Radiofrequency Neurotomy for Joint Pain

Radiofrequency neurotomy (RFN) is a treatment that uses heat from radiofrequency waves to target a specific nerve that is causing pain in a diseased joint. It can be used to stop the pain in arthritic or injured joints in the neck, back, pelvic and knee areas.

This minimally invasive procedure is done by a pain specialist, in an outpatient clinic. It involves the placement of a special needle through the skin, to the painful joint areas. Radio waves emitted from the needle, heat the painful nerve until its ability to send pain signals is turned off.

Pain relief is almost immediate and can last from six months to two years. This is a low-risk procedure that can be repeated if your joint pain returns after an initial successful procedure.

Radiofrequency neurotomy – basic concepts

RFN, also referred to as radiofrequency ablation (RFA), is a treatment that is provided to you by a pain specialist when conservative treatments such as rest, medications, and physical therapy, have failed.

During the procedure, a special needle is used to deliver radiofrequency waves (heat) and burn a specific nerve, that is creating pain sensations in your affected joint. Thus, by temporarily destroying the nerve, your pain specialist is able to stop the nerve from sending pain signals to the brain.

Advantages of RFN:

1. Minimally invasive procedure – this treatment involves only the placement of needles in your painful area. There is no surgical scar.
2. Safety – this is a low-risk treatment performed by a pain specialist under X-ray guidance, for increased safety.
3. No hospital stay – you are able to go home the same day.
4. Long-term pain relief – RFN provides months, even years, of pain relief for your joint pain. Since the lesioned (burned) nerve regrows very slowly, you can enjoy long-term pain relief.

Common types of joint pain treated with RFN

Radiofrequency neurotomy (RFN) is commonly used to treat joint pain in your neck, back, sacroiliac joint, and knee. A brief review of these common joint conditions will clarify when a RFN treatment can help you.

Facet joint pain – neck and back arthritis

You may think of “back pain”as a problem with an injured disc, muscle spasms, or a pinched nerve. However, arthritis of the multiple small joints in your spine is another common cause for neck and back pain.

Each backbone unit in your spine contains two sets of facet joints. Facet joints add flexibility to your spine and limit excessive motion. Sensation in the facet joint is provided by the medial branch nerves. Facet joint pain, known as facet joint syndrome, may be treated by applying RFN to these nerves.

Symptoms of facet joint pain:

• Limited ability to turn your neck or back.
• Numbness/muscle spasm in your neck or back.
• Facet joint pain in your neck is felt as pain at the base of your skull and causes frequent headaches.
• Facet joint pain in your back is felt in the center of your spine, and may travel to your buttocks and thighs.

Sacroilliac joint pain

Sacroilliac (SI) joints are large joints that connect your lower spine to the hip bones. There is one SI joint on each side of your body. The SI joints withstand a lot of pressure while helping you maintain an upright position. They’re also under a lot of strain in women during pregnancy and birth.

Just like other joints, the SI joints contain a lubricating fluid and contain free nerve endings that send pain signals to the brain. The nerve(s) responsible for SI joint pain vary among people. RFN treatment for the SI joint can target the L5 to S3 lateral branches.

Signs of SI joint pain:

• Dull ache on one side of your lower back that may extend into your thigh.
• Pain in your legs or groin area.
• Pain increases with prolonged standing or repeated movement (stair climbing).

Knee joint pain

The knee is one of the largest and most important joints in your body. It consists of two parts. One joins the thigh with the lower leg and the other joins the thigh (femur bone) with the patella (kneecap). Therefore, the knee joint is essential for movement in horizontal (walking, running) and vertical (jumping) directions.

The knee receives a lot of strain and is likely to develop pain in patients of all ages. It is prone to sport-related trauma and arthritic pain. A genicular nerve RFN can help with your knee pain. Additionally, it can even help with pain after knee replacement.

Signs of knee joint pain:

• Constant ache at rest.
• Sharp, shooting pain when moving.
• Weakness or instability.

Common triggers for joint pain:

1. Osteoarthritis – much like the wear-and-tear on your car breaks, arthritis wears down the cartilage in your joints. With time, this leads to joint inflammation and bone-on-bone grinding.
2. Obesity – Being overweight places additional stress on your joints.
3. Trauma – a car accident can cause whiplash and dislocate (shift out of place) smaller joints, like the facet joints, causing pain in your neck and back. You may experience an SI joint fracture after a fall.
4. Intense Sports – repetitive pounding during jogging is a frequent cause of knee joint pain.

Finding the painful joint

Your doctor can diagnose joint problems based on your clinical history, physical exam, imaging tests and by performing diagnostic injections. Additionally, the physical exam may include provocative tests, meant to reproduce your pain.

Diagnostic tests:

• X-rays – is a quick, painless test, particularly useful in showing disorders in your bones, or joints.
• MRI – magnetic resonance imaging is a non-invasive imaging test that uses a magnetic field to create detailed images of body tissues.
• Intra-articular block – is a direct injection of numbing medication (and dye) into the painful joint.
• Nerve block – this is an injection of numbing medication around the nerve that is causing joint pain. Significant improvement after a nerve block, tells your doctor where to perform additional treatments, such as RFN.

When is RFN performed?

Treatment starts with conservative measures (rest, medications, physical therapy), then advances to steroid injections to decrease inflammation. Your pain specialist will suggest RFN if all these measures have failed.

Treatments for joint pain:

1. Rest – reduced motion in the painful joint and may help ease symptoms, at first.
2. Anti-inflammatories – nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain for brief periods of time, allowing you to finish physical therapy.
3. Muscle relaxants – muscle spasm in the area overlying your painful joint, can improve with these medications.
4. Physical therapy – stretching and strengthening can restore normal function to the painful area.
5. Steroid shots – an injection with cortisone may provide weeks-months of pain relief.
6. Regenerative treatments – a joint injection with platelet-rich plasma (PRP) can stimulate your joint to start growing healthy tissue again.
7. Surgery – is considered if other less invasive treatments fail or if your joint pain is due to severe trauma.

The RFN procedure

Before RFN:

• You may need to stop taking blood thinners several days before your appointment.
• Arrange for a ride home.
• Take your (blood pressure) medications as scheduled, with a sip of water.
• Avoid eating.

During RFN:

• First, you will lie on your stomach on an X-ray table (for lumbar joint or SI joint procedures).
• Secondly, the skin over the treatment area is cleaned with a disinfecting solution.
• Next, a local anesthetic is used to numb the skin.
• Then, needles are placed and correct positioning is verified with x-ray.
• You may then feel some pressure and muscle twitching to ensure correct needle positioning.
• The tiny nerves responsible for your pain will then be numbed with more local anesthetic and the RFN will then proceed over the next few minutes.
• Finally, needles are removed and band-aids are placed over the needle sites.

After RFN:

• The procedure itself takes 15-30 minutes; there will also be a recovery period, before you go home.
• You may be sore in the treated area. It helps to apply ice.
• You may have temporary numbness or some mild burning.
• It may take a few weeks before you feel the full benefits of RFN.

RFN outcomes

The Spine Intervention Society has determined that most patients who received RFN for chronic neck joint pain, were pain-free at 6 months; over a third were pain-free at 1 year.

Although success rates vary among individuals, about 30% to 50% of patients undergoing RFN for low back pain will have significant pain relief for as long as two years.

RFN of the sacroiliac joint may provide significant relief lasting up to 1 year.

After a period of 6 to 18 months, your nerve may regenerate and joint pain may return. A RFN treatment can be repeated by your pain specialist, and offer you pain relief again.

Joint pain due to arthritis or injury can interfere with your work and leisure activities. A pain specialist can find the best treatment for you. Our doctors at NSPC are available to help you return to a more active lifestyle.