Radiofrequency Ablation: Everything You Need to Know

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Radiofrequency ablation (RFA) is a minimally invasive procedure that can help provide relief for people with chronic pain. Also known as rhizotomy, the procedure involves using electric currents produced by radiofrequency waves to destroy certain nerves. The goal is to block or reduce pain signals to the brain.

RFA is most commonly used to treat chronic pain conditions such as arthritis of the spine, sacroiliac joint inflammation, facet joint inflammation, and neck, back, knee, and peripheral nerve pain. The benefits of the procedure include having little to no recovery time and nearly immediate pain relief.

Radiofrequency ablation

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What Is Radiofrequency Ablation?

Radiofrequency ablation is a non-surgical procedure performed for pain control. During the procedure, a doctor uses radio waves to apply heat to specific nerves through specialized needles, temporarily shutting off their ability to send pain signals to the brain. X-ray imaging is used to help the doctor ensure the correct nerve is being targeted.

RFA is especially helpful in providing pain relief for patients who haven’t had success with other approaches, such as medication or other surgical procedures. Because RFA treats chronic (or longer term) pain, this is a procedure that's scheduled in advance, and usually not done under emergency circumstance

Contraindications

As with any procedure, not everyone is a candidate for RFA, so you'll want to discuss all potential options with your doctor. People who have an active infection, allergies to local anesthetics, or bleeding issues should not have an RFA procedure.

Check with your doctor if you are pregnant. Both adults and children/adolescents may be candidates for RFA, as long as your doctor deems it safe and appropriate for your particular case.

Potential Risks

Because it’s done in an outpatient setting and usually does not involve general anesthesia, RFA is considered to be a safe, less invasive way to treat certain forms of pain. That said, there are some potential side effects and risks to be aware of.

Common side effects that are felt at the procedure site and typically go away within a few days include:

  • Temporary numbness
  • Temporary pain
  • Swelling and bruising

Rare, more serious risks include:

  • Excessive bleeding
  • Nerve damage
  • Infection at the insertion site

Purpose

Radiofrequency ablation can be an effective pain control option for some chronic pain patients, particularly those who experience back, neck, knee, and other arthritic joint pain.

RFA can be especially effective for patients who have experienced success after getting injection treatments—like steroid injections, epidural, or nerve block injections. It also can be a good option for people with health conditions or illnesses that would make having a traditional open surgery too risky.

In preparation for a potential RFA procedure, your doctor may refer you to a pain specialist and suggest a diagnostic pain receptor block injection. In this case, a doctor will inject a small amount of numbing medication into the nerves where the RFA would be performed.

If that relieves the pain, it's likely that RFA in those areas would be successful. If it doesn't, there's a chance that your doctor could suggest a different procedure or treatment to help with your chronic pain.

How to Prepare

Before your procedure, familiarize yourself with how to prepare.

Location

RFA is performed on an outpatient basis, meaning you get to go home the same day of the procedure (barring any unexpected complications or emergencies). Depending on your specific circumstances, your RFA procedure could be done at a facility connected to the hospital, a surgical center, or even your doctor's office.

Wherever the procedure takes place, it's reasonable to expect to be at the location for a few hours or more, factoring in preparation and recovery time.

What to Wear

Even though RFA is a minimally-invasive procedure, you'll still need to undress and wear a hospital gown. This allows the medical team to easily check your vital signs and access the injection site.

It may be helpful to wear comfortable clothes that are easy to take off and put back in case you are groggy or feel some discomfort following the procedure. Plan to remove your jewelry and body piercings ahead of time, as you don't want any metal on the body to interfere with RFA's electric currents.

Food and Drink

Patients are typically advised not to eat within six hours of an RFA procedure, but it's usually OK to have clear liquids up until two hours before the appointment. Your doctor will provide detailed instructions on what time you can stop and resume eating and drinking normally, as this will depend on what time you're having the RFA procedure.

Medications

No specific prescriptions will be prescribed ahead of time, but be prepared to provide your doctor with a list of all medications you're currently taking so that they can advise you on what is safe to take on the day of the RFA procedure.

Necessary medications are usually allowed, as long as they're taken with a small sip of clear liquids and at least two hours before the appointment. For other medications that are not daily or essential, you may be advised to wait until after the procedure’s over to continue taking them.

It's important to let your doctor know about all medications you're taking to avoid any potential complications, especially if you use insulin or blood-thinning medications. These may need to be stopped or adjusted in the days leading up to the RFA procedure.

What to Bring

In addition to bringing your photo ID, health insurance card (if applicable,) and any other necessary paperwork, you'll need someone to drive you home after the procedure.

Sedative medications given during RFA will likely make you feel drowsy after the procedure, so plan on bringing a responsible adult to your appointment. It's not recommended to drive or operate machinery for 24 hours post procedure.

What to Expect on the Day of Surgery

Your RFA procedure will take place in a doctor’s office or outpatient setting. You’ll likely get medicine to help you relax for the procedure, in addition to numbing the area.

Be prepared to stay home and rest for the remainder of the day after the procedure is over. That may also involve finding someone who is available to help you out with child care or other duties that day, if needed. 

Before the Procedure

After getting checked into the facility and settled in an exam room, a nurse or or other member of the medical team will monitor your vital signs, such as body temperature, pulse rate, and respiration rate. As long as your vitals are within a healthy range, you'll be cleared to start the procedure.

During the Procedure

The entire RFA procedure can take anywhere between 20 and 45 minutes. Because the affected area will be numbed and you'll be given a sedative, you should not feel any pain during this time, though tingling or other similar sensations are possible. Expect these steps:

  • Your skin will be carefully cleaned before an IV (intravenous) line is placed in a vein in your arm. This delivers medication to your body, which will likely include a local anesthetic to numb the area, and a mild sedative to make you feel relaxed and calm.
  • Once the medications have kicked in, the doctor will insert a small needle (or tube called a cannula) into the area where you have pain.
  • Using X-ray guidance, your doctor will ensure the needle is in the correct position before stimulating the nerves with a radiofrequency current to heat up the surrounding tissue. This is what destroys the nerves, and eventually blocks the pain signals from being sent to the brain.
  • When the procedure is done, the cannula is removed, and a small bandage may be placed on the skin, depending on the treated area.

After the Procedure

Immediately after RFA, you'll be shifted to a recovery room and monitored for the next 15 minutes to an hour. This involves a nurse checking your blood pressure and monitoring your vital signs until the doctor clears you to leave.

The medical team will also want to make sure there are no allergic reactions or other medical episodes. Note that the procedure site may still feel sore or numb, and it's possible you may also feel some pain.

Since you'll have an empty stomach, you may be offered a clear beverage or saltine crackers as you become stable. A nurse will provide discharge instructions that outline when you may eat and resume normal activities and medications.

Recovery

For the 24 to 48 hours after RFA, your doctor will your doctor will likely advise you to take it easy and rest as much as possible by following these tips:

  • Do not drive or operate machinery for the next 24 hours.
  • Do not engage in any rigorous activity for the first 24 hours
  • You may resume your normal diet as soon as you feel hungry.
  • You may shower, but don't take a bath or sit in a hot tub for one to two days after the procedure.
  • You may remove any bandages before bed or the next morning.

Keep in mind that you may also still feel pain for the next few weeks, which can be a lingering effect of the nerve ablation. If necessary, your doctor may be able to recommend or prescribe pain relieving medications.

Mild pain and discomfort can also be managed with an ice pack on the area in 15- to 20-minute increments. Note that heat packs are usually not advised on the injection site after RFA.

A follow up appointment with the doctor is typically not necessary unless you request one or if you have another health condition that requires an additional check up.

If you feel severe pain at the injection site and notice swelling, redness, or leg weakness, call 911 or seek immediate medical attention to be evaluated for potential bleeding and injection complications.

Long Term Care

While you should feel back to normal within 24 hours after the RFA procedure, the timeline for pain relief and recovery varies by person. If the correct nerves were targeted during the procedure, you'll notice gradual pain relief as your body fully heals, which may take up to four weeks.

Depending on your particular condition and pain levels, there's a chance your doctor may recommend physical therapy to help improve your strength and stamina.

Possible Future Surgeries

While reports estimate that a majority of patients treated with RFA experience pain relief, it's not a permanent solution. There is always a chance that the destroyed nerves will grow back and the pain will return in the months and years ahead. Fortunately, RFA is a procedure that can be safely repeated in the future, with your doctor's approval.

A Word From Verywell

Pain relief from a successful RFA procedure can open up a whole new world of activity and adventure. Though it may be tempting to jump straight back into sports or the gym, it may be worth taking things more slowly.

As some experts have pointed out, people who have lived with chronic pain for months or years may have weaker muscles, so consider building up your strength and activity tolerance gradually with physical therapy or a doctor-approved form of exercise.

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