Advanced Treatments for Chronic Back Pain: SCS and RFA

Understanding Chronic Back Pain

Chronic back pain affects millions worldwide, significantly diminishing quality of life, mobility, and overall well-being. While conventional treatments such as physical therapy, medication, and lifestyle changes can provide relief, some patients require more advanced interventions to manage persistent pain effectively. Two leading interventional pain management techniques—Spinal Cord Stimulation (SCS) and Radiofrequency Ablation (RFA)—have become prominent options for patients whose chronic back pain has not responded adequately to other treatments.

When to Consider Advanced Treatments

Patients who may benefit from advanced interventions like SCS and RFA often:

Have chronic back pain lasting longer than six months
Experience inadequate relief from conservative or other interventional treatments
Seek alternatives to long-term use of pain medication, especially opioids
Wish to avoid invasive surgical procedures

Spinal Cord Stimulation (SCS): A Targeted Approach

SCS is a minimally invasive therapy involving the implantation of a small generator device, typically placed under the skin in the lower back or abdomen. This generator is connected to thin, flexible wires called leads, which are carefully positioned along the spinal cord. Once activated, the generator sends mild electrical pulses through the leads directly to the spinal cord, masking pain signals before they reach the brain, thereby significantly reducing the perception of pain.

Indications and Patient Population

Patients best suited for SCS typically have:

Persistent neuropathic pain (pain caused by nerve damage)
Failed back surgery syndrome (chronic pain following spinal surgery)
Complex regional pain syndrome (CRPS)

Procedure and Benefits

Procedure: Initially, a trial phase is conducted using temporary leads to assess the effectiveness of the stimulation. If the trial successfully reduces pain by at least 50%, a permanent implantation is planned. During the permanent procedure, a small pulse generator is implanted under the skin, typically in the lower back or abdominal region. This generator connects to insulated wires (leads) that deliver precise electrical impulses directly to targeted areas along the spinal cord.
Benefits: SCS offers substantial pain relief, improved overall function, reduced reliance on pain medications, and it remains completely reversible if necessary, allowing the device to be adjusted, replaced, or removed.

Treatment Efficacy and Timeline

Patients typically notice initial pain relief during the trial period.
Optimal pain control is generally achieved within a few weeks after permanent implantation.
Long-term effectiveness has been consistently demonstrated, with many patients experiencing sustained relief for several years.

Radiofrequency Ablation (RFA): A Precision Technique

Radiofrequency Ablation (RFA) is a minimally invasive procedure that utilizes radio waves to produce heat through a specialized needle electrode precisely placed near the targeted nerve. Guided by real-time imaging, usually fluoroscopy or ultrasound, the physician accurately positions the electrode near the nerve responsible for transmitting chronic pain signals. Before the actual RFA procedure, patients often undergo diagnostic nerve blocks—temporary injections of anesthetic—to confirm that blocking these specific nerves effectively reduces pain. This trial phase provides essential proof of efficacy, similar to the SCS trial.

Once the trial confirms effectiveness, the RFA procedure is scheduled. After precise placement of the needle electrode, sensory testing ensures that only the nerves responsible for pain are targeted, sparing motor nerves. Radiofrequency energy is then delivered for approximately 90 seconds to two minutes, generating controlled heat (around 80-90°C) to disrupt the targeted nerves' pain signals.

Indications and Patient Population

Patients suitable for RFA typically have:

Chronic pain originating from the facet joints of the spine
Persistent low back pain responsive temporarily to diagnostic nerve blocks
Conditions like osteoarthritis affecting the spine

Procedure and Benefits

Procedure: A minimally invasive outpatient procedure performed under local anesthesia with mild sedation. A needle electrode is inserted near the targeted nerve under imaging guidance, followed by sensory testing and application of radiofrequency energy to disrupt pain signals.
Benefits: RFA offers effective reduction of localized chronic pain, minimal recovery time, improved mobility, enhanced quality of life, and decreased dependency on pain medication.

Treatment Efficacy and Timeline

Pain relief typically begins within a few days to weeks after the procedure.
Effects can last from six months up to two years, with repeat treatments in the same part of the spine possible up to twice per year.
Proven track record of improved function and reduced medication dependence.

Which Treatment Is Right for You?

The decision between SCS and RFA depends largely on the specific characteristics of your pain, your medical history, and personal preferences:

SCS is more suitable for neuropathic or nerve-related pain conditions, providing adjustable, ongoing relief.
RFA is often preferred for structural, radicular, or joint-related pain, providing targeted relief with a simpler, quicker procedure.

The Ospina Medical Advantage

Navigating chronic back pain requires personalized care. Consulting with a specialist like Dr. Matthew Kohler at Ospina Medical can help identify the most suitable advanced treatment tailored specifically to your needs. Dr. Kohler specializes in interventional pain management, offering comprehensive assessments and individualized treatment plans, including the ability to perform Spinal Cord Stimulation trials prior to full implantation at specialized surgical facilities. Additionally, he provides the complete Radiofrequency Ablation treatment process—from initial diagnostic nerve blocks to the final procedure—right in the comfort and convenience of Ospina Medical. For personalized guidance and relief, schedule your consultation today.

Author: Camden Rowe

Medically Reviewed By: Matthew Kohler, MD