Wave of Relief

by: Jackie Makowski

Chronic back and neck pain can disrupt nearly every aspect of life. A minimally invasive treatment option is turning the tables by disrupting pain at its source. Radiofrequency ablation (RFA) is a nonsurgical procedure for patients suffering from recurrent pain in the lower back, neck and arthritic joints.

RFA uses radiofrequency waves to ablate or “turn off” the specific nerves transmitting pain signals to the brain. This minimally invasive technique can provide extended pain relief, improved mobility and a quick recovery time – with no incision.

“Radiofrequency ablation is a great option for patients experiencing facet-mediated low back or neck pain,” says Morris Scherlis, M.D., anesthesiology & pain management physician with Tennessee Valley Pain Consultants. “These patients often experience localized pain and stiffness which can increase with prolonged periods of inactivity.”

The facet joints are pairs of small joints between each vertebrae in the spine. They help stabilize and limit excessive spinal motion.

Each facet joint contains small nerves called medial branch nerves which carry pain signals to the brain. These nerves become painful when the facet joints are inflamed, injured or arthritic. This is known as Facet Joint Syndrome.”

A variety of conditions can lead to inflammation of the facet joints including spinal stenosis and osteoarthritis. Trauma to the spine such as a car accident can also lead to inflammation.

Common symptoms of facet joint syndrome in the lumbar spine include localized pain over the affected joint segment, referred pain to the buttock, hip or back of thighs and stiffness. Patients often describe increased stiffness typically in the morning after sleep.

Patients experiencing cervical facet pain often describe pain in the base of the skull, neck, upper back or even shoulders. Some patients may present with frequent headaches.

Physicians specializing in interventional pain management and non-surgical spine procedures can provide a thorough diagnostic exam to determine if a patient’s back pain stems from the facet joints. A history and physical are gathered access timeline and triggers of pain along with imaging scans to determine a diagnosis.

“Our goal is to not only manage pain but to try and change the pain at its source,” says Dr. Scherlis. “This often involves injections or ablation under fluoroscopy to specific and precise pain generators.”

Conservative treatment measures such as therapy are usually combined with a course of anti-inflammatory medications to decrease inflammation. Facet joint injections and medial branch blocks using steroid medications are also used to help localize and reduce pain. If facet pain is temporarily improved or resolved by these injections radiofrequency ablation may be suggested. “When considering a patient for radiofrequency ablation, we will perform a diagnostic medial branch block to pinpoint the exact nerves for treatment” says Dr. Roddie Gantt, anesthesiology & pain management physician with Tennessee Valley Pain Consultants.If a patient is a candidate, radiofrequency ablation is performed safely using fluoroscopic X-ray guidance in an outpatient setting. During the procedure, a physician inserts a small needle-like tube to the back of the spine next to the medial branch nerves. A radiofrequency electrode is inserted through the tube to heat the cells that act like insulation around the nerves. This “turns the nerves off” without damage and blocks pain signals from transmitting to the brain.The procedure takes approximately 15-45 minutes with minimal recovery time. Patients are able to go home after typically 30 minutes to an hour of monitoring. While some patients experience immediate relief, it may take up to 10 days to experience full pain relief from RFA. “Depending on a patient’s lifestyle and physicality of work, pain relief may last 6 months to a year,” says Dr. Gantt. “When the insulation cells around the nerves begin to function normally again ablation may be repeated if necessary.” RFA is also offered for severe knee pain patients suffering from progressive diseases like osteoarthritis. Pain can also present after a partial or total knee replacement. For these patients, a Genicular Knee Block or Ablation can be performed and works similarly to RFA by targeting three medial branch nerves in the knee.

The physicians at Tennessee Valley Pain Consultants, Drs. Ronald Collins, Morris Scherlis, Roddie Gantt, John Roberts and Thomas Kraus, perform Radiofrequency Ablation for the cervical and lumbar spine as well as the knee. All five physicians are double board-certified in anesthesiology and pain management and offer non-surgical treatment options for common spine, nerve and joint conditions. To learn more, ask your physician or visit www.tnvalleypain.com.