0BRADIOFREQUENCY DENERVATION TREATMENT Information Leaflet Your Health. Our Priority.
Page 2 of 6 What is radiofrequency denervation treatment? Radiofrequency denervation is a specialised treatment that aims to treat nerves that cause pain and thereby reduce levels of pain. It is usually done for patients who experience pain from the facet joints (of the spine) and also the sacro-iliac joints. It is also sometimes used to treat other rarer types of pain elsewhere in the body. The specific nerves involved are located and then treated with radiofrequency. This can alter the ability of the nerve to transmit the pain signals from the joint by switching off the nerve supply to those joints. The nerves are exposed to an electromagnetic field. This causes a small heat lesion that stops the nerves from functioning. These pain nerves serve little other function and therefore patients experience very few other effects. This treatment is carried out by the Consultants in Anaesthesia & Pain Medicine Why have I been offered this treatment? Your pain consultant would have examined you and evaluated your pain. Your pain will have some specific features that suggest your facet or sacro-iliac joints are involved. Many patients with wear and tear of the spine can develop pain that comes from the facet or sacro-iliac joints. Usually a change in the alignment of your spine can increase the weight borne through these joints thereby causing the wear and tear, and therefore pain. There are no surgical treatments for this type of pain, and often painkillers are ineffective. Your consultant will perform some diagnostic injections to check if your pain is from these specific joints. If these injections work, then radio-frequency treatment can be considered. How successful is this treatment? The results are variable. Generally about 75% patients will see their pain reduce, but only a minority will be left pain free. The duration of pain relief varies from approximately 4 to 18 months, about half of patients will see benefit for one year. About 20% may see no benefit and 5% may see their pain symptoms increase (usually temporary). Return of symptoms can be due to regeneration of the treated nerves, or advancement of the underlying problem. Occasionally this treatment can be repeated, but the results with repeat treatments are generally less effective than the first treatment. This variation in outcome is explained by the fact that the causes of pain are complex, and often patients have more than one cause of pain. Successfully treated patients will be able to improve their mobility and therefore strengthen their backs.
Page 3 of 6 How safe is this treatment? This treatment is considered safe; the doctors that carry out the procedure are experienced in its practice. The risks include: Flare up of pain (this commonly occurs, and lasts up to 4 weeks, often patients report a burning sensation over the treated area) Dysaesthesia (an area of skin with altered sensation; can feel numb or tender. This is usually easy to tolerate, but can last a few months) Failure of pain relief (25%) Worsening of existing pain (5%) Nerve injury, this is rare, but can lead to pain, numbness and weakness in one or both legs. This can be temporary or occasionally permanent Infection (rare) Bleeding & bruising (haematoma) Drug reaction (very rare) In general apart from an initial flare up of pain, few side problems are seen. How and where is the treatment carried out? You will be asked to report to the Maple Suite, off the main hospital corridor. Here you will be checked in by a nurse who will check some medical details and ensure you don t have any new medical problems since you were last seen in the Pain Clinic. If you have a new medical problem, e.g. an infection, please contact the pain clinic as it may prevent treatment. You will need to know what medications you are taking, and what allergies you have, if any. If you are on any medications to thin your blood, please telephone the pain clinic in advance as some medications may need to be stopped (Aspirin 75mg a day can be continued). Your pain consultant will see you and explain the procedure and you will be asked to sign a consent form. You will have an opportunity to ask any questions.
Page 4 of 6 The procedure You will be asked to lie on your front. Your back will be cleaned with antiseptic and x-ray pictures taken to show your back in detail. Local anaesthetic will be injected through a small needle into the skin of your back, and then a fine needle will be passed deeper into your back onto the nerve that transmits pain from the facet joint; you may have up to six nerves that need treatment, and therefore may need typically between three to six needles inserted. Placement of these needles can sometimes be uncomfortable despite the local anaesthetic. The needle position will be checked with the x-ray pictures, and also by passing a small stimulation current through the needle, this may cause some tingling, tightness, or pressure in your back. Your consultant will ask you what you feel; if you feel anything in your leg then the needle may need to be repositioned. Once the needle positions have been confirmed then some local anaesthetic, and possibly some steroid is injected. Then the radiofrequency treatment will start; this takes about a minute per nerve, and should not cause pain but might cause some discomfort. It takes up to 45 minutes to complete the treatment. Expect to be in the Maple Suite for 2 4 hours in total. We will observe you for approximately an hour afterwards, and ensure you are safely mobile. You will need to get a friend or relative to accompany you on your journey home. You are not allowed to drive or operate machinery for the rest of the day. There is no need to avoid food or drink on the day, unless you have been told otherwise. Please bring a dressing gown and sensible footwear (e.g. slippers); you will be asked to walk into the treatment room. What can I expect afterwards? Avoid strenuous activity for the next few days. Expect some pain and light bruising over the injection sites. Patients often don t experience pain relief for up to 4 weeks, so you can continue to take your pain killers if needed. If you experience any worrying side effects, please either contact the pain clinic, or your GP. You will be followed up in the out-patient clinic (usually in the Lilac Suite) in due course.
Page 5 of 6 Contact us The information in this leaflet is not intended to replace the advice given to you by your doctor or the pain service looking after you. If you require more information or have any questions, please speak to your doctor or contact the Pain Clinic. The number below is generally manned 08:00 16:00 Monday to Friday; there is an answer machine out of hours, please leave a message and we will return your call. The Pain Clinic Stepping Hill Hospital Poplar Grove STOCKPORT SK2 7YB 0161 419 5015 / 5643 Keep all medicines out of reach of children.
Page 6 of 6 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: 0161 419 5678. Email: PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number CC41 Publication date June 2016 Review date June 2018 Department Pain Clinic Location Stepping Hill Hospital