Pain Awareness Month: How Radiofrequency Ablation Can Alleviate Low Back Pain
For Pain Awareness Month, let’s talk about an excellent interventional treatment for low back pain due to arthritis.
Among all musculoskeletal disorders, low back pain is the number-one reason patients seek medical care and is the leading cause of disability. The causes of low back pain are complicated and at times difficult to diagnose. A common source of pain within the degenerative spinal disorders is lumbar osteoarthritis otherwise known as lumbar facet arthropathy or lumbar spondylosis.
The facet joints are located in the posterior aspect of the spinal column opposite of the discs which are found in the anterior portion of the spine. Typically, the spinal discs become degenerated or “wear out” with age. This in turn increases the facet loading leading to accelerated degeneration within the joints. Arthritic back pain presents as increased pain while in upright positions such as standing or walking or even when lying flat on one’s back. Usually sitting or sitting hunched forward will improve symptoms. Oftentimes, the pain does not radiate although in severe cases patients will experience pain radiating into the lower extremities but usually not past the knees. Patients will also complain of stiffness and pain with activities that incorporate forward bending such as vacuuming, mopping or stooping over to pick items off the ground. Pain will usually arise without particular inciting event and can sometimes become debilitating.
The treatment for patients with acute low back pain are a combination of physical therapy, home exercises and over-the-counter pain relievers. For those with chronic low back pain due to arthritis who try and fail a course of conservative treatments, it would be reasonable to trial injection therapy. For facet arthropathy, nerve blocks are typically performed to diagnose the affected joints. This will involve injecting a small amount of local anesthetic, typically without corticosteroid, next to the medial branch nerves which are the small nerves near the facet joints that carry the pain signals from the joints to the brain. The injection aims to block the pain signals transmitted through the medial branch nerves and produce targeted pain relief. A successful block would result in 80% relief or more following the injection for several hours following the procedure. If two sets of these blocks provide such relief then the next step would be to proceed with radiofrequency ablation (RFA) treatment which involves creating heat lesions on the nerves to offer longer pain relief. Pain relief typically lasts 6 to 12 months and patients will usually begin to experience relief within the first 4 to 6 weeks. If successful, RFA can then be repeated should the pain relief wear off.
The benefits of RFA treatments are the longer duration of relief and lower potential risks linked to repeated corticosteroid use. Both the medial branch blocks and RFA are performed at the hospital under x-ray guidance typically under local anesthetic. Procedures take between 15 minutes to an hour and patients will return home the same day with a driver. Patients taking blood thinners can often proceed with the procedure without needing to stop them – although this is decided on a case-by-case basis following shared discussion with your physician.
About Palo Pinto General Hospital
Palo Pinto General Hospital, operated by Palo Pinto County Hospital District, is dedicated to providing high-quality convenient health care throughout the region. The county’s leading health care provider operates healthcare facilities in Mineral Wells, Gordon, Santo, and Possum Kingdom Lake, emphasizing prevention and wellness.
PPGH’s growing network includes an acute care hospital and skilled nursing unit; Urgent Care and primary care clinics; physical therapy, specialty clinics in women’s services, cardiology, orthopedics and sports medicine, pain management, pediatrics, urology, and pulmonary; and a mobile healthcare unit.