No Pain, More Gain

RFA Provides Relief Without Surgery

The excruciating pain radiated from Patricia Fox’s neck into her right shoulder. Advil didn’t help. Tylenol didn’t help. Pressing down on the areas didn’t help. She kept thinking ‘this will clear up and go away,’ but instead the pain got worse for two years.
Then she heard about radio frequency ablation, RFA.

RFA uses a tiny needle that emits radio waves to heat up and cauterize the nerves that carry pain signals from the spine to the brain, says Dr. Raj N. Sureja of the Orthopaedic and Spine Center in Newport News. Since 2007, Sureja has performed more than 1,000 RFA procedures with a 75 percent to 80 percent success rate, he says.

To determine if RFA is called for, Sureja examines the patient, looks at his or her clinical history and studies X-rays or an MRI. He first may try therapeutic cortisone injections into the spinal joints. But cortisone shots typically provide only a month or two of pain relief—and patients can’t get those shots that often. The next step is to perform a diagnostic medial pain block to identify the exact source of the pain.

RFA targets the medial branch nerves that carry pain signals from the spine’s facet joints to the brain. The procedure is especially helpful in treating pain caused by injuries such as whiplash and by degenerative arthritis, Sureja says.

RFA is an outpatient procedure and takes 20–45 minutes. The patient is awake, with local anesthesia and perhaps a mild sedative, Sureja says. The patient is lying on his or her stomach under an X-ray machine so needle placement can be monitored, he says. To confirm accurate placement of the needle, the doctor asks the patient if he or she feels a tingling sensation or muscle twitch—those reactions ensure that the electrode needle tip is in the correct location.

Unlike temporary pain block injections, RFA takes two to six weeks to see maximum results, Sureja says. But most patients receive as much or more pain relief as with temporary blocks, and that relief lasts much longer—six months to several years compared to several weeks to several months with cortisone injections alone.

Diabetics can have RFA without worrying that their blood sugar levels will be elevated, as happens with therapeutic cortisone injections, he says.

People who have pacemakers shouldn’t have the procedure because the electrical energy could interfere with the pacemaker’s electrical transmissions, Sureja says.

“Overall it’s extremely safe,” Sureja says.

Fox, 73, of Williamsburg is one of his many success stories.

Although Fox was nervous before undergoing RFA, the procedure wasn’t bad, she says. “It was just pressure—you can deal with that,” she says. “It was great that there was no cutting, no stitching.”

Within a few days, Fox’s pain was just a memory.

“I couldn’t believe the pain was gone,” Fox says. “It was such a relief.”

Sureja has treated patients as young as 18 and as old as in their 90s. The younger people are usually looking for relief from pain caused by sports injuries or car accidents while the older patients are dealing with arthritis pain, he says.

“My younger folks tell me that before the procedure, they have a difficult time running, doing physical activities that involve twisting or even throwing a ball with their children,” Sureja says. “My older folks tell me they have a tough time standing for long periods of time. They are leaning on shopping carts when they go shopping, leaning on the kitchen counter when cooking to alleviate pressure on their neck and back.”

Afterward, “They’re able to do those activities again,” he says. “They’re able to stand up straighter and stand up for much longer periods of time.”

Patients can usually significantly cut back on pain medication, he says. “If they have to remain on medication, it works much more effectively because it’s not so much of an uphill battle against the pain.”

As for Fox, she isn’t taking any pain meds at all. After two years, she’s still feeling no pain.

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