. The site of the injection may be swollen and painful. Applying ice to each site is one way to reduce both swelling and pain. Apply ice for 15 to 20 minutes per session and take breaks of at least two hours in between to keep the skin from being injured or getting irritated in the first 24 to 48 hours. Avoid using heat packs or taking baths. Warm showers are preferable after an RFA procedure. Don’t lift anything over 10 pounds on the first day. Side effects should subside in a few days.
Recovery Time and Side Effects from the Procedure
Pain relief post-procedure is expected between 1 and 3 weeks. Recovery time is relatively short. Patients can resume their normal activities but take it easy and don’t overdo it. Use any pain you feel as a guide to whether to stop doing something. You may be prescribed a guided physical therapy regimen to help increase your activity tolerance and strength safely. RFA is considered a low-risk procedure but it is not without its side effects. Side effects that can occur include:
Pain including temporary injection and procedure site pain
Once the local anesthetic wears off, feeling temporary pain at the injection site is normal and is relatively minor. You may experience pain in the muscles around the nerves where RFA was performed. You might also have increased muscle spasms and resulting in pain temporarily. Numbness or burning is also something you may feel as the injected corticosteroids and analgesics wear off. These sensations should stop within 2 weeks of the procedure.
Bleeding and Infection at the injection site
Because RFA involves a needle that punctures the skin, infection, as well as bleeding, are something to be aware of. They’re not common side effects with RFA but something to be aware of. If the bleeding doesn’t stop or the injection site becomes red, swollen, and seems to be infected, seek treatment at the hospital.
Swelling or bruising at the site
A small amount of swelling or bruising may appear at the injection site. If it does not resolve within a few days of the procedure. If you are experiencing any side effects other than what is to be expected after the procedure, contact your doctor, or seek treatment at the hospital as this can be a sign of an adverse reaction.
Risks and Complications associated with RFA
RFA has risks and complications that are very uncommon. But patients with existing medical conditions may be at increased risk for them. This is why Downtown Pain Physicians asks for medical history at your initial consultation. Please let us know if you have any medical conditions such as heart conditions, diabetes, or other conditions. There is a risk that blood vessels or motor nerves may become damaged. The likelihood of this occurring is very rare. Burns on the nerves may occur as the current passes through the electrode. This is another rare side effect.
Statistics or other data
Success rates for facet joint pain RFA is approximately 45 to 60 of patients. A study of patients who received cervical facet joint RFA reported a reduction in pain of 55.2 2 months after their procedure. Half of the 65 patients in the study or 50.8 saw improvement after treatment. 15 people who had lower back pain received lumbar RFA. 60 pain relief a year after the procedure.
“BEST MEDICAL PRACTICE”
Best medical practice I have in my entire life received the best treatment for multiple injuries I received causing pain and he has also provided the best treatment to my son as well. Dr. Raval takes his time always returns my calls and has treated my son and I as his own family. The staff are all amazing and professional. I would give them more than a 5 Star. So grateful they exist.
Dr. Raval was extremely professional, thorough, and kind. He explained everything he was doing as he did it and really helped to put my mind at ease. He also recommended a physical therapist for further treatment. Great doctor, great visit. Highly recommended.
Frequently Asked Questions
How Long Does Pain Relief From Radiofrequency Ablation Last?
The length and degree of pain relief depends on the individual, the location of the pain, and its cause. Some people have relief for years while others have pain relief for 6 months to 2 years depending on the nature of the pain and injury.
When Does Pain Relief Kick In?
Pain relief is typically felt within 10 days of the procedure.
What if RFA Does Not Last As Long As It Should or I Need Multiple Treatments?
If you need RFA in more than one area, it can be done during the same procedure or within a few days. Some people may need treatment again because nerves do regenerate over time. If the same pain level returns after a recent treatment, you may need another type of treatment.
Who is a Good Candidate for RFA?
RFA is an effective way to treat pain. One way to determine if you are a candidate for this procedure is to consult one of the doctors at Downtown Pain Physicians. The doctor will base your treatment on your diagnosis and medical history. Another way is to try a diagnostic nerve/pain receptor block first. If it’s successful, RFA can work for you.
What are the Side Effects From RFA?
Common side effects include temporary bruising, pain, and swelling at the injection sites(s). You may also experience an increase in pain temporarily but it goes away within a week. Infection is also a risk but the RFA procedure is performed in a sterile environment to minimize the risk.
Find Relief From Chronic Pain at Downtown Pain Physicians
If you’ve had chronic neck, thoracic, or lumbar pain and haven’t found a pain management solution in New York, NY that relieves your pain, radiofrequency ablation for the spine could be a solution for you. Call Downtown Pain Physicians at 212-404-8070 to schedule your consultation today.
Dr. Raj Raval, M.D.
- Board Certified
- Interventional Pain & Musculoskeletal Medicine Specialist
Education & training
- SUNY Downstate PMR Residency
- Rutgers University Fellowship