Radio Frequency Ablation in Chronic Pain Conditions

Introduction

Radiofrequency ablation (RFA) uses radio waves and they produce heat to destroy the nerve tissue. We use the inbuilt technologies to identify the selective pain-producing nerve in the specific area. Hence, we selectively ablate (burn) the nerve which signals the corresponding pain area. RFA is therefore best considered in long-term pain conditions – in degenerative spine, various joint arthritis and chronic neuropathic pain conditions. Various kinds of RFA techniques are available for specific sites and ailments. In this article, we will see the conditions and treatment benefits of RF ablation.

Pain Conditions Treated with RFA

As per clinical practice, chronic pain conditions are difficult for both the clinicians and the patients, because these pains are very resistant to conventional treatment methods like medications, physiotherapy and even surgical interventions. Finally, those are the patients who land up in the pain clinic and we selectively choose who will benefit from radiofrequency ablation.

• Spine pain conditions like low back ache, disc disease and neck pain.
• Arthritis-related pain of knee joints, shoulder joints and hip joints.
• Chronic neuropathic pain conditions like trigeminal neuralgia, occipital neuralgia, diabetic neuropathies, intercostal neuralgia and post-herpetic neuralgias.
• In cancer patients with chronic pain, RFA as per se reduces the requirement of multiple analgesics and opioid intake and improves the psychological well-being and quality of life (cancer pancreas, cancer breast & cancer colon).
• In vascular insufficiency, RF ablation of the lumbar sympathetic chain reduces the ischemic pain.

So, to conclude, RFA used in the above-mentioned conditions has proven to benefit the patient for a long duration.

Benefits of RFA

• Effective and longer duration in pain management
• Day care procedure
• Minimally invasive
• Reduces opioid intake
• Reduces pain medication intake
• Early ambulation
• Improves quality of life
• Safe procedure

Conclusion

RFA offers a longer-term effect by targeting nerves and innervating pain generators involved in chronic pain conditions. RFA is a minimally invasive treatment. The advantage of RF ablation is pain relief which usually lasts from 9 months to more than 2 years. The advantage is the regrowth of nerve fibers within a span of 6-12 months after the procedure. Hence, we may need to repeat RF ablation for the specific nerve if the patient feels the pain again. So, in conclusion, RFA is mainly for chronic pain conditions when all the other modalities have failed.

Dr. Karthickraja Velayutham
Senior Consultant Anaesthesiologist,
Kauvery Hospital, Chennai