Treating Lumbar Facet Joint Pain With Radiofrequency Ablation
In American, millions suffer from chronic back pain, and 45% of them have the facet joints as their pain generator. This is called facet joint syndrome. Out of all the interventional pain management procedures, facet joint injections are by far the most common. They have good to excellent results 80% of the time.
Making the diagnosis of facet joint syndrome is difficult with simply a history, physical examination, and imaging studies. Similar to arthritis seen in other body joints like the knee and hip, the presence of arthritis does not mean the patient will have pain. End stage degenerative arthritis may be present with the patient experiencing minimal pain.
The best method available for determining whether or not a patient has facet joint syndrome is a diagnostic injection into the joint. This injection is when a pain doctor performs a diagnostic injection of numbing medicine around the facet joint to numb up the small nerve endings supplying sensation to the joint (and pain). If the patient’s pain is substantially relieved from the numbing injection, then the diagnosis of facet joint syndrome is cemented.
Facet joint intra-articular injections and medial branch blocks have been shown to provide on average five to seven months of pain relief. When the pain comes back, the injections can be repeated with similarly successful results.
Radiofrequency denervation (ablation) was developed in the 1970’s and 80’s and subsequently modified as its popularity grew. It has gained popularity as more and more clinical studies have shown satisfactory outcomes.
Radiofrequency ablation involves putting a catheter in the same area as where a medial branch block is performed. Rather than injecting the numbing medicine at that point, the tip of the catheter is heated with radiofrequency waves and the tiny little nerve endings are deadened.
Outcomes of studies looking at radiofrequency ablation have been encouraging. Successful results after radiofrequency procedures have been seventy to ninety percent for a year with pain relief lasting for up to 2 years. This is over twice as long as an average facet joint injections. Eventually the medial branches that were deadened will grow back and the pain may come back. At that point the RFA may be repeated with similar satisfactory results expected. The RF procedure may allow patients to reduce their necessary pain medications.
It should be noted that patients may temporarily see increased pain after a radiofrequency ablation. This may be due to muscle spasms from the procedure. Typically within a week the pain relief will begin and the benefits will be noticed.
Radiofrequency procedures are done as an outpatient. They can be done with sedation or simply local numbing medicine. The procedure is fairly safe with low risks, but complication can occur. They can entail infection, spinal cord trauma, dural puncture, increased pain, or painful hyperesthesia/dysesthesias.
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