Treating Lumbar Facet Joint Pain With Radiofrequency Ablation

In the US, there are millions suffering from chronic back pain, and just under half (45%) suffer from facet joint pain. This is called facet joint syndrome. The most common pain interventional pain management treatment by far is facet joint injections. They have a good result 80% of the time.

Even with a history, physical exam, and imaging, establishing the diagnosis of facet joint syndrome is fairly difficult. Simply because arthritis is present in facet joints does not mean the patient will have pain. End stage arthritis can be seen on the xrays, however, the patient may have no pain at all.

The best way to determine if the facet joint is the pain generator is a diagnostic injection into the facet joint. This is when a pain doctor performs a diagnostic injection of numbing medicine around the facet joint to numb the small nerve endings around the joint (medial branches). If the patient receives significant pain relief from this injection, then the diagnosis is established.

Medial branch blocks and facet joint injections have been shown to give 5 to 7 months of pain relief on top of just confirming the diagnosis. When the pain comes back, the pain doctor can repeat the injections with similar results expected.

In the 1970′s and 80′s, radiofrequency denervation was developed for the first time and modified as it became more successful. It has grown in popularity as clinical research studies have shown very good outcomes with the procedure.

Radiofrequency neurotomy (also called radiofrequency ablation or RFA), involves putting a catheter in the exact same area as where the medial branch block was performed. Rather than injecting numbing medicine and/or steroid, the tip of the catheter is heated up with radiofrequency energy which deadens the small nerve endings.

Results of studies that have been done looking at radiofrequency neurotomy have been encouraging. Good to excellent results after RF procedures have been 70-90% for a year with pain being relieved for up to 2 years. This is much longer than facet joint injections. Eventually the medial branches that were deadened will regenerate and the pain may return. At that point the procedure may successfully be repeated. The RF procedure may allow patients to decrease their pain medication needs substantially.

Individuals may unfortunately see a temporary increase in pain after a radiofrequency procedure. This could be a result of muscle spasms sparked up from the procedure. Typically within a week or two the pain subsides and the pain relief benefits get started.

RF procedures are performed in an outpatient setting. They can be done under local numbing and/or IV sedation. The procedure is predominantly safe with a low risk profile, but there are potential complications. Those include dural puncture, spinal cord trauma, infection, painful dysethesias/hyperesthesia, or increased pain.

Want to find out more about pain clinics in Arizona, then visit Preferred Pain Center’s site on how to choose the best AZ chiropractor for your needs.