Killing the nerves that cause back pain

By BARBARA BEAN-MELLINGER

Feeling Fit Correspondent

Back pain is one of the most common complaints, yet it can be severely debilitating. When the pain is caused by osteoarthritis degenerative arthritis and other treatments have failed, surgeons may opt for radiofrequency ablation (RFA).

In this minimally invasive procedure, surgeons use heat to destroy the small nerves that send pain signals from the facet joints in the back to the spinal cord. Although RFA can be used to eliminate pain elsewhere, it is most often used when facet joints are causing the pain.

Facet joints are the small, bony knobs that extend out from the spine. There are two of these knobs between each of the 24 vertebrae of the spine, and together these knobs form the joint. Each of the facet joints is covered with cartilage, which keeps the bones from rubbing against each other during movement. Like all cartilage, it can wear away, or degenerate, causing pain.

According to an article on WebMD, to see if a patient is a good candidate for RFA, the doctor will inject medication into the joint to block the pain. If the block is temporarily successful, that means the pain is coming from the facet joint.

The patient remains awake during radiofrequency ablation to assist by telling the surgeon whether or not he or she feels a tingling sensation when the needle is inserted. The surgeon uses an x-ray as a guide to know the general area to insert the needle. Local anesthesia is given so the patient feels no pain, but he or she can still feel the sensation.

When the patient signals that he or she feels the sensation, the surgeon knows that is the optimal place for the procedure. He then sends radiofrequency current through the electrode to heat the tissue and destroy the nerve.

Afterwards, there may be swelling and bruising at the injection site, but that should go away within a few days. The effects of the RFA should last from 6-12 months, although some patients remain pain-free for years. Some, however, do not experience relief, or only minor relief, from RFA. According to WebMD, up to 70 percent of patients treated with radiofrequency ablation feel relief from pain after the procedure.

Dr. Christopher Dawson, an orthopedic surgeon in Fort Myers, has performed radiofrequency ablation on many patients.

"Prior to the procedure, nerves are tested with a pain block to make sure that once disabled, the pain would be diminished by at least 50 percent," Dawson explained. If he decides to opt for the ablation, he chooses a five-millimeter area next to the nerve.

"You want that small area that heats up to be very close to the nerve," Dawson said. He heats the area at four levels for a total of 90 seconds.

It can take up to four weeks before the patient feels the full effect of the ablation. After four weeks, Dawson sees the patient to assess his condition.

More information and detailed explanations of the procedure can be found at www.webmd.com/pain-management/radiofrequency-ablation and at www.eorthopod.com/content/radiofrequency-ablation.

Dawson practices at Orthopedic Specialists of Southwest Florida, and can be reached at 239-334-7000.