Bend Spine &
Pain Specialists

929 SW Simpson Ave.
Suite 250
Bend, OR 97702

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Chronic
Neuropathic Pain

Narcotic
Pain Medications

Radiofrequency
Ablation

Radiofrequency Ablation
Chronic pain can result from arthritis in the small joints of the spine called facet joints.  Although there is no cure for arthritis, it is useful to help patients temporarily relieve their pain in order to promote employment, exercise and social activities (improved function).  Relief of pain through interventional techniques can often reduce the need for habit forming narcotic pain medications.  Facet joint pain can be relieved for 6-12 months at a time with the use of radiofrequency ablation.  Over 40% of patients presenting to pain clinics with back pain have back pain due facet joint arthritis.  Facet joint arthritis can co-exist with other causes of back pain such as sacroiliac joint pain, disc degeneration  or herniated disc.

The facet joints are near the back of the individual bones of the spine called vertebra.  The front of the vertebra are attached to the discs, which act as spacers and shock absorbers.  In between, on both sides of the vertebra are openings through which spinal nerves exit the spinal canal.  The facet joint is a true articulation where movement of adjacent vertebra  occurs  at the cartilage surface associated with joint fluid and a joint capsule.  Pain from the facet joint itself usually involves the midline of the back as well as the muscles on both sides of the midline.  Pain from the lumbar (low back) facets can refer pain out to the hips and upper leg.  Pain from the cervical (neck) facets can cause daily headache or shoulder pain or pain between the scapulae (shoulder blades).

A small nerve called the dorsal and medial nerve  is a branch of the spinal nerve, and it transmits pain from the facet joint to the spinal cord. Each facet nerve transmits pain through two or three of these nerves.   Medial branch radiofrequency ablation  is a technique that makes use of a tiny heat source at the tip of a needle to quiet the pain transmitted by these minor  nerves .  Despite their small  size, the medial branch nerves can transmit a lot of chronic back pain.  The ablation is even less invasive than minimally invasive surgery.

After discussion of the pain pattern, an examination and review of relevant x-rays and medical records, Dr. Ford will make a recommendation for testing to determine where the pain is coming from.  Most doctors and patients don’t realize that MRI and other expensive imaging studies do not show pain.  These are just detailed pictures of our bodies.  In fact, when patients have spinal arthritis, so many structures can be reported as abnormal on an MRI, that it only serves to confuse the diagnosis.  The way to tell if a part of the body is painful is to block the pain impulses coming from that part of the body, and see if the pain disappears.  This is called a diagnostic injection.  A diagnostic injection can be into a facet joint or the nerves that go to the facet joint.  A diagnostic injection often involves more than one nerve branch at a time.  This is because if even a single nerve branch is left behind to transmit pain from the back, it feels bad.

When the patient and Dr. Ford are convinced that the right combination of nerves has been found to eliminate the pain, the next step is the decision to ablate the nerve.  If the painful facet has been identified using a local anesthetic block into the joint, the addition of a steroid may provide weeks or months of pain relief.  If only short term relief is obtained, then radiofrequency ablation is usually recommended to achieve 6-12 months of pain relief.

Frequently Asked Questions

How long does the test injection take?
Is it painful?
How long does the test injection pain relief last?
How long does the RF ablation take?
Is the ablation painful?
Will I lose function with a nerve burning procedure?
How effective is the procedure?
Why isn’t it permanent?
How effective is the procedure?
What happens when the pain returns?
What are the risks?


How long does the test injection take?
Usually 20 minutes.  The procedure is done under sterile conditions, under x-ray guidance in the Bend Spine and Pain Specialists office.
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Is it painful?                 
Most patients have this procedure done with local anesthetic since it uses very small needles.  Most patients do not find the procedure very painful.  For those patients who are anxious, an IV can be started and relaxation medicine given.  We do not put patients to sleep for spinal injections.
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How long does the test injection pain relief last?
Pain relief after the test injection can last for hours due to the local anesthetic.  However if there is a good result from the steroid, pain relief can last for days.  Patients are asked to record their pain score for several days after a test injection.

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How long does the RF ablation take?
The burning procedure takes longer because it is necessary to precisely locate each nerve.  It can take over an hour.

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Is the ablation painful?
Dr. Ford uses local anesthetic to numb the nerve prior to ablation.  Performing an ablation without anesthetizing the nerve with local anesthesia is painful.
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Will I lose function with a nerve burning procedure?
No useful function is lost after RF ablation of the medial  branch nerves.  Special precautions are taken to avoid injuring spinal nerves during the medial branch ablation.

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Why isn’t it permanent?
The ablation doesn’t kill the nerve.  It just disconnects the nerve arm (axon) from the nerve cell  body which lives near the spinal cord.  The nerve cell body can re-grow its nerve arm in 6-12 months.

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How effective is the procedure?
We select patients using the test injection procedure with local anesthetic as a “dry run” in order to predict whether ablation will be effective.  In well selected patients the procedure provides pain relief in 80% of patients.  Some may need to undergo the procedure more than once if a nerve was missed. 5% of patients develop a painful neuritis which feels like sun-burn, itching or worse pain.  The ablation does not give more effective relief than the local anesthetic test injection.  It just lasts longer.

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What happens when the pain returns?
RF ablation can be repeated after the pain returns in 6-12 months.  Usually no repeat test injections are needed unless the arthritis has progressed.

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What are the risks?
Bleeding, bruising, pain at the injection site, infection, nerve damage, organ injury, temporary loss of balance, weakness, or numbness, worse pain, no change in pain.

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