Axon pain management

centre, hyderabad

RADIOFREQUENCY IN PAIN MANAGEMENT

Definition: Radiofrequency nerve (RFN) ablation is a

treatment that uses radiofrequency energy (high
frequency alternating current) to interrupt of alter
nociceptive pathways of various sites.

Modalities

Continuous radiofrequency Pulsed

radiofrequency

Continuous radiofrequency---continuous radiofrequency

current is used to produce thermal nerve in a target nerve.

Pulsed radiofrequency---short bursts of radiofrequency

are delivered to target nerve producing effects on signal
transduction to reduce pain.

Mechanism of action

Radiofrequency current (low energy, high frequency)

Oscillation within the molecules

Friction between molecules

Heat production

Blockade of nerve transmission

 Radiofrequency generator

One arm-large plate attached to body Second arm-

needle electrode

Continuous radiofrequency:

Frequency- 100 to 500 Hz, Duration- 60-90 sec

Continuous current

Heat is produced transversely along the active tip of the

needle

Temperature- 65-75 degrees

Needle should be placed parallel to nerve

Interrupt conduction of nociceptive signals

Lesion=1-1.5 times of the electrode diameter

Blocks pain transmission

Duration of effect depends on time required for

regeneration of coagulated nerves
 Nonselective destruction of nerve fibers (motor and
sensory)

Pulsed radiofrequency

Current: 50 kHz in 20ms

Alternating current

Long pauses between impulses

Heat dissipation convection and conduction

Temperature< 42degrees

Current is delivered distal to tip of electrode

Electrode is placed perpendicular to the nerve

Mechanism of action: poorly understood

- May involve altered signal

transduction of pain pathway.

-Increased expression of c-Fos an

early activator gene.

-Increased expression of
activator transcriptor 3, marker of cellular stress in
neurons.
Patient selection

History and examination

Diagnostic local block of target nerves

Preparation

NBM hours- 6 hours, clear fluids upto 2

hours

Consent

Procedure

Local anesthesia is infiltrated in target site, Using X-ray;

guide the needle to the exact target area. A
microelectrode is then inserted through the needle to
begin the stimulation process.
Once the needle and electrode placement are verified, a
small radiofrequency current is sent through the electrode
into the surrounding tissue, causing the tissue to heat.

Postoperative notes
-Not to drive or operate machinery -24 hours after the
procedure.
-Resume normal diet.
-Not to engage in any strenuous activity -24 hours after
the procedure.
-Not to take a bath for 1 to 2 days after the procedure.
Specific indications
Trigeminal neuralgia: The needle electrode is passed under
fluoroscopic guidance through foramen ovale to trigeminal
ganglion that lies close to cranial opening of foramen
ovale.
Cervical cordotomy: Creation of lesion in lateral
spinothalamic tract on contra lateral side of pain. This
reduces pain sensation but retains temperature and
proprioception which are carried by dorsal columns.
Cervicogenic headache: ablation of third and greater
occipital nerve.
Spinal pain: median branch neurotomy supplying the facet
joints.
Groin pain and orchalgia: radiofrequency ablation of
genitofemoral, ilio-inguinal nerves and nerve roots.
Miscellaneous syndromes: deafferentation, plexus
avulsion, post-surgical neuropathic pain, spinal radicular
pain, post surgical thoracic pain.
Complications
-Pain or discomfort around the injection site
-Numbness of skin covering the injection site
-Worsened facet or sacroiliac joint pain due to muscle
spasm in the area of the injection
-Permanent nerve pain
-Allergies or reactions to medications used
-Infection