Can Rhizotomies Be Effective for Pain?
Rhizotomy, also called radiofrequency ablation (RFA), is a rising star on the pain management stage. RFA procedures interrupt pain signals from getting to the brain from specific areas of the body. Because RFA is a non-surgical treatment, the patient does not face the risks inherent in surgical operations, according to the University of California at San Francisco. The doctor targets specific nerves, depending on where the patient experiences pain.
Nerves carry messages to the brain from all over the body. Without these messages getting interpreted by the brain, a person cannot feel pain. Often, a pain signal to the brain alerts a person that something is wrong, for example, that he injured his ankle when he fell. Sometimes, however, a person endures chronic pain from irritated nerves.
When a person has ongoing pain from something like arthritis, cerebral palsy, or terminal cancer, the pain messages do not help the person. Chronic pain diminishes the quality of life and robs a person of the ability to be physically and socially active. Rhizotomies can diminish or eliminate pain by passing a small electrical current through a probe to the affected nerve.
At Westcare Clinic, we care about our patients and want them to enjoy their life. We have a wide variety of treatments available to address pain issues. When a patient does not get the desired pain relief from other therapies, we can evaluate whether a rhizotomy may be appropriate and effective.
An Overview of Rhizotomies
A rhizotomy is an effective treatment for axial pain that does not respond well to more traditional approaches. During this non-invasive process, you will be under intravenous (IV) sedation while the doctor inserts a tiny needle probe/electrode that delivers a radiofrequency pulse. The doctor will use a local anesthetic to numb the injection site before inserting the tiny needle probe/electrode.
An RFA procedure usually takes only an hour or two, and the patient can go home afterward. A person should not drive for at least 24 hours after an RFA, so the patient should arrange transportation home. Complications are rare and include nerve damage, bleeding, and infection. Nerves often regrow, so after a few months to a year, the effectiveness of the RFA might diminish. Results vary from one patient to another.
Most RFA procedures target the facet joints of the spine, but RFA can also help address chronic pain in other areas of the body, like the knees and hips. The National Institute of Neurological Disorders and Stroke (NINDS) of the National Institutes of Health (NIH) conducts extensive research on treatments for pain. The NINDS explains that rhizotomy/radiofrequency ablation decreases pain signals from specific areas by heating up a small portion of nerve tissue with radio waves from an electrical current.
In the past, many doctors merely prescribed opioid painkillers for patients with chronic pain, but the national epidemic of opioid addiction caused a different approach to pain management. Narcotic painkillers still have a place in the treatment of pain, but in lower doses and for brief periods. Rhizotomy is a tool that can treat chronic pain without causing addiction.
Rhizotomies for Back or Neck Pain
The National Center for Biotechnology Information (NCBI) of the U.S. Library of Medicine published a report on the use of rhizotomy (RFA) for chronic neck or back pain. Many people experience temporary back pain at some point in life, but as much as seven percent of adults live with chronic back pain. Chronic neck or back pain presents a pain management challenge for doctors. This ongoing discomfort limits the ability of many patients to lead a fully productive life or to enjoy life, yet the causes of chronic pain are complex and hard to treat.
The report indicates that rhizotomy can alleviate muscle spasms as well as pain. The procedure uses pulses of heat to sever small areas of nerve roots that send pain signals to the brain. Healthcare providers typically try other pain management interventions before turning to RFA, but this treatment can be useful in patients with persistent neck or back pain that does not respond well enough to standard therapies or who cannot undergo other treatments.
The NCBI report reviewed the existing literature for evidence of the effectiveness of RFA for neck or back pain. The research studies included patients with:
- Low back pain from facet disease of the lumbar spine
- Chronic neck, upper back, mid-back, or low back pain that had gone on for at least three months
- Chronic low back pain due to sacroiliitis of at least three months duration
- Pain from facet joint or sacroiliac joint or a combination of facet joint, sacroiliac joint, or intervertebral joint that did not respond to conservative treatment
- Chronic low back pain secondary to ankylosing spondylitis that lasted at least three months
The literature revealed mixed results, finding that a rhizotomy is effective at treating pain from some causes, might provide benefits for chronic pain from some other causes, and does not provide consistent pain relief for certain groups. The studies did establish that generally, a rhizotomy is a superior pain treatment to oral medications. Patients who take oral medications like arthritis drugs to manage chronic pain tend to experience drug-related side effects like abdominal and epigastric pain, nausea, diarrhea, and severe itching of the skin (pruritis).
The guidelines from these studies indicate that rhizotomy can be effective for certain types of neck and back pain like facet joint issues. Doctors should evaluate other, more conservative treatments such as chiropractic therapy, physical therapy, or home exercises before considering RFA. The patient’s pain level should be at least a 4 on the pain scale.
Rhizotomies for Knee Pain
Hundreds of thousands of people every year undergo knee replacement surgery because the joint breaks down from things like osteoarthritis. Knee replacement surgery is a major operation with a significant recuperation time. Recovery from knee replacement surgery involves months of painful physical therapy. Even after going through the surgery and recuperation, many knee replacements fail, and the patient is worse off than before the operation.
Every kind of surgery carries risks like infection, bleeding, and tissue damage. When the operation involves removing a body part like a knee and replacing it with an artificial joint, there are additional risks, like an allergic reaction to the material in the implanted device or a defect in the artificial joint.
The Cleveland Clinic advises that people whose knee pain from osteoarthritis had not responded well enough to conventional treatments might want to consider a rhizotomy, also called a radiofrequency ablation (RFA). The traditional non-surgical treatments for knee pain from osteoarthritis include:
- Weight loss to take pressure and strain off of the knee.
- Physical therapy to keep the joint flexible and functional.
- Over-the-counter pain relievers and anti-inflammatories like acetaminophen (Tylenol), naproxen (Aleve), and ibuprofen (Motrin).
- Knee braces help some patients.
- Steroid injections to reduce inflammation.
- Injections of hyaluronic acid. This substance is present in healthy joints.
When those interventions do not work, the patient might turn to knee replacement surgery, but there are several reasons not to take that route, including:
- Knee replacement surgery typically only lasts for 10 to 20 years, and then the patient has to undergo another surgery to have the failed replacement joint removed and a new one implanted. Then the patient has to go through the entire recuperation process again. With orthopedic surgery, each subsequent replacement tends to be less successful than the previous surgery and last for less time.
- Knee osteoarthritis is appearing in much younger patients now than in the past. People do not want to sign themselves up for a lifetime of knee surgeries that eventually fail and have to get repeated, each time with diminishing results.
- Some patients have underlying medical conditions that place them at a high risk of anesthesia or surgical complications.
- Some people get allergic reactions to the materials (like nickel and other metals) in some of the components of replacement knees.
Because of those issues, many people now opt for rhizotomy to relieve the pain of knee osteoarthritis by heating the malfunctioning nerves with radio waves. The heat deadens the nerve so that it can no longer send pain signals to the brain. Some patients experience a small amount of soreness in the area of the RFA procedure for a few weeks, but most people get more pain reduction than discomfort.
Nerves tend to grow back or regenerate, so the RFA procedure is not a permanent solution. Discomfort can return after about six months to two years. There is no limit to how many times a person can have a rhizotomy for regrown nerves to manage the pain of knee osteoarthritis. Continuing physical activity after a knee rhizotomy can help minimize future pain. The RFA can take away the pain so that the patient can tolerate beneficial exercise, but excessive physical therapy can do more harm than good causing excessive wear and tear conditions.
At Westcare Clinic, we offer many different options to treat pain. Rhizotomy can deliver excellent results, but it is not for everyone. You can call us today to find out how we might be able to help you escape the clutches of pain and enjoy your life again.