WRITE A NOTE ON THE USE OF RADIOFREQUENCY ABLATION FOR THE TREATMENT OF CHRONIC LOW BACK PAIN ?
A 2 INTRODUCTION
1 Ablation” means to melt, vaporize, and remove or destroy using a very high temperature or chemicals.
So ,
A ) RFA uses radiofrequency, converting electromagnetic signals into heat energy.
B ) The heat energy travels into the tissue being treated via a tool such as a probe or needle.
2 During this procedure, radiofrequency energy is used to disrupt function of a lumbar medial branch nerve, so that it can no longer transmit pain from the irritated joint.
3 This is a safe and very effective procedure for chronic pain stemming from the cervical facet joints.
4 This procedure is normally done with intravenous sedation.
A ) Sedation will require that you fast for four hours prior to the procedure.
B ) If you will not be having sedation, we recommend that you eat a normal meal prior to the procedure.
C ) A local anesthetic will be used to numb the skin.
D ) Then insert a thin needle directly into the facet joint.
E ) Fluoroscopy, a type of x-ray, will be used to ensure the safe and proper position of the needle ( v imp )
1 The doctor will then check that the needle is in the proper position by stimulating the nerve.
2 This may cause muscle twitching. When the needle is in the correct position, the area will be numbed. Radiofrequency energy will then be used to disrupt the medial branch nerve.
3 This often feels warm or tingly, but should not be painful.
DEFINITION
1 Radiofrequency ablation is a therapy that uses radio waves to create an electrical current through the body.
2 This current delivers heat to targeted nerve tissues. And this can help reduce your chronic painsymptoms that are associated with various conditions.
3 This is because the heat is applied to the nerve tissue in a way that impairs or destroys the nerves.
4 This can result in a semi-permanent disturbance of the transmission of pain signals from the spinal column to the brain.
5 Radiofrequency ablation was initially discovered to be an effective treatment for the relief of chronic pain in 1931.
6 It was first utilized to treat a patient with trigeminal neuralgia, which is a pain condition that affects facial nerves, resulting in severe jolts of pain.
EPIDEMIOLOGY
Low back pain is the most common pain in the modern society with estimates of lifetime prevalence as high as 84–90% and the 5-year recurrence rate as high as 69%
ETIOLOGY
Multiple structures can contribute to lower back pain including but not limited to the lumbar vertebral bodies, intervertebral discs, facet joints, spinal nerves, the surrounding muscles, and ligaments.
1 The incidence of Sacroiliac joint (SI joint) dysfunction in patients with back pain may range from 15 to 30% and lumbar facet joints may account for 15 to 40% of back pain
2 In about 2–10 percent of patients, the back pain becomes chronic in nature.
TYPES
1 Continuous radiofrequency and pulsed radiofrequency are the two basic types of radiofrequency ablation.
2 Both of these methods have been shown to be effective for disrupting pain signal transmission from specific nerves, resulting in a reduction or elimination of chronic pain symptoms.
3 It has been found that the damage that is induced by the heat is primarily responsible for the efficacy of this pain therapy procedure.
Vv imp - However, some reports have suggested that the effect that the electrical field has on gene expression within the pain processing neurons may be responsible for relief of pain symptoms.
A ) Continuous radiofrequency
Continuous radiofrequency was developed in 1931, and pulsed radiofrequency was developed in the 1970s. The frequency of the current used in continuous radiofrequency is gradually increased until the electrode temperature is between 50° and 80°C (122° and 176° F). This temperature is maintained for 80 to 90 seconds, which is approximately the length of time required for the heat to cause nerve damage.
1To increase the likelihood of causing the nerve to be completely cut, multiple sites along a nerve are often exposed to the heat.
2 As a result of the heat that is generated by the electrodes, the nerve’s ability to transmit pain signals is reduced.
3 This procedure can take approximately one to two hours, depending on the injection site position as well as the number of nerves that need to be targeted for treatment.
B ) Pulsed radiofrequency ablation
1 While a pulsed radiofrequency ablation procedure is similar to continuous ablation procedure, it uses brief intervals of high voltage current (20 milliseconds) followed by silent, longer intervals (489 milliseconds).
2 The alternating current produces temperatures ranging from 40° to 42°C (104° to 107.8°F) and the pulsed pattern is maintained for at least two minutes, and for up to eight minutes depending on the number and location of nerves that need to be targeted for treatment.
3 In between the intervals of high voltage current, the heat is able to disperse and the targeted tissue remains lower than 42°C.
4 Therefore, the degree of tissue damage that is accomplished with continuous radiofrequency ablation procedures is not achieved with the pulsed procedure.
5 The purpose of the pulsed approach to radiofrequency ablation procedures is to stun the targeted nerves as opposed to damaging or cutting them, which is achieved with the continuous method.
6 Clinical studies have revealed that alternating between bursts of heat and silence weakens the membranes of the targeted nerves, but does not cause lesions.
7 Therefore, pulsed radiofrequency ablation results in a temporary inhibition of the nerve’s ability for pain signal transmission from the spine to the brain, without causing serious nerve damage.
8 Pulsed radiofrequency carries advantages compared to continuous radiofrequency ablation procedures, including a reduced degree of nerve injury and a reduced need for anesthetic medication during the procedure.
9 Furthermore, the pulsed radiofrequency approach results in fewer cases of pain after the procedure, reduced scarring, and it can be utilized for various sites and conditions that would be inappropriate for the continuous radiofrequency approach.
10 An example of this is the treatment of certain neuropathic pain conditions, including trigeminal neuralgia.
A ) This condition is the result of nerve injury and therefore using a continuous approach to treatment would result in further nerve damage and potentially worsen the patient’s symptoms.
B ) In these cases, it is more advantageous to block the pain signals by stunning the nerves through a pulsed radiofrequency procedure.
THINGS TO BE AVOIDED AFTER PROCEDURE / FOR RECOVERY
1 Driving or operating heavy machinery should be avoided for a period of 24 hours after the procedure
2 Vigorous activity (i.e. weight lifting, etc.) should be avoided for a period of 24 hours after the procedure
3 Bathing should be avoided for 24 to 48 hours after the procedure; however, showers may be taken
4 Swimming should be avoided for 48 hours after the procedure
5 Bandages covering the site may be removed prior to bedtime, but may need to be reapplied upon waking until the injection site has healed completely
6 Ensure that the bandage is securely adhered prior to taking a shower to avoid getting the injection site wet, as this will help to avoid infection
OTHER USES / INDICATIONS
1 Neck pain
2 Lumbar facet pain
3 Cervical facet pain
4 Dorsal root ganglion pain caused by aherniated disc
5 Lumbar spine pain caused by sacroiliac joint complex
6 Trigeminal neuralgia
7 Sympathetic ganglia
8 Sphenopalatine ganglion pain (headache and atypical facial pain)
9 Arthritis pain
CONTRAINDICATIONS
1 With active infections (e.g. a cold or sinus infection)
2 With blood clotting issues
3 Who may be pregnant
SIDE EFFECTS
1 Minor bleeding
2 Swelling
3 Skin discoloration
4 Bruising at the needle insertion site