Radiofrequency ablation or RFA, is a pain intervention where needles are placed under ultrasound or xray guidance to target area. These target areas usually have tiny nerves that are the pain generators. Applying RFA to these nerves deactivate them via heat; also colloquially termed “burning the nerves”. However, while there is some thermal damage to these pain generating nerves, these nerves do grow back. The pain signals may reset after they grow back.
1.Facet Joint Innervation
The facet joints are the supporting cast of the back bone, from the neck to the waist. While we all see the main body of each vertebra (or each piece of the back bone), the facet joints play a role in stability during movement of the spine. Understandably strain, degeneration or trauma to these joints will cause the sensation of neck or back pain.
While giving steroid injections or applying RFA to the joints is ineffective, RFA to the joint innervation is a proven technique to reduce neck or back pain.
RFA to the hip nerve supply can be an option for intractable hip pain for patients who opt not to undergo surgery or are not suitable surgical candidates.
This procedure is done under ultrasound guidance with sedation. It is quick, and with ultrasound, may avoid the large blood vessels and major nerves running through the area.
Do note that this is a pain reducing procedure. Any existing degeneration does not go away even if the pain is reduced.
The nerve supply to the knee can be ablated for intractable knee pain or for patients who opt not to go for surgery. This simple procedure is performed under ultrasound to better visualize the nerve supply to the knee.
This nerve supply is complex and occasionally near major nerves, so partial denervation is usually performed. This means that pain signals will be reduced but may not be totally eliminated.
As with hip denervation, the reduction of pain signals does not mean the degeneration has healed.
While uncommon, ablation to the shoulder joint nerve supply may be performed to reduced intractable shoulder pain.
This is performed under ultrasound as the shoulder joint is surrounded by many sensitive structures, including major blood vessels.
The shoulder nerve supply is more complex than the knee, hence total elimination of pain symptoms via ablation may not be possible. However, the main goal is to reduce pain so that other adjuncts such as physiotherapy may be commenced, or while awaiting a suitable date for surgery.
5. Sacroiliac Joint Innervation
The sacroiliac joint is a tough joint that is very immobile. However, it is located in a high stress area- the waist, where the hips and the lower back bone are located. It is also susceptible to pain due to falls or degeneration.
This safe procedure is performed under xray or sometimes ultrasound guidance. The nerve supply runs along the sacrum, a piece of protective bone surrounding the last ends of the spinal cord and covering the lower parts of the intestines.
6. Celiac Ganglion/ Splanchnic Nerves
The celiac ganglion is a special gathering of nerves near the back bone that supplies the intestines. Occasionally, due to abdominal disease such as pancreatitis, or tumours, there may be chronic abdominal pain.
Ablation of the celiac ganglion or splanchnic nerves (which are the precursors to the celiac ganglion) may be performed safely via xray guidance.