Rfa?

[lindy55]

I am scheduled to have RFA done to cut a painful nerve in my lower back on Thursday. I have been talking to some friends(none of whom have had it done) and they don't think it is a good idea. I wondered if I could get some feedback on this procedure. I kno that I remember having read some posts on BT1 on this subject but at the time, I didn't have a reason to absorb the info. Any info would be appreciated.-Linda

[Fancylady_2006]

Sorry Linda, I can't help you but wanted to welcome you to Spinal Disorders. Have you googled it in to get info? Sometimes it can be a good place to go if no one comes in. I too have read from the Old Boards but I can't remember what it said.
Billie:)

[janster]

Hi Linda~
Geesh, at times like THIS do we ever miss our information on BT! This subject was very controversial.

I'm not sure whom is here from which side, so all I can do is give you my viewpoint.

I was scheduled for RFA last December, but when I got there my Anesthesiologist talked with me. He said he had talked with my Physiatrist and they had decided to NOT do the RFA, but instead do ESI's because there was no long term data out there for a woman my age. (49)

He told me no one knows of the long term effect of RFA on younger people at this time and he doesn't want me to be a guinna pig. He wanted me to be safe rather than sorry.

OK, this is MY experience, and MINE only. If anyone made it over here from the 'opposing' side, I'm sure you will hear THEIR experience.

As I said earlier, this was quite controversial, and I opened up a hornet's nest when I posted about it there. BUT, the information was unbelievably informative, and I'm terribly sorry I don't remember any of it for you.... As usual, things always had a way of working out, and we all gained valuable information after things settled down.

I don't think Doc W or Chirogeek are here to add their input, and it's extremely sad we can't reference their posts. If I remember correctly they were on opposing sides. Then again, what little memory I did have went *POOF* with the prescribing of 400mg Topamax/day quite a while ago, so someone please correct me if I'm wrong.

I hope you will get some more info Linda. I know there were two sides, and they both had their advantages. Good luck and I look forward to reading how you turn out!
Hugs,
Jan

[Jyes]

RFA? Radio Frequency Ablation?? If so, I had an RFA in April on C3/4 facet joints.

My results of the procedure were not good, I ended up with Occipital Neuralgia and associated pain from that when an adjoining nerve branch was only partially lesioned. (fried). However, it did appear to relieve pain in my original area that was caused by the C3/4 nerve roots, but C2 nerve branch was also paritally fried, thus the new pain and neuralgia....

I was told my by PM Doctor yesterday that if I required the procedure in my Lumbar or Thoracic area that the chance of the complication I had was only around 1%, he never said what it was for the cervical area but I believe I read somewhere in the 5-10% range, so lucky me.

I can neither recommend it nor not recommend it, you have to find out as much as you can from others and of course each person has different circumstances involving what is wrong with them and how to treat it. Of course, anything somewhat conservative in treating for relief of pain is better than going under the knife in my opinion.

Sorry, cannot be of much more help, but if your RFA is what I have had done, Goggle "Radio Frequency Ablation" and you should find a bit of information about it.

Jyes

[carolynms]

Linda, I was going to have an RFA done at L4-L5 bilaterally, but my PM said that the test to see if it (RFA) would work, was to do facet joint injections, to see if the injections relieved the pain. He said you get two sets of the injections (if the 1st one works). I did them, they did help, but then I chickened out on the procedure. I googled it, and found the success rate fairly low (I think it was about 33%, but that is a guess). Plus, I asked my OS about it, and he said he had patients come back to him where they did not work. But he also said, it doesn't mean that some of his patients had them, they worked, and did not come back to him. He did not advise me, because I had already decided I really did not want it.
There was a lot of info on BT, and I hope you can find the info you need.

I am 47, and my PM didn't mention a thing about age and long-term effects. So, I think even the doctors do not have the same opinions. Maybe a second opinion? Good luck, and I hope others come through with their experiences. I know there were alot on BT that they worked for, and alot that they didn't work for (I posted the question there, myself).
Carolyn

[snoozie]

My 2 cents for what its worth. I had an RF done at c2-c3 I think, somewhere in the cervical area. I did have the facet injections and they did help but for some reason the RF did not. I experienced more pain and soreness for about a month or so and I had hoped that once that leveled off I would get some relief but I didn't. I would say read all you can about it and hopefully others will come who have had a positive experience than you just have to weigh your options. Good luck to ya...Sue

[lindy55]

Well, I had RFA today. I just got home a few minutes ago. It was kind of tough, and I can stand a lot of pain. My back is still numb so I don't know if it did any good. Same old ice, rest and no bath for 24. I just hope it was worth it. I am having my right side done in 2 weeks. Gonna try some ice. Later Linda

[GJZH]

Linda,

It is nice to see you back...I was going to post some information on it, but I see you already had it done...If you really want or need more info just post...I hope you are comfortable and resting well...

I personally decided it was not for me...but that was me and we are all different...

[lindy55]

Gloria-I would appreciate any information that you have on the subject of RFA. I am not sure it was the right choice that I made, but I had to do something. I had too much pain to enjoy anything. I had injections but they never lasted more than a day or two at the most. I really have never had much luck with pain meds either. Surgery seems to be out of the question for the moment at least. The pain has made me feel like I am on the edge. I don't know how else to describe it. It seems like I can not deal with anything right now. -Linda

[Bobbi]

(((( Linda ))))

I hope that your pain lessens. I can't even imagine how it feels to have the RF'ing done unilaterally; each time I've had it done, it's been bilateral, multi-level. The second through about fourth day following having, generally, been the roughest for me.

[GJZH]

Linda,

I was given the option of Rhizotomy by Hopkins after my laminectomy failed. I went back to Penn and the docs at Penn told me they thought that was bad medicine for me...Hershey was also willing to try it. After I read about it I decided it was not for me...I will see if I can find some research about it as well...We did have some great infor on the old BT board.

Facet Rhizotomy
Steven Richeimer, M.D.
Director
USC Pain Management, USC Medical Center
Los Angeles, CA, USA

Ms. Mary Claire Walsh
SpineUniverse Staff Writer

http://www.spineuniverse.com/displayarticle.php/article200.html
The facet joints are often the primary source of pain for many back pain sufferers. Facet joints are small joints located in pairs on the back of the spine that provide stability to the spine and allow the spine to move and be flexible.


http://www.spineuniverse.com/displaygraphic.php/146/facetjoints2_250-BB.jpg



Depending on where the problematic facet joints are located, they can cause pain in the mid-back, ribs, chest (thoracic facet joints), lower back, abdomen, buttocks, groin, or legs (lumbar facet joints), neck, shoulders, and even headaches (cervical facet joints).

Facet joint injections of steroid medications are often given to patients with this type of pain. The injections not only provide pain relief, they can also help the physician pinpoint exactly where the pain originates and can confirm or reject the facet joints as the source of the pain. For many patients, facet joint injections provide adequate relief. For others, however, the pain relief is too short-lived. For these patients, facet rhizotomy may be the answer.

What is facet rhizotomy?
The goal of a facet rhizotomy is to provide pain relief by "shutting off" the pain signals that the joints send to the brain. The pain relief experienced by most patients who have this procedure lasts months or even years.

How it is done
Patients who are candidates for rhizotomy typically have undergone several facet joint injections to verify the source and exact location of their pain. Using a local anesthetic and x-ray guidance, a needle with an electrode at the tip is placed along side the small nerves to the facet joint. The electrode is then heated, with a technology called radiofrequency, to deaden these nerves that carry pain signals to the brain.

Serious complications with facet rhizotomies are rare. A new technique using pulsed radiofrequency does not actually burn the nerve, but appears to stun the nerve. This technique appears to be even safer than the regular radiofrequency technique, but does seem to have the drawback of not lasting quite as long. Some specialists (such as the author) prefer to use the pulsed technique in higher risk areas such as the neck.

The procedure takes about 30-60 minutes. Afterwards, patients are monitored for a short time before being released.

What to expect
Very little preparation is required for a facet rhizotomy procedure:

•Your physician will give you detailed instructions about whether you can eat before the procedure.

•In most cases, you can continue to take your usual medications before a rhizotomy. However, make sure you discuss what medications you use with your physician before the procedure.

•Since a rhizotomy requires the use of a local anesthetic, you may need someone to drive you home after the procedure.

Once you are ready, you will be given an IV with a mild sedative to keep you comfortable but awake during the procedure. A local anesthetic will be used to numb the area where the injection is to be done. An x-ray machine is then used to guide the exact placement of the needle/electrode. Once the needle is injected, a mild electrical current is used to stimulate the nerve and confirm its exact location. You may feel slight pressure or tingling during this part of the procedure. Then the electrode is heated to deaden the sensory nerves. When the procedure is completed, the needle is removed and the injection site is bandaged.

After the procedure
Some initial discomfort may be experienced immediately after the procedure, including bruising, soreness, or swelling at the injection site. However, most patients are able to return to work and their normal daily activities the following day.

Also, your back may be sore for a few days after the procedure. This is procedure-related pain and can be treated successfully using ice packs or over-the-counter pain medications. After a few days, you should begin to notice an improvement in your usual pain and can expect continued improvement over the next several weeks.

Serious complications are rare, however contact your physician if you experience any of the following:

•Prolonged pain at the injection site
• Fever
• Chills
• Dizziness
• Weakness
• Numbness that lasts more than 2-3 hours
• Bleeding or drainage at the injection site

Facet joint rhizotomy or medial branch neurotomy can effectively treat low back pain emanating from painful facet joints unresponsive to steroid injections. This efficacy hinges on the technical skill of the physician performing the procedure. Each facet joint is supplied by two small nerves so two needles must be placed to treat one joint. Findings of a recent surgical anatomical study have confirmed the accurate course of these nerves targeted in this procedure providing more compelling evidence for proper needle placement. Safe needle placement is critical in avoiding complications related to inadvertent injury to nearby structures leading to increased back or new leg pain. Although symptom reduction may be appreciated within a few days, facet joint rhizotomy should not be considered unsuccessful unless no pain relief occurs by 6 weeks after the procedure. Evidence shows that 60% of properly selected patients experience at least a 90% reduction of their low back pain that is sustained for 12 months, and 87% obtain at least 60% relief. If low back pain symptoms return over time, repeating the procedure can restore similar pain relief. However, one must keep in mind that these results are attainable when completed by well-trained interventional spine specialists experienced in executing these procedures.

[Jyes]

GJZH I might be confused but it seems that there appears to be at least 3 names for what I believe is the same procedure?

RF Lesioning
RF Abalation
Rhizotomy

As I mentioned earlier in this thread, I was one of the unlucky ones to have complications after the procedure. It is over 5 months since my RF of C3/4 facet joints and I still have the numbness, neuralgia and new painful spots I did not have before the procedure. (Thanks to paritally hitting C2 nerve branch)

On my copy of the "Report of Operation" The technical name listed is: Radiofrequency rhizotomies Right C3/4 medial branches with fluoroscopic guidance. Yet, my Doctor first called in verball an RF Abalation and the written literature I was given describing the process it was called an RF Lesioning.... :)

Jyes

[GJZH]

http://www.cigna.com/health/provider/medical/procedural/coverage_positions/medical/mm_0144_coveragepositioncriteria_radiofrequency_ab lation_for_chronic_spinal_pain.pdf#search=%22radio %20frequency%20ablation%20of%20spinal%20nerves%22

Study done by ASIPP (American Association of Interventional Pain Physicians)

Study by pain physicans that demonstrates that RFA does work to stop pain for spinal patients. This particular study may be just a little biased since it was a study done by the very people who may stand to profit by the doing the procedure. JMO

[GJZH]

Jyes wrote:

GJZH I might be confused but it seems that there appears to be at least 3 names for what I believe is the same procedure?

RF Lesioning
RF Abalation
Rhizotomy

I think they do this to confuse us, but...I think in the end they are trying to achieve the same goal, deaden the nerve, but they may go about in different ways.

Just as in the article they call it "Facet joint rhizotomy or medial branch neurotomy."

Neurotomy means the surgical severing of a nerve while Rhizotomy means resection of the dorsal root of a spinal nerve to relieve pain and sometimes to decrease spasms. Ablation is the amputation, excision of any part of the body, or the removal of ... This is all according to Mosby's Medical Dictionary...but then it depends how they are going to do this..


This procedure can be done using two different methods. I was offered both and both are deemed effective.

One method was described in the article I posted and the other is by cryoablation. During this procedure cold is used and is described here:


cryoneurolysis/cryoablation: a technique that relieves pain by using cold to destroy nerve tissue.


Radiofrequency nerve ablation is the term used when radio waves are generated and used to produce heat. By generating heat around a nerve, the nerves ability to transmit pain is destroyed, thus ablating the nerve.


Rhizotomy- surgical severance of spinal nerve roots to relieve pain or hypertension.

Severance can be performed by cryoneurolysis/cryoablation and radiofrequency nerve ablation. These are two methods of deadening the nerve tissue and stopping the pain. The nerve is severed during these procedures.

I think the argument on the forum (Braintalk1) (I feel like I am referring to a Dr. Seuss book) was that there is not enough evidence to support using this procedure on spinal patients. There are studies and they do support that pain does subside in some people. The problem with all of this is that these procedures were used on cancer patients and the cancer patients were terminally ill so correct me if I am wrong...we do not know the long term side effects of these procedures because unfortunately the cancer patients died. The one side effect with all of this is that the nerves grow back. When they do, you tend to have more pain because the nerves look much like the branch of a tree because they have been severed..You can go through the procedure again in hopes of finding relief. ..I hope I am explaining this correctly...and if not someone please feel inclined to correct me...I will not be angry...and if Doc W is around...someone please have him explain the pros and cons...He knows better than any of us...

I just decided that this was not for me...My OSS at Pennsylvania Hospital did my cervical fusion. He thought this procedure would not help me...I asked my pain management doctor and he nixed it as well...That was two docs, so I respectfully declined the procedure and went for surgery...The spinal blocks did not work for me either...

[GJZH]

You know the problem with google is that the big drug companies and doctors can pay to have their websites right at the top, so when you do a search to try to determine if this procedure might not be right for you...What do you find...? One advertisement after the other for the procedure ...A website setup for a pain management doctor...Is this what google was originally intended to be? A gigantic advertisment forum for the rich? Is this objective or subjective...I mean I googled problems with rhizotomy and only one page popped up and that was Patrick's page..and Patrick is angry so I do not know if he is being objective either...and some of his information is incorrect....

http://home.inreach.com/doodle/shtml/neurolysis.htm

Also, there has got to be more than one guy with problems from this procedure. I remember on BT that a woman had some nerves severed by mistake and she had trouble walking for awhile, didn't she? Does anyone else remember? Wasn't it on BT?

We have to remember that just because it is on the Internet does not mean it is correct either....I quoted the Hand University Website to my hand surgeon last week and the information at the website was old and wrong...so you have to be careful and fully research every thing...

[janster]

I think the argument on the forum (Braintalk1) (I feel like I am referring to a Dr. Seuss book) was that there is not enough evidence to support using this procedure on spinal patients. There are studies and they do support that pain does subside in some people. The problem with all of this is that these procedures were used on cancer patients and the cancer patients were terminally ill so correct me if I am wrong...we do not know the long term side effects of these procedures because unfortunately the cancer patients died.
Hi G~
This was the exact way my Anesthesiologist explained it to me as to why he and my Physiatrist decided against the procedure. They opted for the injections because of my age. Again, this is just my experience.

Hugs,
Jan

[lindy55]

I am not sure if this is related to my procedure or not, but I had the strangest thing happen to me this morning. I know that if I could see everyone, I would never tell this.;) I woke later than usual this morning and knew that I had to go get some blood work done. So I was laying in bed thinking about getting up, when I had this strange feeling. My (girl thing between my legs) was spasming. I had 3huge orgasms!!! I don't know if it was related, but it was not bad. :D :D :D -Linda

[J-moe]

Just found this page, Googling RFA. I agree with the people that feel Google is an advertisement media for the rich. All the info I've read thus far has, hands-down sided with the procedure (cleverly disguised as a non-biased informational source). Then I find this forum full of sceptics. Instantly changing my view. It feels far more honest here.
I am suffering from a Facet Joint problem, C2/3 - C3/4, resulting from my head smashing into the window frame of the windshield on a Geo Metro, at 60 miles an hour. My multitude of doctors over the last two-and-a-half years have labelled it, a compression fracture, myofacial, or"whiplash"(not even a medical term, and Webster's definition isn't even consistent with my case, but doctors still, after I bring this to their attention, use the term).
I have tried ciropractic care with no help. Accupuncture is quite helpfull as well is Physical Therapy. I have already had two set of facet joint injections. Both with great improvement of my pain, and range of motion. I believe these were to pinpoint the nerve, so the RFA could be administerred. I'm this far now and affraid of "frying", or "severing" any amount of nerve tissue in such a sensative area. Seems like the risk is too great. Who knows what these scarred, mutilated nerve endings will do in 20 years.
Any additional info. on the Cryoneurolysis/Cryoablation, or Pulsed RFA would be appreciated. Thanks you all. J-Moe

[semurray]

Hi, great forum. I have been suffering with osteoarthritis for several years and over the past 18 months things have gotten progressively worse. I have cervicogenic headaches that keep me non-functional for days. Have had facet joint injections in c-spine worked for about a month and wham back to the headaches. They sent me to PT for 16 weeks at 3xs a week, that's 58 sessions, cost me $580.00 in co-pays. They worked on stuff that I did not even have nor did I complain about; shoulder impingement, they wasted 4 weeks on that one. PT helped for my low back pain for a while. But when they started on my neck it became a misery, extensions, retractions and the last straw was when they put me in c-cpine traction on two occassions, elicited extremely brutal headaches.
So I moved onto pain management where they started with the facet joint injections in c-spine, that worked for about a month. Headaches have now returned and I cannot function with them. Spoke to my neuro today and he is recommending RFA. I have read a lot about it and understand the possible side effects and the mistakes that can be made but anything has got to be better than these headaches. I have considered paying out of pocket for botox injections in the nerves actually until I made that statement to the neuro he had only perscribed NSAIDs and PT for the pain.

For anyone who doesn't know facet joint injections are diagnostic as well as therapeutic in nature, if they work then they know the cause of the pain is the nerve at the facet joint if they do not work then that is not the source of pain. The local that is injected wears off in several hours and the steroid they inject can take several days to kick in for the full effect, so if the injections do not provide any relief than your source of pain more than likely is not the nerves at the facet joints. If the injections are not effective they will not follow with RFA, there is no point to it, it won't work.

Oh, the physiotherapist called and left a message "I don't understand why your doctor has not responded to the patient note I sent and the request to continue PT for you." "Give me a call and we will see about getting you back for more PT". This guy didn't want me to have the epidurals in the first place he wanted to extend PT for yet another 8 grueling weeks or longer.

Here's one you will all appreciate: Spoke to neuro this afternoon as PM is on vacation. He has perscribed Tramadol for my head and worsening back pain and on Monday I should make appt. with PM for RFA. I take 20 to 30 mg of Elavil at bedtime for sleep and some pain (from my GP). I ask neuro if the Tramadol can be taken with Elavil, he says sure no problem, I ask pharmacist when I pick up Tramadol if there is a problem with that and Elavil, she says no problem. I read the drug sheet provided by the pharmacist and low and behold YOU CANNOT TAKE TRAMADOL AND ELAVIL TOGETHER can cause seizures and other pretty major problems. Now what do I do, if I stop the Elavil I will go through withdrawl, but the pain is pretty intense so I opted to take the Tramadol this evening and tomorrow morning, if my headache and backache are improved I will need to take at least 10 mg of Elavil. Honestly you can't trust any body with your health these days!

Sharon

My Test Results
MRI C-SPINE
Multi-level spondylosis most marked at C4-5 with right foraminal stenosis by osteophytes. Advance spondylitic narrowing of the C4-5 interspace with anterior and posterior spurring. Foraminal encroachement by osteophytes. Mild narrowing of C5-6 and C6-7 interspaces with mild spurring. Osteophyte on the right at C4-5 attenuates the ventral aspect of the thecal sac but cause no mass-effect upon the cord.

MRI L-SPINE
(Minor Grade I, 5% anterolisthesis of L4 on L5 due to severely degenerated facet joints. Marrow changes at L2-3 reflect DD change. T12-L1 mild DD changes with disc bulge. L1-2 is normal. L2-3 moderate DD and facet changes with disc bulge. L3-4 mild facet degenerative changes. L4-5 mild to moderate dd and moderate degenerative facet changes with left side disc bulge. Mild left lateral recess and left more than right foraminal stenosis. L5-S1 mild to moderate facet degenerative changes.) **This one done in 2006, the one done in 2004 shows the disc at L4-5 "small herniation to the left of midline". They claim the MD in 2004 was probably not well trained in reviewing spinal MRI.

Xray of T-Spine: Degenerative changes fo the thoracic spine, no evidence of fracture of subluxation. (Suppose I should have an MRI done for the T as well)

[J-moe]

Glad to see some more action in this forum. I've decided against the RFA. I'm glad the first injections were succesful in pinpointing the pain, but now am trying to research any other options. My doctor completely blew me off and denied any further help once I decided against the procedure. I really felt abandonned. I don't like health care people too well right now.
Any suggestions on other treatments would be greatly appreciated.
Be careful with those drugs Sharon. Some of these doctors really don't have a damn clue, or give a damn, I think. J-moe

Also my doctor denied that the RFA actually cuts or burns or severs the nerve. Complete oposite of everything else I researched. He also made his nurse explain all of this to me, and would not talk to me.(He makes me so mad) Because I'm not going through with this multi-thousand dollar treatment that will indefinately need repeating, thus giving job security to this a#$hole, he is completely and cold-heartedly denying any form of guidance other than this procedure.

[janster]

Hi Sharon~
Welcome to the forum, but sorry you have to be here. Sounds like you have a lot to deal with too. Hang in there!

I did want to comment on this:
Here's one you will all appreciate: Spoke to neuro this afternoon as PM is on vacation. He has perscribed Tramadol for my head and worsening back pain and on Monday I should make appt. with PM for RFA. I take 20 to 30 mg of Elavil at bedtime for sleep and some pain (from my GP). I ask neuro if the Tramadol can be taken with Elavil, he says sure no problem, I ask pharmacist when I pick up Tramadol if there is a problem with that and Elavil, she says no problem. I read the drug sheet provided by the pharmacist and low and behold YOU CANNOT TAKE TRAMADOL AND ELAVIL TOGETHER can cause seizures and other pretty major problems. Now what do I do, if I stop the Elavil I will go through withdrawl, but the pain is pretty intense so I opted to take the Tramadol this evening and tomorrow morning, if my headache and backache are improved I will need to take at least 10 mg of Elavil. Honestly you can't trust any body with your health these days!
I take 50mg of Elavil at bedtime and I also take Tramadol 37.5mg 4x’s/day. I've been on this combination for over two years with no problems. Sometimes I think they have to put the warning on there if something happened to one person out of 3 million, just to cover their butts. Of course this is just my opinion and I am not a medical professional.

I hope you find some relief soon! Take care and keep us in formed--we care!
Hugs,
Jan

[janster]

Hi J-moe!
First of all, welcome to the forum. Sorry I didn't welcome you sooner. I'm also sorry you were treated so badly by your doctor. Sad to say there is too much of that going around! You hafta kiss a lot of frogs before you find your prince......well, ya know what I mean!! :) I didn't believe it when I heard people say it either, but it IS true--they (good, compassionate, kind, empathetic, caring doctors who GET it) are out there! Your doctor sounds like a frog to me. ;)

I would suggest just keep looking for a different, caring doctor. You need help to decide what your next step is. I wish I could help more. Don't give up, you'll find him/her! Please let us know how you're doing--we care!
Hugs,
Jan :)

[Kathi49]

Hi All,

I am about ready to have a facet Rhizotomy done at L3/L4/L5 and S1. My spinal PM doc is a "gem" and I have been with him for 4 years now. He did an ESI first; helped a little. Then he did a Sacroilliac injection; same thing. Then he did the facet blocks which lasted about a week...all on the left side by the way. And it is the left leg that has been giving me fits. His point is is that the pain will keep coming back (and it has), plus the fact that the facet blocks gave me relief. So, his deal is that the Rhizotomy should give me relief. I am not so sure this will work but I am willing to give it a try. :)

[janster]

Hi Kathi~
Wishing you good luck, fast healing and pain-freeness! <-huh?? :Scratch-Head: Well, you know! :D Please come back and let us know how it went and keep us informed on your progress! We care.
Hugs,
Jan :Good-Luck:

[LizaJane]

I've just had a facet block, one week ago, and the anesthesiologist would like to follow it up with RFA. In the meantime, the injection helped, and then I did an acupuncture, and that helped a bit more, and then a Feldenkrais therapy session, and that helped a bit more.

So, while far from perfect, far from it, it's helpful, and I'm thinking that even though the RFA is recommended (he says I'd probably get them every 6 months), I'm not quite ready to be a revenue stream for another doctor. I'll take a few more blocks, if given the chance.

About Elavil and Tramolol. I've taken both, or Elavil and oxycodone. They are not contraindicated to give together, but they do react. One slows the breakdown of the other in the blood, so the effects of them are a bit more than additive. This means that if you get drowsy, youll be more so. Alcohol, opiates,benzos,all interact in this way, and one needs to be prudent.

Finally, it would be really graet if all the links for info on RFA could be put together and put into the stickies, so people know what to think about.

I have neuropathy, and usually post there, and I'm reluctant to kill off ANY nerves, when they die so easily on their own.

[janster]

I have neuropathy, and usually post there, and I'm reluctant to kill off ANY nerves, when they die so easily on their own.
I also have Neuropathy and totally agree with LizaJane.
Hugs,
Jan

[Dodrill]

Hi

The old brain talk is alive and well. If you google brain talk you will find them. They mention something about hasty pasty so you will know which one to click on. All of the old information is there. All you need to do is search the threads and you will get a lot of information.

Good Luck, Pam

[Junie]

Hello all,
I had the RFA in 2002 at age 45 after several steroid epidural injections along with a couple of extremely painful myelograms and after each proceedure I had more and more pain until I finally said no more punctures in my back...until I had my level 2 spinal fusion on L3-4 4-5 and now am left with the cauda equina syndrome as well as a severe case of arachnoiditis! The only other puncture going into my spine will be a pain pump which makes much more sense to me in the fact that I will be cutting my narcotic use down to a fraction of what I take now!
I wish you all the best with your outcome!

[Kathi49]

Thanks Janster!

I also forgot to mention that I have small fiber peripheral neuropathy as well. But I did want to say also that my disc are not all that bad; I have one that is bulging. It is the facets that are terribly arthritic. As I said above, my PM did 3 types of injections and the pain kept coming back. However, the facet block lasted the longest. I, too, am a little afraid of having the nerve lesioned because of the PN. I asked my Neuro and another Neurologist about my cervical fusion in September as I was afraid then that the PN would worsen. They both told me it wouldn't, and it didn't. The main reason for the Rhizotomy, besides the pain/radiculopathy, is I have to have pelvic floor physical therapy. Both my Urogynecologist and my PM feel that I need to get the lumbar/sacral nerves calmed down in order to go into PT. I suppose I could have insisted on more blocks but my PM says it is rather pointless since he knows where the pain generators are. And I don't think he wants to give too many steroid injections in a given year.

[Kathi49]

Oh, I wanted to add one more thing I was told today.

I talked with my Neurologist about this upcoming Rhizotomy (being done by the spine group I go to). And she told me that the Rhizotomy would not worsen my PN at all. If I remember correctly, it is the medial branch nerve in the facet. I would have to look at a chart again LOL! Somebody, please correct me if I am wrong about that nerve. But I think that is what it is called. Anyway, my PM told me that it was the nerve whose "sole purpose in life was to transmit pain...that's all it does." So, hopefully, this will eventually help with the left leg pain I have and then I can get into PT.

[Kathi49]

Hi All,

I just had the RF done today; L4/L5 and S1 on the left side. I was given Versed and Fentanyl I believe he said but was still alert enough to talk about anything and everything...and believe me I did! I was chatting away LOL! I did not hurt AT ALL! All I felt was a slight tingling and that was it!

I came home put ice on my back and have been asleep most of the day. Now, I will post again once 3 or 4 days have gone by because right now I still have some of the Toradol in me as well.

But for the most part I think it went well! I was scared to death of the pain...but there was NONE! Not yet anyway! :)

[janster]

Hi Kathi!
Sorry I haven't been around or I would have replied to this before now. I'm glad your procedure went well for you and seemed to be pretty painless. That's good!

Since it's been a week let's have a progress report girl!! I hope you're still doing well! Did your doc say about how long it would take until you would notice anything from it, or would that vary? Fill us in please!
Hugs,
Jan :)

[Kathi49]

Hi Jan!

I am doing just fine after the Rhizo! :) I did have soreness the next day; more like a deep, achy bruised feeling. But, I am telling you...that's it! The neuropathic pain down my leg has stopped in particular my ankle which is what I was hoping for. God only knows if I had or have radiculopathy or small fiber pn. Sometimes I really wonder since this idiopathic PN almost didn't show up on the QSART.

Anyway, it has only been a week and they say to give it 3-4 weeks. But, so far so good. I am able to sit down for the first time in months without saying ouch! And am able to drive without pain. I can tell though, that the right side needs to be done since the facets are bad there also. It is just that the left was worse than the right. But now that I have been split in half so to speak, it is easy to tell that I have arthritic facets on the right.

Now, if I can just get my trapz, rhomboids, etc. to calm down I will be fine. This second cervical fusion has caused some spasms recently and it is difficult to remain on the computer for too long.

So, there you have it...doing just fine. And I will not hesitate to do it again; just wish I had done it sooner. :)

[LizaJane]

My PM who gave me a facet block at L5 late December wanted to do an RFA tomorrow. I spent the weekend online googling and reading whatever I could find.

I was surprised to find no long term studies at all, and only 3 studies that were at all reasonable. Most are very short term, maybe a month or two months. Nobody has studied or written on patients 5 years out. There are NO articles reporting side effects or bad outcome. I found all this unreasonable. I found guidelines for reimbursement by insurance companies, and some excluded people who had had prior spinal surgery.

There was one review article, and the abstract concluded that there was no evidence that Lumbar RFA is better than sham treatment. The email address of the authors was on the abstract on pubmed, so I sent him an email, and asked if he'd send the entire article, and, if he'd learned anything new since 2003 when he wrote the article.

HE CALLED ME. He said there is one more study, in Europe, done after his review, and it showed, again, that lumbar RFA does not work better than sham. He said there are definite risks, even though nobody has written on them. Some people ARE in worse pain when the nerve grows back. Many people are in pain again as early as 2 months, if they've had a "good" response. But specifically, he wanted me to know that the best evidence AGAINST RFA is with spinal surgery patients. There it absolutely never works.

He explained why. He said that the needle is put in to get the medial branch of a nerve, and that they can hit that nerve because they know pretty exactly how it travels. He said since you can't see it, you count on it being where it's supposed to be. But if you've had lumbar surgery, he said, the nerve is moved by retractors, and it's impossible to know exactly where it is. So doctors who say they are injecting the medial nerve in lumbar surgery patients are full of hot air. They have no idea where they are injecting.

So he thought it very important to call me and tell me not to get it--it's full of risk and no benefit.

I told him I'd gotten a facet block that worked; isn't that the predictor that they know it will work? And he asked me exactly how the block was done. I told him I got injected into both facets and the joint space. Aha, he says, that's what everybody's doing and saying it predicts RFA will work; there's a very specific protocol, and that''s not it.

He's an anesthesiologist in the pain group at Mayo.

(I then told him I have 6 loose screws in addition to the facet pain, and he suggested I talk to their spine department; five minutes later my phone rings again. He talked to the head of spine, who says nobody should be walking around with 6 loose screws and no plan. There's all sorts of tissue damage that could result. So they took the liberty of booking me for March 3.

The appointment is there; mine to cancel, he says. But the spine guy wasn't happy that I'm without a plan.)

[Kathi49]

Liza,

I am sorry to hear that.

But I did not have lumbar surgery of any kind. The facet injections proved where the pain generator was. I had the Rhizotomy and am doing just fine. I had also read up on all of this; the pros and cons. But I took the risk and would repeat it again in a heartbeat. Maybe I am like Bobbi in that I had good luck with it. Plus, my spinal PM is an excellent doctor so I felt safe with his opinions and recommendations. However, I have also read that sometimes they just don't work or increase pain. I have not had that happen yet. But like I said, I have not had lumbar surgery so what you have posted makes sense. :)

[LizaJane]

Please don't feel sorry--I feel I've had a couple of pieces of luck. First, it was good that the Mayo guy held me back, because the pain seemed a bit lighter. I'm also glad he was clear about what's been shown and not shown. Because in my case, I don't meet criteria for RFA having been shown to be useful, and it is a risk; there is a risk of worsening.

But in the last two days, my butt pain has eased. And oddly, it's been the left side that hurts, and has hurt for months, but now the right side is hurting. So while the facet block worked, it might not have worked as he thought, and injecting the nerve to the left might not have worked.

It's an odd thing, and I have no good explanation.

[semurray]

Well I already posted my story so I won't go into details here. But suffice it to say it worked for a little while, now I am on Gabapentin and my podiatrist knows a good rhuematologist and the neurologist and pain guy who think I am still one of their patients will be surprised when I send the letter asking for my test results and my treatment notes so I can bring them to the new doctor. As my 18 month old grand daughter would say, DONE, DONE, DONE.

My head pain is worse then ever and now I am having full blown migraines with the nausea and everything else. I can't even get meds into me because I know they will come right back up. So the "pain guy" who will not discuss the reason for the headaches until I see him in two weeks has prescribed Gabapentin for the "neuropathic pain". I didn't have this before the procedures. As debilitating as the headaches were and I didn't think they could be worse, oh boy, they are much, much worse. Now I have been out of work all week, the Gabapentin is working but the effects are dizziness, spatial relationship issues, hand numbness and leg numbness. Can't drive like this and typing is a chore. (excuse the bad typing and possible thought drifting).

When I asked him "Did the procedure fail, are the nerves regenerating, was this only parital lesioning" He said "You are asking too many questions we will discuss in a couple weeks at your appointment". Surprise I won't be there!
Well what do expect when I can't lift my head from my pillow?

Gabapentin/Neurontin works like a charm, you can feel it follow the track of pain right up the back of the neck, back of the head and up and around. It numbs as it goes. Hopefully the effects will level off. My Gp and yes I did see him, why they made an appointment for me immediately, hmmm, you need to come in, hmmm, pain guy couldn't care less. Well GP says give Neurontin a few more days and call if it does not level off we can try others. OH, a big OH, read the package insert on-line because I didn't get one with Neurontin. I take 500mg Naproxen 2 xs a day, not good. Naproxen, in animal studies, increased effects of Neurontin by 14% at doses much lower than human therapeutic doses so dose of each should be adjusted. They don't know what the effects will be at the usual or higher doses, hmmm. So I have switched to OTC Aleve 220 mg 2xs a day. Maybe still should drop the dose or discontinue the Naproxen (I don't think the Naproxen does anything anyway since I have widespread tendonits, don't know why, part of the arthritic process maybe.)

Doctors with the exception of my GP who is a Godsend do not like those of us who read. Now this is only my opinion based on my personal experience and I don't mean to insult doctors who appreciate patients who read and show an interest in their own health care and their diseases and disease processes. They are the best physicians if you are lucky enough to find one.
I really hope my new rheumatologist is of the appreciative doctors.

[semurray]

Thanks Jan,
I have not been online in a long time, just no time and meds are interferring with my life.
I took the Tramadol Saturday morning. I had taken 30mg of Elavil the night before. Oh boy, text book reaction; vomitting, brutal headache, tremor, profuse sweating, etc. Could literally not lift my head from the pillow for 1.5 days. I don't know, all I know is I need to unload 98 Tramadols (you can't flush any of the stuff anymore it's in the ground water, the highest concentration of drug found is estrodial, waste water plants can't filter all the drugs out, they aren't set up for that). I don't know why, I can take any and all opiods with only minor effects, upset stomach and the expected drowsiness that stuff. I have never had a reaction to anything like that. I thought I was dying and I could not pick up my head long enough to dial the phone. That's bad!

The Rhizotomies failed, I am in worse shape now due to brutal headaches, and neck pain (that I really didn't have before now my main complaint was headache). Now I have this crap going on in my neck, feels like something inside is twisting, I get this jumping nerve thing that drives me crazy and the headaches are full blown migraines with nausea and all the other manifestations of migraine, I did not have all that before.

Now pain guy says "neuropathic pain" put me on Gabapentin, which works wonderfully but I am having the effects from the Gabapentin, dizziness, spatial relation issues, numbness, and so on. He says we will talk about it at the next visit in two weeks. Well surprise!! I found a rheumatologist highly recommended by my podiatrist (ankle pain, no bone problem yet he thinks it's OA starting in the soft tissue). I am no longer their patient. And they will find out when I cancel my followups. I will write them for my test results (EMG/NCV) and treatment records that I want for the rheumatologist. And I will, if needed, have the new doctor refer me to real pain management if that's where I need to be.

[drmikep]

Hi All,

I'm new to the forum but I had RF on my neck (c3-c5), Monday 2/18/08. So far, I haven't seen any improvement but I understand it takes time and it's been only 4 days. I hope that in a couple of weeks th pain will subside and I will see results.

My background: I'm a 52 y/o male and I have Degenerated Disk Disease. My past treatments: I have had a Micro Laminectomy and a Cage Fusion on my lumbar (L5-S1). these were done after many facet join and Epidural injections. and my lower back is still crap. Then, about 2 years ago, my neck started giving me trouble. My MRI shows that C3-C6 as having problems with C3/C4 being the worst. I have had several facet join and Epidural injections with NO help. The RF is basically my last stop before another major surgery that, in the past, hasn't helped at all.

I guess I'm ranting a bit, but I'm hoping that someone here has had similar experiences and can perhaps offer some advice.

Thanks

[Puptrainer A.D.]

Hello out there! I am not sure if this is even the correct place to respond (as the previous posts are rather old) but I am scheduled for the diagnostic test that proceeds the RF..... but when talking to my worker's comp nurse today she recommended that I do some research before agree to either procedure. She knows that I tend to be very proactive about my treatment.

I am very glad she had me take a look around, and I am left feeling pretty hesitant now. Did anyone out there end up with positive long term results??

[Bobbi]

I did; the effects of mine have lasted roughly 18 months. I was quite happy with the outcome, in that the procedure did help quite a bit. One of the RFA procedures was for occipital neuralgia (the high C-spine was nerve nuked - and I don't remember the exact levels without digging out the post-op report); it was also bilateral and multi-level.

For several months, as I mentioned, the major effect of the procedure was that I didn't have daily, horrendous headaches.

The effects, most likely, from RFA will not be permanent, since the nerves will (most probably) regenerate with time. The benefit is that the procedure, if successful or effective in reducing symptoms can be repeated.

Also, when I've had RFA, it de-clawed (lack of a better way to say it right now) my hand; I couldn't get the darn'd thing to open without hours on end of each day passing.

I've had the procedure done on my C-spine and L-spine, each time bilateral, multi-level. It was quite effective for me.

I know it's not the same for everyone, and that's also why it's beneficial that doctors do the diagnostic procedure - to better assess what might be the outcome if going ahead with RFA, etc.

[nwdgill]

Afer numerous Cortisone injections, my pain management doctor suggested RFA and suggested I check the research on it for my own peace of mind!

Has anyone actually had success with this procedure to help the nerve pain associated with bulging discs?

I detest taking pain medicine, so I'm willing if there's a good chance of zapping this pain...... N

[Kathi49]

Ditto what Bobbi said! :)

EXCEPT that I have only had it done in the lumbar and twice. Both times I have had about a year's worth of relief. And ready to have it done again on October 1st.

N,

I would give it a try. As Bobbi said, the nerves will regenerate. But if you can get some significant relief, I would go for it. Good luck! :)

[HoneyButter]

I had RFA's done in Feb and Mar of this year on L1,2,3 bilateral. 100% success. No pain. I would have it done again in a second. Got rid of 2 1/2 years on opioids. Clear head finally. :)