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Radiofrequency Neurotomy (RFN)

Overview

If you’re living with ongoing back or neck pain that hasn’t improved with medication or physiotherapy then your doctor may suggest radiofrequency neurotomy (RFN).

 

Though you’ve probably never heard of it, RFN is a well-established non-surgical treatment that uses heat generated by radio waves to target the nerve responsible for your pain.

What Conditions Does Radiofrequency Neurotomy Treat?

RFN is a treatment for nerve-related pain, often in your neck or your back.

 

Your nerves are your body’s communication highway, sending messages between your brain and your body. They’re responsible for sending pain signals to your brain. Disabling those signals can improve your pain levels.

 

The nerves involved in chronic back pain are:

 

  • Medial branch nerves: These small nerves are connected to your facet joints, the hinges that hold your spinal vertebrae together.
  • Lateral branch nerves: These small nerves are connected to your sacroiliac joints at the bottom of your spine, above your tailbone.

 

Remember, we’re talking about disabling small nerves that are sending annoying pain messages, not larger nerves responsible for controlling your movements or providing sensation.

 

Exactly how much pain relief you experience from RFN depends on which joints and nerves are responsible for the pain. It also depends on whether your pain is entirely related to one joint/nerve or whether there are several contributing factors.

How Do You Know if RFN Will Help Me?

Before we recommend RFN, we examine you, review your medical history and check any previous scans you’ve had.

 

If we think RFN may help you, we then do something called a diagnostic block to help us decide.
A diagnostic block involves giving you a local anaesthetic to numb the nerves we would target in RFN. If numbing those nerves significantly relieves your pain, then RFN will probably be a good long-term solution.

How Does Radiofrequency Neurotomy Work?

RFN is an outpatient procedure. It’s done under sterile conditions in an operating theatre using a local anaesthetic and mild sedation.

 

During the procedure, you will:

 

  • Lie on your stomach on a special X-ray table
  • Have your back cleaned and the correct injection sites marked.

 

Your doctor will then:

 

  • Numb the skin on the injection site
  • Insert a needle into your back
  • Guide it to the nerve responsible for your pain using a live X-ray called a fluoroscopy
  • Test that the needle is in the right position (sensory and motor testing), which may cause you minor discomfort
  • Inject a local anesthetic and wait for it to take effect
  • Pass a small electrical current through the needle to generate heat that destroys the nerve and stops it sending pain signals to your brain.

Does RFN Work?

A number of studies have been performed on the efficacy of RFN.

 

For neck pain and headaches following motor vehicle accidents, research shows that RFN delivered significant improvement in pain levels lasting around 7 months.1,2

 

For patients with proven facet joint pain affecting the back, RFN treatment on the lower back enabled 90% of patients to have a 60% reduction in pain that lasted 12 months (and 60% of patients did even better and experienced 90% pain relief).3

What Happens to the Nerves and Surrounding Muscles?

The muscles innervated by the destroyed nerve have been shown to atrophy but this rarely causes significant weakness or paralysis. Patients have, for example, played in AFL finals and grand slam tennis finals within weeks of these procedures.

 

Your nerve function generally recovers in about 12 months. The outer sheath of your nerve remains intact and the axons (which send electrical impulses) regenerate meaning that normal nerve function eventually returns.

 

That may also mean that your pain comes back eventually and the RFN needs to be repeated. In the meantime, though, you’ve had the opportunity for a long break from pain, which may greatly improve your quality of life.

What Are the Risks of Radiofrequency Neurotomy?

The potential risks of RFN include:

 

  • An allergic reaction to the medications and anaesthetics (usually treated easily on the day)
  • Short-term nausea following sedation
  • Infection (extremely unlikely in modern, sterile operating theatres)
  • Post-procedure soreness usually only lasting a few days, though persisting for two months in some patients
  • Neuropathic pain, a tingling or burning feeling that can be treated with medication.

After the Procedure

Generally, you’ll be sent home about two hours after your procedure and can get back to your usual routine the next day.

 

You might need painkillers for a few days but this will be discussed before we send you home.

 

If you develop neuropathic pain, you may need prescription medicines to alter your nerve signals until it settles down.

 

We encourage you to keep mobile with gentle exercise and stretching.

 

We’ll usually see you again about 6 weeks after your procedure to check your progress.

Can the RFN Be Repeated?

Yes, RFN can be done on multiple occasions.

 

The treatment lasts for at least a year on average. If it wears off, and the same pain recurs, it can be repeated.

 

If you’ve had success with RFN before but the pain has returned, then please contact Metro Pain Group to discuss a repeat procedure.

Like to Know More About RFN?

If you’re living with ongoing nerve pain and would like to know if RFN could help you, then please make an appointment with us. We can assess your symptoms and talk about the various options for reducing your pain, including RFN.

References

  1. Lord SM, Barnsley L, Wallis BJ, et al: Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med 1996; 335:1721-1726
  2. McDonald GJ, Lord SM, Bogduk N. Long-term follow-up of patients treated with cervical radiofrequency neurotomy for chronic neck pain. Neurosurgery 1999:45: 61-68
  3. Dreyfuss, P; Halbrook, B, Pauza, K, Joshi, A, McLarty, Jerry, Bogduk, N. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Spine 2000:25; 1270-1277

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Disclaimer 

Please note the contents contained in this Patient Fact Sheet are not intended as a substitute for your own independent health professional’s advice, diagnosis or treatment. At Metro Pain Group, we assess every patient’s condition individually. As leaders in pain intervention, we aim to provide advanced, innovative, and evidence-based treatments tailored to suit each patient. As such, recommended treatments and their outcomes will vary from patient to patient. If you would like to find out whether our treatments are suitable for your specific condition, please speak to one of our doctors at the time of your consultation.

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