Radiofrequency Therapy

Transcutaneous radiofrequency neurolysis

Transcutaneous radiofrequency (RF) neurolysis is a modern, minimally invasive method that is applicable to various chronic pain conditions. It can provide relief to people with pain in the lower back, neck, joints as well as in many cases of cancer pain.
Kirschner first presented this method in 1931 to treat pain associated with trigeminal neuralgia [1]. However, Shaley (1975) made the first presentation of this procedure several years later for the treatment of pain in the spinal facet joints [2].
Numerous studies have shown that RF neurolysis of sensory nerves considerably lessens or even completely eliminates pain. Patients who have previously undergone infusions (infiltrations), with favorable but transient effects, are typically suitable for transcutaneous neurolysis [3-5].
There are two types of radiofrequency therapies —continuous and pulsed— applied either under CT- or fluoroscopic guidance, after the administration of a local anesthetic. In both approaches, a special insertion needle is used to implant an electrode on the target area, which provides controlled heat production. To confirm the electrode’s final position, a tiny amount of contrast media is always injected, combined with sensory and motor testing.

 

Continues Radiofrequency

In a continuous radiofrequency therapy, the temperature rises to 80-90°C, which destroys the target and prevents the spinal cord and brain from receiving painful signals.

 

Pulse Radiofrequency

In pulse radiofrequency therapy, the temperature reaches up to 42°C, causing neuroconversion in the target nerve. The “damage” is not permanent but the transmission of painful stimuli is markedly reduced.
After ablation, the majority of patients report feeling less pain, although the level of relief varies depending on the cause and location of the pain. The typical duration of the effect is between 3 and 18 months, with an average of 6 to 9 months. The first radiofrequency neurolysis session may be followed by additional sessions if the discomfort is noticeably decreased. Patients are advised to follow a monitoring and rehabilitation program from the Chronic Pain Team to ensure that the symptoms will not recur with the same, or less intensity.
After the procedure, patients are typically no longer dependent on continuous pain medication.

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  • It is performed under local anesthesia
  • It is bloodless
  • No need to stay in the hospital for more than 3-4 hours in total
  • Most of the time, patients may resume their daily activities (social, professional, and athletic) the next day.

 

Advantages

Indications for RF neurolysis:

  • Facet joints
  • Pain due to lesions in the sacroiliac joints
  • Denervation of the trigeminal branches in trigeminal neuralgia
  • Peripheral nerves
  • Intercostal neuralgias
  • Knee osteoarthritis
  • Headaches/Migraines
  • Post-traumatic conditions
  • Tailbone pain

Complications

This minimally invasive procedure has a very low risk of complications. Complications may include a neurological deficit in the distribution area of the nerve where the treatment was applied or in neighboring nerve structures, hyperalgesia and neuritis effect. Major complications include infection and bleeding but they are very uncommon [6,7,8].

Contraindications

RF application is contraindicated in patients with coagulation disorders, psychiatric problems, and sepsis. Patients with pacemakers (at risk of asystole) and those with implanted spinal neurostimulators (which must be turned off during the application of radio waves) require special consideration [7, 8].

References:

1. Kirschner M. Zur Electrochirugie. Arch Klin Chir 1931;161:761-768
2. Van Kleef M, Spaans F, Dingemans W, Barendese GAM et al. Effects and side effects of a percutaneous thermal lesion of the dorsal root ganglion in patients with cervical pain syndrome. Pain 1993;52:49-53.
3. Erdine S, Yucel A , Cunen A, et al. Effects of pulsed versus conventional radiofrequency current on rabbit dorsal root ganglion morphology. Eur J Pain 2005:9:251-6.
4. Cosman ER Jr, Cosman ER Sr. Electric and thermal field effects in tissue around radiofrequency electrodes. Pain Med 2005;6:405-24.
5. Sweet WH, Wepsic JG. Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibres. J Neurosurg 1974;40:143-56.
6. Sluijter ME, Mehta M. Treatment of chronic back and neck pain by percutaneous thermal le In: Lipton S, Miles J, eds. Persistent pain, modern methods of treatment. London, UK. Academic Press, 1981: Vol 3, 141-79.
7. Koning HM, Koster HG, Niemeijer RF. Ischemic spinal cord lesion following percutaneous radiofrequency spinal rhizotomy. Pain 1991;45:161-6.
8. Hsia AW, Isaac K, Katz JS. Cauda equina syndrome from intradiscal electrothermal therapy. Neurology 2000;55:320.

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