Spinal pathology has increased its incidence in today’s modern society: lumbar and cervical pain is a pathology that affects 60% of the population, who at some time in their lives will suffer from low back pain.
The treatment consists of changing lifestyle habits, avoiding a sedentary lifestyle, exercising regularly within the possibilities of each person and maintaining a healthy diet. But in some of those affected, the pain becomes chronic and cannot be controlled with healthy habits, drugs or rehabilitation. It is in these cases when more specific techniques such as radiofrequency are indicated, in the hands of an expert in Pain Unit and as a previous step to more aggressive techniques such as surgery.
The Radiofrequency (RF) technique for the treatment of pain involves the passage of a high frequency current (500,000 Hz) through a cannula, which is a needle that is totally insulated except for the 2 to 15 mm tip, the active part that will exert the therapeutic action.
Types of radiofrequency for back pain
There are two clearly defined modes of RF: Continuous RF and Pulsed RF.
– In Continuous RF, as the current passes through the cannula, the temperature of the cannula increases only at the active tip. The degree of temperature reached is controlled voluntarily (temperatures between 60-90ºC are used), it is therefore a neuroablative technique in which thermocoagulation is produced, i.e. the treated tissue is destroyed by the action of heat.
– In pulsed RF the electric current is pulsed, so that neither the cannula nor the tissue is heated. RFP interrupts the current periodically by means of pulses to control the temperature and eliminate the heat in the tissue (the maximum temperature reached is 40-42ºC in a time of 120 seconds). The advantage of pulsed radiofrequency is that it is not destructive so it can be indicated on structures where conventional radiofrequency cannot be used, such as nerve roots.
When is radiofrequency treatment necessary?
It is recommended in patients with pain at the level of the spine, and it can be used at practically all levels of the spine: cervical, dorsal and lumbar. It is very effective in cases of pain from nerve root involvement or radiculopathy, pain in the facet joints (which are the joints in the spine that join one vertebra to another), pain from disc degeneration, or in the sacroiliac joint.
Radiofrequency can also be used on peripheral nerves such as the suprascapular nerve in patients with pain or difficulty mobilizing the shoulder. As well as in complex regional pain syndromes with pain maintained by the nervous system or in the sphenopalatine ganglion for certain cases of migraine among many other uses of this treatment for pain.
Results of radiofrequency
Before performing the radiofrequency treatment, the specialist in the Pain Unit performs a blockade in the area to be treated with local anesthetic and sometimes corticosteroid. The block is diagnostic, because if the pain disappears it means that it is an area that generates pain, and it is also therapeutic because it relieves and removes the pain for a time. Radiofrequency is superior to blockade because its duration is much longer, from 3 to 6 months or even a year. It is considered a success if it reduces the patient’s pain by at least 50%, and it can be repeated after 6 months or a year without consequences for the patient.
Risks of radiofrequency
The technique in the hands of an expert in Pain Unit and following the safety guidelines has few side effects. It is essential that the procedure is performed in an operating room to maintain asepsis and an exact vision under radiological control of the area where the cannula is introduced.
Other safety measures would be the verification of sensory and motor stimulation once the cannula is in place and controlled radiologically. Before proceeding to radiofrequency stimulation, a stimulation with parameters in which the patient feels a tingling in the area that usually presents pain should be practiced. This ensures that the cannula is in the right position. To corroborate that it is not a motor nerve, it is verified by giving a stronger stimulation that no structure such as arms or legs move. If, on the contrary, they move, it is a sign that the cannula must be repositioned.
Being a physical technique, there are the effects derived from the discomfort of the infiltration, which are minimal thanks to the local anesthesia and sedation. If the insertion of the cannula is not controlled, it could lead to an unwanted puncture in another structure or vessel and cause a hematoma.
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