Pulsed Wave Radiofrequency Lesioning (RFL)
If your physician suggests a procedure called Pulsed Radiofrequency Lesioning as a means of treating your pain, some commonly asked questions are listed and answered below.
What is Pulsed Radiofrequency Lesioning?
Pulsed Radiofrequency Lesioning is a procedure using a specialized machine to interrupt nerve conduction on a semi-permanent basis. The nerves are usually blocked for 6-9 months (can be as short as 3 months or as long as 18 months).
Am I a candidate for the procedure?
Currently Pulsed Radiofrequency Lesioning is offered to patients with:
Complex Regional Pain Syndrome (CRPS), type 1 and 2
Sympathetically mediated pain
Femoral, Lateral femoral cutaneous nerve neuralgia
Mechanical neck or low back pain due to facet joint arthropathy
Greater and lesser occipital nerve neuralgia
Other areas of pain may be treated using this technique. You must have responded well to local anesthetic blocks to be a candidate for Pulsed Radiofrequency Lesioning.
What are the benefits of the procedure?
The procedure disrupts nerve conduction which may in turn reduce pain, and other related symptoms. Approximately 70-80% of patients will get a good block of the intended nerve. This should help relieve the area of pain the blocked nerve controls. Sometimes after a nerve is blocked, it becomes clear that there is pain from other areas as well.
How long does the procedure take?
Depending upon the areas to be treated the procedure can take from about twenty minutes to an hour.
Where is the procedure performed?
The procedure is performed in a procedure room and requires the use of fluoroscopy.
How is the lesioning actually performed?
Since nerves cannot be seen on x-ray, the needles are positioned using bony landmarks that indicate where the nerves are usually located. Fluoroscopy (x-ray) is used to identify those bony landmarks. After needle placement, an electrode is inserted through the needle. When the needle is in good position, electrical stimulation is done before any lesioning. This stimulation may produce a buzzing, tingling, or pressure sensation. You may also feel your muscles jump, which is a normal response.
You need to be awake during this part of the procedure so you can report what you are feeling. The tissues surrounding the needle tip are then heated when electronic current passes using the Radio Frequency machine. This numbs the nerves semi-permanently.
There are two types of lesioning that may be done. Pulsed radiofrequency lesioning utilizes a pulsed current at approximately 40 degrees Celsius for a period of 3 minutes. Radiofrequency lesioning utilizes a non-pulsed current at a higher 70-90 degrees for shorter duration of time. The type of lesioning to be done will be based upon your physician’s knowledge related to the area of your pain.
Will the procedure hurt?
Nerves are protected by layers of muscle and soft tissue. The procedure involves inserting a needle through skin and those layers of muscle and soft tissue, so there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the needle.
Will I be “put out” for this procedure?
No, the procedure is done using local anesthesia. Most patients receive intravenous sedation and analgesia, which makes the procedure easier to tolerate. The amount of sedation given generally depends upon the patient tolerance. It is necessary for you to be awake enough to communicate easily during the procedure.
How is the procedure performed?
It may be done with the patient lying on the stomach, on the back, or on the side, depending on the area being lesioned. You will be monitored during the procedure with EKG, blood pressure cuff, and blood oxygen-monitoring device. The skin will be cleaned with alcohol and an antiseptic solution, the area draped with sterile drapes and then the procedure is done. X-ray may be used to guide the needles.
What should I expect after the procedure?
Initially, there will be muscle soreness for up to a week afterward. Ice packs will usually control this discomfort.
What should I do after the procedure?
You should have a ride home. We advise you to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform the activities as tolerated by you.
Can I go to work the next day?
You should be able to return to your work the next day. Sometimes soreness at the injection site causes you to be off work for a day or two.
How long will the effects of the procedure last?
If successful, the effects of the procedure can last from 3-18 months, usually 6-9 months.
How many procedures do I need to have?
If the first procedure does not relieve your symptoms completely, it may be recommended to have a repeat procedure after re-evaluation. Because these are not permanent procedures, they may need to be repeated.
Will the Pulsed Radiofrequency lesioning help me?
It is very difficult to predict if the procedure will indeed help you or not. Generally speaking, those patients who have responded to repeated local anesthetic blocks will have better results.
What are the risks and side effects?
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and the possibility of complications.
The risks and complications are dependent upon the sites that are lesioned. Any time there is an injection through the skin, there is a risk of infection. This is why sterile conditions are used for these blocks. The needles have to go through skin and soft tissues, which will cause soreness. The nerves to be lesioned may be near blood vessels or other nerves, which can be potentially damaged. Great care is taken when placing the needles, but sometimes complications occur. Please discuss your specific concerns with your physician.
Who should not have this procedure?
If you have an active infection, you should not have the procedure. You should make your physician aware of the use of any blood thinning medications. If you have not responded to local anesthetic blocks, you may not be a candidate for this procedure.