Radiofrequency ablation (RFA) Neurotomy is a process in which heat is applied in order to destroy the nerve that is implicated in transmitting pain sensation from the region of complaint. It is indicated for back pain and other regional pains. There are two main types of RFA – continuous and pulsed.
RFA is an outpatient procedure and the patient is allowed to return home the same day. The area must be kept dry at all times. But it’s okay to take a shower the following day and remove the bandages thereafter. All strenuous activities must be avoided for a day or two. There will be some soreness or pain for a few days. Most people are able to return to work and perform normal activities in two to three days.
It can take two to three weeks before the ablated nerve is fully inactive and there is no more pain transmission.
If that becomes bothersome, analgesics may be prescribed.
Nerves are able to regenerate post RFA and resume pain transmission. If the pain returns, a repeat RFA may be considered by the doctor. If repeated attempts prove to be ineffective, surgery may be considered as an option.
As there might be some deconditioning due to persistent pain and likely limited motion over time, physical therapy may be indicated to allow them to increase their strength and activity tolerance gradually.
Side effects or complications include superficial burning pain with hypersensitivity or light numbness of the skin that lasts for 1 – 2 weeks. In some cases, the pain worsens due to muscle spasm in the area treated. Rarely yet, there may be permanent nerve pain.
Success rates for RFA neurotomy vary, but typically about 30% to 50% of patients will experience significant relief from their back pain for up to two years. About 50% will get some pain relief for a shorter period. Indeed, there will be some patients who do not experience any relief from pain after this procedure.
If there is severe pain at the injection site along with swelling and redness, or if there is increased leg weakness, have someone rush you to the nearest emergency room or call 911, as this might be because of bleeding and injection complications.
In order to avoid major complications, RFA neurotomy should not be performed on patients who are allergic to any of the medications to be injected, those who are on a blood-thinning medication, or those who have an active infection. Warfarin will need to be stopped for 4-7 days beforehand. Anti-platelet drugs like Plavix may have to be stopped for 5-10 days prior.
Overall, RFA is a useful pain control procedure and it has the additional benefits of reduced recovery times, improved quality of life, increased range of motion, and decreased need to take pain medications (which is highly desirable given the known side effects/complications thereof).