You need Radiofrequency treatment?

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You need Radiofrequency treatment?
03 September 2023

You need Radiofrequency treatment?

Nowadays most patients with chronic pain would get offered Radiofrequency as a means of treatment for his/her pain problem at certain point and a lot of those patients would lack knowledge about this treatment and what to expect.

First of all we need to understand what is Radiofrequency and what are the indications for its use in order to be able to make informed decisions about what treatment to accept.
I always simplify the concept to my patients by likening Radiofrequency to the microwave we use at home where we deliver certain wavelength of energy through needles very close to the area we would like to treat and this energy generates certain degree of temperature either in a pulsed fashion, we call it pulsed Radiofrequency, where we generate heat up to 42 degrees, very close to body temperature. This happens when we are aiming at preserving the nerve we would like to treat since we can not destroy it for example when we are dealing with a mixed nerve that carries signals for both motion and sensation. Here the function of Radiofrequency would be modulating or modifying how the nerve works rather than destroying it. There are numerous indications for this mode of Radiofrequency, one of the most common is patients with sciatica where they experience nerve type pain down a limb due to irritation of a nerve root at the spine. Here, patients would undergo nerve root injection on therapeutic and diagnostic basis which means treating the pain while confirming the source of pain with local anaesthetic and steroids. If this gives good result but not long enough, it’s very acceptable to follow this with pulsed Radiofrequency to give longer term pain relief.

The other form of Radiofrequency is what’s called conventional Radiofrequency where temperature reaches 80 degrees; more than double body temperature, hence intuitively we are burning the nerve that’s contributing to the pain problem. There are many indications for this treatment for example back pain arising from the small joints between vertebrae called facet joints. Here we start with diagnostic numbing of the nerves that supply those joints using local anaesthetic only and we ask patients to carry on with their routine life while paying attention to any improvement in their pain level and/or function over the first few days after injection. If patients achieve 50% or more improvement in their pain over the first few days we consider this a success and we can follow it up with conventional Radiofrequency ablation of the nerves that we numbed before, aiming to give patients long term pain relief that can extend up to a year or more especially in patients who engage in a parallel physical rehabilitation program and stay in a positive mindset about their condition, focused on quality of life and daily functioning.

There are many other indications for the use of conventional Radiofrequency such as pain coming from joints; hips, knees and shoulders or pain coming from Sacroiliac joints. Treatment follows the same concept where we offer patients diagnostic block first to the nerves that supply the painful structures to be followed by Radiofrequency ablation of those nerves if the diagnostic block is successful.

Patients tend to frequently ask some questions, for example, can I have the Radiofrequency repeated in the future and the answer is yes but sometimes subsequent Radiofrequency ablation gives less favourable results since we won’t know for sure where the nerves initially ablated are going to regenerate. Also patients ask, if I have Radiofrequency ablation of a joint could I still have surgery and the answer is also yes, in fact, if your pain improves after Radiofrequency ablation and you are able to engage in a physical rehabilitation program you will enter surgery in an excellent shape and your postoperative rehabilitation will be quicker.

Here I need to give my patients sincere advice, please don’t accept Radiofrequency procedures without a successful diagnostic injection first. It might sound counterintuitive and you ask why would I have two procedures when I can have one and why shall I pay twice when I can pay once and the answer is pain is a complex disorder and usually it’s hard to pin point the source of pain without some sort of diagnostic injection first and you would risk high failure rate if you go to Radiofrequency straight ahead , more importantly this is what all scientific bodies looking after interventional pain practice recommend.

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