A PSA on RFA: Taking a Deep-Dive into Radiofrequency Ablation for Chronic Pain

What is Radiofrequency Ablation?

Radiofrequency Ablation (RFA) is a medical procedure designed to alleviate symptoms of chronic pain using localized heat or voltage. By using high-frequency electromagnetic waves, RFA creates precise lesions on dysfunctional nerves, deactivating pain signals and providing relief. This targeted technique offers numerous advantages over surgical methods, including reduced time in a clinic or hospital and significantly quicker return to daily life. RFA treatment is particularly effective for managing conditions such as facet joint pain, sacroiliac joint pain, and post-surgical spinal pain.

Getting Started

RFA is a minimally invasive procedure that involves inserting a needle or electrode near the target nerve and applying radiofrequency energy to create a lesion. This lesion disrupts pain signals, providing significant pain relief. Though the procedure carries minimal risk, it is typically only covered by insurance every 6 months and up to two times per year. Eligible candidates for RFA typically experience chronic pain lasting more than six months and show significant short-term pain relief from trial nerve blocks.

The RFA Procedure

Before proceeding with RFA, target tissue confirmation using nerve blocks is essential. In cases of chronic back pain, medial branch blocks (MBBs) are typically performed twice, with greater than 50% pain relief needed to move forward with treatment. Unlike traditional nerve blocks that use local anesthetics for temporary relief, RFA provides a longer-acting method to silence the nerves and offer sustained pain relief.

Preparation: The patient is comfortably positioned on the procedure table, and the affected area is cleaned and numbed with a local anesthetic. Twilight sedation, or monitored anesthesia care (MAC), is also typically provided at a patient’s request.
Insertion: A narrow needle/catheter is inserted into the affected area using imaging guidance, ensuring precise placement near the nerve. The electrode is then guided through the opening to sit just atop the treatment area.
Test Simulation: Mild electrical stimulation is applied to confirm the correct placement. Patients often report a tingling sensation to verify accuracy.
Ablation: Once confirmed, radiofrequency energy is provided through the needle, heating the targeted tissue to 60°C to 80°C (140°F to 176°F) for 60 to 90 seconds.

The total procedure time ranges from 30 to 60 minutes, depending on the number of nerves treated. Patients typically experience some soreness for a few days after the procedure.

Motor and Sensory Testing

Motor and sensory nerve tests are conducted before thermal ablation to ensure correct nerve targeting and maximize pain relief while minimizing unintended damage.

Motor Nerve Testing: Low voltage stimulation is applied to avoid motor nerve contact, preventing muscle weakness. Notable twitching during this stage of testing may imply the needle is too close to a motor neuron, and the electrode placement should be reassessed.
Sensory Nerve Testing: Sensory nerves are tested to confirm proper placement, with patients reporting sensations in the affected area.

Recovery and Results

Recovery from RFA involves immediate post-procedural soreness, with noticeable pain relief often seen within a few days. Pain relief often peaks within 1 to 3 months and can last from several months to over a year. Patients might experience increased pain as the local anesthetic wears off and the nerve reacts to the ablation. Depending on individual responses and nerve regeneration rates, RFA treatments can be repeated if pain relief diminishes significantly.

Potential Risks and Considerations

RFA provides effective management of chronic pain using minimally invasive techniques that target specific nerves with high-frequency electromagnetic waves. This unique approach offers reduced hospital or clinic visits, as well as faster recovery compared to traditional methods. RFA improves patient outcomes by alleviating pain and enhancing function.

Like all medical procedures, RFA treatment is not without risk. Though highly unlikely, RFA may cause nerve damage, infections, bleeding, increased pain, and allergic reactions. It’s important to consult with a medical professional such as Dr. Matthew Kohler before opting for RFA treatment.

Take the Next Step Toward Pain Relief

Are you or a loved one looking to experience the benefits of Radiofrequency Ablation ? Contact our office today to schedule an initial consultation with Dr. Matthew Kohler and find out how our personalized treatments can help get your life back on track.

Written By: Navya Kalidass

Edited By: Camden Rowe

Medically Reviewed By: Matthew Kohler, MD