Chronic Back Pain    from The Mayo Clinic

A new treatment option

 It seems like you’ve tried everything to relieve the pain caused by the arthritis in your lower back---but with only minimal success.

 You wonder: Can anything besides surgery be done?

 Perhaps. For arthritis---related back pain, radiofrequency ablation is a developing therapy that involves stunning or destroying with heat energy the nerves of a painful joint. In the right situation, this may bring welcome---though not usually permanent---relief.

Pinpoint the Cause

The foundation of pain relief with radiofrequency ablation is determining if arthritis is the cause of some or all of your back pain. Radiofrequency ablation only produces relief of the back pain from arthritis---and not other common causes such as muscle or ligaments, bone fractures or a disk rupture.

            The most common type of arthritis (osteoarthritis) involves wearing away of the cartilage that lines each of the 24 pairs of facet joints that help stabilize your spine. When this happens, bone ends touch and rub causing pain, stiffness and a loss of spine flexibility.

            The best candidates for the procedure are those who have arthritis pain that’s primarily confined to the spine area and possibly the upper buttock region---as opposed to pain that travels down the legs. The best results are often achieved in the joints of the neck and lower back.

            Normally, it’s best to have first tried more-conservative therapies, including physical, occupational, or chiropractic therapies, using heat and cold, reducing stress, correcting bad posture, or the judicious use of pain medications. These options can be effective at providing pain relief, often without the cost and risk of more advanced procedures.

            Radiofrequency ablation of spine joint nerves is an outpatient procedure, often requiring only local anesthesia. Special X-ray imaging is used to place a needle where the nerve typically runs. Tests to help ensure results and limit risk may include placing a drop of anesthetic on the nerves to one or more of your spine joints. If your pain is coming from one of those joints, it’s likely you’ll feel immediate, through temporary, pain relief.

            If testing fails to produce acceptable results, your doctor may avoid the procedure because ablation probably won’t provide much pain relief and any risk related to the procedure would be unnecessary

Applying the Heat

            Applying radiofrequency energy to the facet joint nerve involves placing an insulated wire near the nerve tissue. This can be done in two main ways, including using:

• Continuous radiofrequency---This involves heating tissue of the facet nerve to destroy it and sustaining that heat for about one to two minutes. This deadens a length of nerve tissue, preventing it from transmitting pain signals to the brain. The majority of people properly selected for the procedure are likely to experience a greater than 50 % pain reduction. Unfortunately, relief only lasts on average, 6 to nine months. It’s not clear why pain often returns, but it’s suspected that the nerve reconnect over time. The procedure can be repeated indefinitely. However, you may experience diminishing returns with each successive application.
• Pulsed radiofrequency---With this same amount of energy is delivered to the nerve as with the continuous method, but it’s delivered intermittently so that the tissue is “stunned” rather than destroyed.

Pulsed radiofrequency may be initially as effective as the continuous method. However, relief is generally of shorter duration, lasting on average three to six months. Since no tissue is damaged, the procedure is theoretically safer than continuous radiofrequency, and not expected to offer diminishing returns with repeated applications.

Minimal Complications

            Mayo Clinic doctors have seen good results using radiofrequency procedures. However, definitive research has yet to accurately quantify success rates. In addition, technique may vary among practitioners, leading to varying success rates.

            However, research indicates that the procedure results in an extremely small number of serious complications, although you may experience some soreness or nerve irritation that typically goes away in a week or two.

            If you have spine arthritis pain that hasn’t responded to more-conservative pain options, talk with your doctor about whether you might benefit from radiofrequency ablation treatment.

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