Treatments
16. Radiofrequency of Peripheral Nerves
Objective: This treatment uses alternating high-frequency currents to produce a thermal lesion in the target nerve(s), resulting in up to 80% pain relief in varying durations (several months to several years). Indicated For: Patients whose pain doesn’t respond to conventional treatments, and who have: Trigeminal Neuralgia (particularly for older patients, or younger patients not interested in posterior fossa surgery); Cervicogenic Headache (a syndrome of chronic hemicranial pain); Spinal Pain; Groin Pain and Orchialgia; and miscellaneous types of pain such as Deafferentation, Plexus Avulsion, and Post-Surgical Neuropathic Pain.
Treatment: This procedure typically requires IV sedation. After we prepare your skin, we inject a small amount of local anesthesia. Using an x-ray, we then guide a thin needle close to the nerve, then block it with Lidocaine. We’ll be asking you questions about mild electrical signals and other sensations. Depending on your response, we might repeat the block up to three times.
Pre-Treatment: If no sedation is scheduled, please eat and drink normally on the day of the procedure. If sedation is scheduled, then please refrain from eating and drinking from midnight the day of the procedure—except for regular medications. Medications: 14 days prior to the treatment, stop Tclid (ticlopidine). 7 days prior, stop Plavix. 5 days prior, stop Coumadin and Warfarin.
Post-Treatment: We’ll need to keep you in the office for 20-30 minutes after the procedure to assess your pain and function, and confirm the lack of leg weakness or numbness. Resume your ordinary activity, diet, and medications, unless otherwise instructed. Feel free to remove your band-aid (if any) the day after your treatment. If there is discomfort at the injection site, apply ice wrapped in a washcloth (up to 20 minutes per hour) during the first 24 hours. After that, apply low to medium heat. IV Site: If IV was used during your procedure, there may be soreness and bruising around the site. It should go away in a few days. You can place a warm moist cloth over the area for half-hour long periods, several times a day. Important: Let us know if you experience increased tenderness or red streaking around the IV site, or swelling of your hand.
Side Effects: Numbness of the leg or arms. Let us know immediately if you experience any new and severe generalized weakness during the first week after the treatment, experience increased pain in the back, or develop a fever of over 102 degrees. Numbness in the skin over your back for a few hours is normal. Risks: Bleeding, infection, abscess, nerve injury, spinal injury are all extremely rare. Incorrect placement of the electrode may result in direct trauma to other structures such as blood vessels and other nerves. Additional risks may be incurred with intravascular or intraneural injection of LA. The CRF modality carries the greater risk due to thermal lesioning and concurrent injuection of LA or particulate steroid. Potential adverse effects include damage to adjacent nerves (e.g. trochlear and abducens nerves in trigeminal rhizotomy), damage to motor nerves, and deafferentation pain syndromes. The PRF modality carries relatively few complications directly attributable to the RF current, and is therefore the more attractive option.