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Millions of individuals all around the world struggle with persistent low back pain, which has an enormous adverse effect on work efficiency and quality of life. Several individuals feel that conventional treatments like physical therapy, medical treatment, and even surgeries barely resolve their problems.

However, a procedure known as radiofrequency ablation (RFA) has been helping several individuals find pain relief. For people with low back pain, this new treatment has transformed the game in non-surgical pain management.

To figure out whether radiofrequency ablation is a real game-changer for backache, we will explore what it is, how it works, its benefits, in this article.

So, there would be several causes for low back pain. If pain in the low back lasts for more than 12 weeks than there can be several reasons such as: Herniated disc, Facet Joint Dysfunction, Sacroiliac Joint Dysfunction, Spinal Stenosis, Post spinal surgery pain syndrome etc.

What is Radiofrequency Ablation?

Radiofrequency ablation (RFA) is a minimally invasive procedure that uses high radiofrequency waves to target the specific neurons which transmit pain signals. In order to prevent damaged nerves from releasing pain signals to the brain, heat is transferred to them. The process involves the application of thermal energy to nerve tissues, effectively stopping them from sending pain signals to the brain.

Radiofrequency neurotomy is performed on any part of the spine that causes you pain. This includes:

Lower back pain (Lumbar facet joint pain)

Middle back pain (Thoracic facet joint pain)

Neck pain (Cervical facet joint pain)

Sacroiliac joint pain (SI joint pain)

Leg pain (Lumbar sympathetic plexus)

Abdominal pain (Sympathetic ganglion)

Pelvic pain (Hypogastric plexus)

RFA offers a long-lasting reduction in pain with minimal recovery time, in contrary to medications that only offer short-term relief.

There are two types of radiofrequency treatment:

Radiofrequency neurotomy creates heat at 90°C to break down nerves (radiofrequency denervation). This treatment can provide lasting relief from 6 months to 2 years. It is typically used to treat pain from facet joints or sacroiliac joint pain.

Pulsed radiofrequency creates heat in the nerves but at a lower temperature of 42°C to not break them down. It is typically used for nerve pain and can provide long-lasting pain relief.

The patient's well-being, medical history, and the outcome of diagnostic tests are among the factors that impact the RFA selection criteria. The following are the main factors in choosing RFA:

1. Clinical Indications

Chronic pain conditions, as discussed earlier (Herniated disc, Facet Joint Dysfunction, Sacroiliac Joint Dysfunction, Spinal Stenosis, etc.), Neuropathic Pain syndrome (Post spinal surgery pain syndrome, Complex Regional pain syndrome, etc.)

2. Diagnostic confirmation

X-ray, MRI, Labs, and  Positive results with diagnostic blocks.

3. Patient Selection

Pain persists after the conventional treatments (Physiotherapy, etc.), and most importantly, the patient who wishes to go for the procedure.

4. Exclusion Criteria

Severe Coagulopathy, Infections, pregnancy, etc.

The RFA Procedure:

1. Diagnosis & Evaluation: To identify exactly which nerve is triggering the pain, patients undergo diagnostic nerve block injections.
2. Preparation: A local anesthetic is administered to numb the targeted area when the patient is in a comfortable position.
3. Needle Placement: A specialized needle is placed close to the damaged nerve after being guided by ultrasound or fluoroscopic (X-ray) imaging.
4. Heating Process: The nerve tissue gets heated to about 80 degrees Celsius (176 degrees Fahrenheit) by delivering some electrical current through the needle.
5. Recovery: After the procedure, the patient is briefly monitored and is usually allowed to get back to their regular activities in 24 to 48 hours.

Pulsed Radiofrequency

Pulsed radiofrequency is unique in that it provides pain relief without causing significant damage to nerve tissue. The mechanism by which pulsed radiofrequency controls pain is unclear, but it may involve a temperature-independent pathway mediated by a rapidly changing electrical field.

Pulsed radiofrequency can be performed on any nerve that causes or generates your pain. These include:

Facial pain

Arm pain (spinal nerve roots or the dorsal root ganglion (DRG), stellate ganglion)

Chest pain (intercostal nerves)

Abdominal pain (splanchnic nerves, coeliac plexus)

Hip pain (obturator and femoral nerves)

Knee pain (genicular nerves)

Leg pain (spinal nerve roots or the dorsal root ganglion (DRG), sympathetic ganglia)

Occipital headache (greater and lesser occipital nerves)

Shoulder pain (suprascapular nerve)

Trigeminal neuralgia

Pelvic pain (pudendal nerves, ganglion Impar nerves)

Advantages of Radiofrequency Ablation:

Compared to traditional therapies, RFA has the following benefits:

Depending on how well the nerves recover, the procedure's relief from pain typically lasts six months to two years. Patients get long-lasting relief from chronic pain and an improved way of life since the treatment deals with the affected nerves specifically. This method is less invasive.

The most important advantage of this procedure is the quick recovery time. It is a quite good option for people who are hesitant about undergoing extensive therapy, as patients can get back to their regular activities in just a couple of days. The method additionally reduces dependency on medications, particularly opioids and anti-inflammatory drugs, which may result in adverse effects and increase the risk of dependency.

Why RFA?

The basic idea behind RFA is to regulate radiofrequency lesioning of sensory nerves, especially the medial branch nerves , which supply the facet joints. By interfering with nerve function, the brain no longer experiences pain in the affected location. According to some studies, RFA may reduce pain by 50% or more in a large percentage of chronic back pain patients. This treatment can be repeated if needed. 

Conclusion
Radiofrequency ablation has altered the treatment of constant back pain by providing a safe, effective, and minimally invasive alternative to traditional approaches. While not a universal treatment, it offers significant relief to people suffering from nerve-related pain in the back, reducing their dependence on drugs and enhancing their overall quality of life.

As research continues, RFA's role in pain management will continue to grow, establishing its spot as a game-changing treatment for persistent back pain.