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Radiofrequency ablation (RFA) treatment uses electrical energy to ablate, or destroy abnormal tissues in the body which may be causing pain or other symptoms in a variety of medical conditions1. In RFA, radio frequencies are generated in the tip of a needle called an electrode, such that electrical energy is formed. The electrical energy created at the tip of the electrode generates movement in any cells that the electrode comes into contact with, causing friction, heat generation, and cellular destruction2, 3, 4. RFA can be applied continuously or in pulses5. Continuous application of RFA can cause targeted cells to reach temperatures in excess of 140°F and has the broadest application in treating medical conditions. Pulsed RFA reaches lower temperatures, and is associated more with electrical disruption of signals traveling through neural tissue. Pulsed RFA is also associated with fewer side effects. Unlike other sources of heat ablation, RFA is a safe energy source with creates the heat within targeted cells instead of applying it without, which minimizes damage to normal surrounding tissue and leads to fewer potential complications4.
RFA is recommended for the treatment of a diverse array of medical conditions, such as:
• Cancers involving the formation of small tumors are particularly amenable to treatment with RFA; tumor cells in particular are susceptible to destruction from RFA heat generation4. Tumors can arise from cells of a specific organ or tissue type, termed a primary cancer. Tumors in advanced stages can also travel from one tissue or organ to another, which is termed metastasis, and is a poor prognostic sign. RFA has shown promising potential as a minimally-invasive treatment for primary and metastatic tumors of the bone, lung, liver, kidney and pancreas, especially for patients who are too sick or are otherwise ineligible for traditional surgical resection (removal)6, 7, 8, 9, 10. RFA can also currently be used to treat a condition called Barrett’s esophagus, which refers to pre-cancerous tissue changes in the lining of the esophagus11. RFA ablation of this tissue can prevent progression of the disease to deadly esophageal adenocarcinoma.
• Cardiac arrhythmias, in which a problem exists with the rate and rhythm of a heartbeat; more specifically, it refers to the heart beating too fast, too slow, or irregularly12. Arrhythmias often occur as a result of abnormal heart tissue interfering with normal electrical signals. RFA is a treatment of choice for ablating this abnormal tissue13.
• Varicose veins, or venous insufficiency, in which the veins become twisted and become pooled with blood due to an inability to push it back to the heart. RFA has been shown to be an effective treatment for this condition, and with fewer complications than alternative surgical treatments14.
• Obstructive sleep apnea, in which a narrowing or blockage of the airway can cause pauses of breathing during sleep, leading to snoring, social discomfort and fatigue15. RFA used on obstructive tissue blocking the airway has shown promise in reducing symptoms of snoring, and may have potential as a treatment for preventing progression to apnea.
RFA has also proven useful for the management of nerve-related vertebral (spinal) problems, which most frequently manifest as chronic headaches, or pain of the lower back and neck3. Vertebrae are connected to one another by two facet, or zygapophysial, joints located on either side of the bone16. When combined, these two vertebrae, along with the inter-vertebral disc cushioning in between the bones, form a spinal segment. The rationale for RFA in this capacity is that ablation and/or electrical interference of nerves which carry pain signals presents an opportunity to prevent these signals from reaching the brain and conferring what individuals perceive as pain3. RFA is indicated for the treatment of cases of chronic spine-related pain that doesn’t respond to conventional, and more conservative, treatment, such as physical and pharmacologic therapy2, 3, 5:
• Headaches for which RFA is an indicated treatment include cluster headaches and cervicogenic headaches, which describes a headache that accompanies, or originates from, primary problem with the neck17, 18. RFA is used for the treatment of cervicogenic head pain referred from problems with facet joints of the first few cervical vertebrae; for cluster headaches, RFA targets a nerve cluster termed the sphenopalatine ganglion.
• Sacroiliac (SI) joint pain can result from improper joint function, affecting the back, buttocks and lower extremities20. Common causes of SI joint dysfunction include car accidents, athletic injuries, arthritis, infection, gout, pregnancy and others20, 22. One review of multiple research studies found RFA to be an effective treatment for SI joint pain, with high patient satisfaction22.
• Trigeminal neuralgia, a common cause of facial pain, describes intermittent attacks of intense, sharp or stabbing pain distributed along branches of the trigeminal nerve; a nerve which carries sensory stimuli from several regions of the face19. Continuous RFA has been shown to be more effective than alternative surgical interventions for targeting and ablating the trigeminal root to relieve pain, particularly for the elderly.
• Back and neck pain is a common cause of disability2, 3, 21. Common sources of chronic back pain are the facet joints which connect adjacent vertebrae of the spine5, 21. Facet joints assist with spinal weight bearing, prevent the sliding of vertebral bones on top of one another, and limit spinal extension and rotation23. Pain at these joints can indicate direct irritation, or mechanical or vascular changes that have occurred due to degeneration or injury. For the treatment of lumbar facet joint pain, RFA is used to ablate the branches of nervous tissue located near the affected facet joint21. Research studies report pain relief and patient satisfaction as high as 90% for RFA treatment of facet joint disorders. Back and neck pain can also be caused by compression of nerve roots near the spinal cord, termed radicular pain, which is a common symptom of a herniated, or slipped, disc. RFA is also amenable to the treatment of these disorders, having the ability to ablate any solid tissue causing compression of nerves without necessarily damaging the nerve roots themselves. RFA has been shown to be very effective for treating cervical and lumbar radicular pain without complications2, 3, 5, 23.
The Radiofrequency Ablation Procedure
RFA procedures are generally performed only after an initial diagnostic trial confirms the source of chronic pain. Diagnosis of anatomical problems leading to chronic pain in the back and neck can be very difficult, as most pathology can’t be seen with radiologic imaging23. In many cases, the only method for determining an exact causal location is for a physician to elucidate likely locations via characteristics of the pain, and perform an injection to chemically inactivate the nerve as an initial trial for pain relief. The diagnosis is confirmed if this nerve ‘test block’ relieves the chronic pain21.
If a trial is successful, a patient may proceed with the actual procedure. In preparation, the patient is positioned and draped for easy access to the RFA surgical site. The surgical site is then sterilized, and anesthetic is injected to numb the region to pain from the procedure4. Radiofrequency electrodes are inserted though a small incision in the skin and are guided to targeted tissue using ultrasound or fluoroscopy, a real-time x-ray4. The electrode is then connected to an external generator which is activated to release radiofrequency waves into the tissue for ablation. Depending on the tissue to be ablated, other medications can be injected to the area as needed4, 23.
Infection and bleeding are risks during any surgical procedure. It should be noted, however, that complication rates for RFA are approximately 1% on average, and of those complications, the vast majority are relatively minor24.
Potential side effects following an RFA procedure can include:
- Changes in skin sensation or sensitivity to stimulation in regions supplied by ablated nervous tissue
- Transient pain due to inflammation at the ablation site, or disconnection of nervous tissue from the central nervous system
- Possible loss of sensation or unintentional damage of motor, instead of sensory, nerves
- Organ damage associated with the treatment of specific cancers, such as lung collapse
And while RFA has shown promise as a long-term solution for many etiologies of chronic pain, it may not represent a permanent solution; reductions in pain can fade with time, especially with regeneration of ablated nervous tissue. In these cases, however, repeated procedures have been shown to be effective for the management of pain23.
Despite these potential complications, RFA remains a relatively safe procedure when performed by experienced specialists. RFA is a treatment with wide utility in medicine, particularly for the management of chronic pain. Experience and new technology has expanded the usefulness of RFA and improved treatment outcomes in recent years4.
- Radiofrequency Ablation – PainDoctor.com
- 1 Mayo Clinic. Ablation therapy. Retrieved from: http://www.mayoclinic.org/ablation/types.html. Accessed March 15, 2012.
- 2 Niemisto L, Jousimaa J, Hurri H, Kalso EA, Malmivaara A. Radiofrequency denervation for chronic neck pain (Protocol). Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD008573. DOI: 10.1002/14651858.CD008573.
- 3 Niemisto L, Jousimaa J, Hurri H, Kalso EA, Malmivaara A. Radiofrequency denervation for chronic low-back pain (Protocol). Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD008572. DOI: 10.1002/14651858.CD008572.
- 4 Ward, E.; et al. (2008) Musculoskeletal Interventional Radiology: Radiofrequency Ablation. Radiol Clin N Am. 46. 599-610.
- 5 Chua, N.; et al. (2010) Pulsed radiofrequency treatment in interventional pain management: mechanisms and potential indications – a review. Acta Neurochiro. Vol. 153(4), 763-771.
- 6 Zhu, J.; et al. (2008) A Systematic Review of Radiofrequency Ablation for Lung Tumors. Ann Surg Onc. 15(6) 1765-1774.
- 7 Wan Yee, L.; et al. (2009) The Current Role of Radiofrequency Ablation in the Management of Hepatocellular Carcinoma: A Systematic Review. Ann Surg. 249(1) 20-25.
- 8 Atkins, M.; Choueiri, T. (2011). Epidemiology, pathology, and pathogenesis of renal cell carcinoma. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
- 9 Volkmer, D.; et al. (2009) The Use of Radiofrequency Ablation in the Treatment of Musculoskeletal Tumors. J Am Acad Ortho Surg. 17(12) 737-743.
- 10 Girelli, R.; et al. (2010) Feasibility and safety of radiofrequency ablation for locally advanced pancreatic cancer. Brit J Surg. 97(2). 220-225.
- 11 Semlitsch, T.; et al. (2010) A Systematic Review of the evidence for radiofrequency ablation for Barrett’s esophagus. Surgical Endoscopy. 24(12) 2935-2943.
- 12 National Heart Lung and Blood Institute. What is an Arryhthmia?. Retrieved from: http://www.nhlbi.nih.gov/health/health-topics/topics/arr/. Accessed March 17, 2012.
- 13 Ganz, L. (2011). Catheter ablation of cardiac arrhythmias: Overview and technical aspects. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
- 14 Scovell, S. (2011). Radiofrequency ablation for the treatment of lower extremity chronic venous disease. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
- 15 Back, L.J.; et al. (2009) Radiofrequency ablation treatment of soft palate for patients with snoring: A systematic review of effectiveness and adverse effects. The Laryngoscope. 119(6). 1241-1250.
- 16 Hansen, J. (2010). Back. Hansen: Netter’s Clinical Anatomy, 2nd Ed. MD Consult Web site, Core Collection.
- 17 Biondi, D.; Bajwa, Z. (2011). Cervicogenic headache. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
- 18 Narouze, S.; et al. (2008) Sp[henopalatine Ganglion Radiofrequency Ablationfor the Management of Chronic Cluster Headache. Headache. 49(4) 571-577.
- 19 Bajwa, Z.; et al. (2012). Trigeminal Neuralgia. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
- 20 ExitCare. (2011). Sacroiliac joint dysfunction. MD Consult Web site, Patient Education.
- 21 Civelek, E.; et al. (2012) Comparison of Effectiveness of Facet Joint Injection and Radiofrequency Denervation in Chronic Low Back Pain. Turk Neurosurg. 22(2). 200-206.
- 22 Aydin, S.; et al. (2010) The Role of Radiofrequency Ablation for Sacroiliac Joint Pain: A Meta-analysis. PM&R. 2(9). 842-851.
- 23 Rashbaum, R.; Ohnmeiss, D. (2009) Facet Joint Anatomy and Approach for Denervation. Minimally Invasive Spine Surgery. 93-98.
- 24 Boswell, M.; et al. (2007) A Systematic Review of Therapeutic Facet Joint Interventions in Chronic Spinal Pain. Pain Physician. Vol. 10, 229-253.