Ep. 41 Pain Procedures: Radiofrequency Neurotomy
Episode Summary:
In this episode of the It's Not In Your Head podcast, hosts Justine Feitelson and Dr. Dan Bates delve into the intricacies of radio frequency neurotomy as a pain management procedure. They discuss the diagnosis and treatment of facet joint pain, techniques used in radio frequency neurotomy, the risks involved, and alternative treatments for specific patient populations. The episode also covers practical considerations such as the effectiveness of the procedure, follow-up care, and managing post-procedure symptoms. Tune in to learn about a non-invasive yet effective method for treating osteoarthritis pain.
Episode Overview:
What Are Facet Joints?
Facet joints are small joints in the back, sometimes called "zygapophyseal" or "Z" joints, commonly affected by arthritis in the spine.
These joints can be a common cause of chronic back pain.
Diagnosing Facet Joint Pain
Medial branch blocks (local anesthetic injections) are used to confirm if facet joints are the cause of pain.
If significant, short-term pain relief is achieved, it suggests facet joints are likely the pain source.
What is Radiofrequency Neurotomy?
This procedure heats the nerve supply to the facet joint using special needles to interrupt pain signals.
The goal is not to cure arthritis but to reduce pain by stopping nerve transmission.
Procedure and Technique Considerations
A specialized needle heats the nerves to 80–90°C, coagulating them to reduce pain transmission.
Two main techniques: laying the needle parallel (preferred, more effective) or perpendicular (less effective unless a "volume" needle is used).
"Volume" needles create a larger burn but are less commonly used due to higher cost.
Expected Results and Duration
Most patients experience pain relief lasting 9–18 months, though the duration depends on individual healing and rehabilitation.
Some achieve longer-term improvement through active lifestyle changes and rehab.
Managing Risks and Side Effects
Potential side effects include temporary increased pain, burning/neuropathic pain (like sunburn), infection, bruising, or bleeding.
About 20% may experience burning pain for up to two weeks; it usually resolves with time and supportive treatments.
Infections are rare (risk about 1 in 5,000), but possible, especially if both sides are treated at once.
Special Populations
Not recommended for patients with complex regional pain syndrome (CRPS) due to high risk of aggravated nerve symptoms.
Alternative (pulsed) radiofrequency can be used for CRPS patients as it does not destroy nerves.
Procedure Limits and Repeatability
Can be repeated, but best results are often seen with limited, spaced procedures.
Repeated burns can increase risk for neuropathic pain, so limiting extent and frequency is important.
Other Areas and Considerations
Radiofrequency ablation can be done for nerves in the neck, thoracic spine, lumbar spine, and even for peripheral joints (knee, hip, shoulder, foot), though results may vary due to nerve anatomy.
Key Takeaways for Patients
Radiofrequency neurotomy is a targeted pain procedure for spinal and some joint pain when other options aren't effective.
Clients should expect a gradual improvement, sometimes needing six to eight weeks for peak relief.
Risks are small but real; careful diagnostic steps are crucial before treatment.