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Referred Pain: Can it be treated by Radiofrequency Ablation (RFA)?

By Christina Lasich, MD

Leg pain, arm pain, and even headaches can all be referred from the facet joints in the spine. These small joints connect each vertebral body. Like other joints in the body, the facet joints can wear out and develop arthritis (inflammation of a joint characterized by swelling and pain). Facet arthritis pain can refer to distant parts of the body as discussed in the article called “Sciatica: What is it?” If the source of this traveling pain is targeted, then vast swaths of pain can disappear. The newest invasive treatment actually targets the medial branch nerve that acts like a telephone line for the facet joint pain. When that line is cut, the pain signals from the joint cannot get through to the brain. The “cut” is actually a burn in the nerve. In other words, the nerve is ablated by radiofrequency heat—called Radiofrequency Ablation (RFA). Because the nerve can repair itself, this intentional injury is just a temporary disruption of the referred pain.

Ralph heard about Sally’s leg pain. Unlike his cousin’s leg pain, Ralph’s leg just aches in the buttock without any numbness, tingling, or burning pain. Usually, his pain is worse when he has been standing for a long time. Occasionally, he feels a cramp in his calf. Every year, the pain just gets worse and worse. Ralph pleads with his doctor to “fix” the pain. His doctor suggested some “nerve blocks” that would determine if he was a candidate for a more permanent nerve burning procedure.

Blocks and burning; sounds very barbaric. But, this method is very sound in principle. Before sticking a heat probe (radiofrequency probe) into the spine, doctors first need to determine if a RFA has a good chance to relieve the pain. The first two blocks use temporary numbing chemicals to anesthetize the nerve. If the first one relieves 80% of the significant pain, then it is successful. But, to be sure, the injection is repeated to validate the initial results. The relief from the first two nerve blocks is time limited according to which chemical is used. With this screening method, only the patients with worthwhile relief will proceed to the nerve burning procedure—RFA. Under x-ray guidance, the heat probe is placed in the vicinity of the facet nerve. Zap, the nerve is burned so that the pain signals cannot get through to the brain. The facet joint will still have arthritis; only the pain is blocked.

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