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Radiofrequency denervation


Expert reviewer, Dr Norman Kufakwaro, Consultant in Pain Medicine and Neuromodulation, Bupa Cromwell Hospital
Next review due August 2021

Radiofrequency denervation is a procedure that's used to treat a type of neck or back pain that originates in your facet joints. Your facet joints are small pairs of joints that link the bones in your spine together. Radiofrequency denervation is also sometimes called facet rhizolysis, radiofrequency ablation or radiofrequency neurotomy.

Not everyone who has radiofrequency denervation finds it helpful. If you've been offered the procedure, it’s important to understand what's involved so you can make a decision that’s right for you.

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What is radiofrequency denervation?

In radiofrequency denervation, radiofrequency waves are used to deactivate nerves around the facet joints in your back or neck that are causing your pain. These nerves are called medial branch nerves and send pain signals to your brain if you’ve got inflammation in your facet joints.

The radiofrequency denervation procedure involves inserting a needle into your back under local anaesthesia. The radiofrequency waves heat the tip of the needle, which is then used to destroy the nerve endings. The aim is to stop the nerves sending pain signals to your brain.

Why would I have radiofrequency denervation?

Your doctor may offer you radiofrequency denervation if you have moderate to severe neck or back pain that starts in your facet joints. Your doctor will only suggest it as an option if other treatments haven't helped.

You can get facet joint pain with conditions such as arthritis, which can cause your facet joints to become worn down and inflamed. You’ll only be offered radiofrequency denervation if you’ve had a facet joint injection or medial branch block first. This will confirm whether your pain is definitely coming from your facet joints. The aim of radiofrequency denervation is to provide longer-term pain relief than a facet joint injection.

You’ll usually have radiofrequency denervation as part of a wider treatment plan that includes other therapies such as exercise programmes.

What happens during radiofrequency denervation?

You’ll need to go into hospital to have radiofrequency denervation. You can have the treatment and go home the same day – you won’t need to stay overnight.

You’ll need to lie on your front while you have the procedure. Your doctor will clean the skin and inject a local anaesthetic to numb any pain. They may offer you sedation too, to help you relax. Your doctor will guide a needle to the affected area of your back or neck, using X-ray images to help them find the right spot.

Your doctor may pass a small electric current through the needle to make sure it's in the right place, next to the nerve that's causing the problem. You might feel a tingling sensation when they do this, or twitching in the muscles in your back. Your doctor may need to reposition the needle if it's causing you any discomfort.

Once the needle is in place, your doctor will apply the radiofrequency waves, which will heat the tip of the needle and destroy the nerve endings. Your doctor may inject local anaesthetic and a steroid to help with any discomfort you might get after the procedure. You may have several injections during the same procedure – so if different areas need treating, this can be done at the same time. Some doctors prefer to treat one side of your back at a time – they may ask you to have a couple of procedures, a few weeks apart.

It will usually take about half an hour to an hour to have radiofrequency denervation.

What to expect afterwards

You'll be taken to a recovery room after the procedure, where you'll be monitored for a short time before you're able to leave. You may have your blood pressure or pulse checked, and you'll be asked whether you're experiencing any side-effects. Sometimes, you'll be asked to lie flat for 30 minutes or more.

You can usually go home between one and three hours after the procedure. You'll need somebody to drive you home – you won't be able to drive yourself. Ideally, you should have someone stay with you for 24 hours after your procedure.

You'll probably have some pain at first after the procedure. In fact, sometimes your pain can get worse before it gets better. Keep taking painkillers and aim to keep as active as you can. Your pain will start to lessen, and you should be able to slowly increase how much you can do. Try going for a gentle walk or swim at first – but be careful not to overdo it. Your doctor will give you more advice about what you can do and when.

How well does radiofrequency denervation work?

It’s important to realise that radiofrequency denervation doesn’t work for everyone. Studies looking at how well radiofrequency denervation works have had mixed results. Much of the research that has been done isn't of very good quality, so it's hard to tell for certain. One recent study suggested that it was no better than taking part in an exercise programme to relieve pain.

Some people do seem to benefit from the procedure though. It's hard to predict whether radiofrequency denervation will work for you. If it does, it can still take some time for your pain to improve. Radiofrequency denervation isn't a cure – if it works for you, it's likely to be effective for around 6 to 12 months or maybe, at most, a few years. It’s a good idea to keep a pain diary as this can help your doctor see whether or not the treatment has worked for you.

What are the side-effects of radiofrequency denervation?

The side-effects of radiofrequency denervation are usually quite mild and clear up on their own quite quickly. But it's important to be aware of them so you know what to expect.

You may have the following.

  • Mild bruising or tenderness in the area where you had the injection, for the first few days after the procedure.
  • Small burns, caused from the heated needle. Your pain may feel worse at first, before it settles down.
  • Prickling, sore skin on your back, similar to sunburn. This usually settles down, but can occasionally carry on for a few months.
  • Rarely, numbness or weakness in your legs if you've had a lower back injection. This usually goes away very quickly.

    More serious complications are rare with radiofrequency denervation. If you notice the area where you had the injection is warm or red, and you feel hot and unwell, it might be a sign of an infection. You should seek medical help and treatment with antibiotics. There is also a risk of injury to a nerve in your spine but this is extremely rare. The measures that your doctor will have in place are aimed at avoiding this.

    If you develop a headache or fever, or have ongoing numbness or weakness after you've got home, call the unit where you had the procedure.

Deciding on radiofrequency denervation

Your doctor will go through all your treatment options with you, including what to expect from radiofrequency denervation. You'll need to give your consent if you do choose to have the procedure.

A good way to help decide whether or not to have any procedure is to weigh up the pros and cons (benefits and risks). Here is a summary of the pros and cons for radiofrequency denervation.

Pros

  • Radiofrequency denervation may help to reduce the pain in your neck or back. This can improve your quality of life and make it easier to get about and carry on with your normal daily activities.
  • If the procedure helps to reduce your pain, you may find it easier to take part in exercise programmes. This may help to improve your condition in the long term.
  • The side-effects of radiofrequency denervation are generally mild and resolve quickly, on their own.

Cons

  • You might not get any pain relief from radiofrequency denervation, and the procedure can at first make your pain worse.
  • The procedure isn't a permanent fix. Any pain relief you get from radiofrequency denervation is likely to last between six months and a year, meaning you may need further treatment.
  • Although rare, there are some serious potential complications linked to radiofrequency denervation, including infection and nerve damage.

Although these are unlikely, you need to bear them in mind when deciding whether or not to have the injection.

Have a think about how much you value each of the issues above when making your decision to have treatment or not. Different people will put different values on each of these, so how you view them is very individual to you.

Questions to ask your doctor

Have a think about any questions you would like to ask your doctor before you decide whether or not to have radiofrequency denervation. Here are some examples.

  • What other treatment options do I have to relieve my pain?
  • What can I expect to happen after I’ve had radiofrequency denervation?
  • Will I be able to exercise after the procedure? What type of exercise is best?
  • Should I have physiotherapy after radiofrequency denervation?
  • How can I tell if radiofrequency denervation has worked? How long will it take until I know if it's worked?
  • What is the likelihood of the procedure working? How long will the effects last?
  • How will you reduce the risk of complications?


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Related information

    • Standards of good practice for medial branch block injections and radiofrequency denervation for low back pain. British Pain Society and Faculty of Pain Medicine of the Royal College of Anaesthetists. March 2014. www.britishpainsociety.org
    • Low back pain and sciatica in over 16s: assessment and management. National Institute for Health and Care Excellence (NICE), 30 November 2016. www.nice.org.uk
    • Niemisto L, Kalso EA, Malmivaara A, et al. Radiofrequency denervation for neck and back pain. Cochrane Database of Systematic Reviews 2003, Issue 1. doi:10.1002/14651858.CD004058
    • Lumbar facet arthropathy. Medscape. emedicine.medscape.com, updated 5 February 2017
    • Maas ET, Ostelo RWJG, Niemisto L, et al. Radiofrequency denervation for chronic low back pain. Cochrane Database of Systematic Reviews 2015, Issue 10. doi:10.1002/14651858.CD008572.pub2
    • Juch JN, Maas ET, Ostelo RW, et al. Effect of radiofrequency denervation on pain intensity among patients with chronic low back pain. JAMA 2017; 318(1):68–81
    • Information sheet for adult patients undergoing: Facet joint rhizolysis/radio frequency lesioning (denervation) for the treatment of pain. Royal College of Anaesthetists, June 2017. www.rcoa.ac.uk
    • Lumbrosacral facet syndrome. Medscape. emedicine.medscape.com, updated 18 December 2017
    • Spinal injections. OrthoInfo – American Academy of Orthopaedic Surgeons. orthoinfo.aaos.org, last reviewed December 2013
    • McCormick ZL, Marshall B, Walker J, et al. Long-term function, pain and medication use outcomes of radiofrequency ablation for lumbar facet syndrome. Int J Anesth Anesth. 2015; 2:2
    • Good surgical practice. The Royal College of Surgeons, September 2014. www.rcseng.ac.uk
    • Personal communication, Dr Norman Kufakwaro, Consultant in Pain Medicine and Neuromodulation, Bupa Cromwell Hospital, 9 August 2018
  • Reviewed by Pippa Coulter, Freelance Health Editor, August 2018
    Expert reviewer, Dr Norman Kufakwaro, Consultant in Pain Medicine and Neuromodulation, Bupa Cromwell Hospital
    Next review due August 2021



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