Beyond pills and surgery: how radiofrequency ablation is helping chronic pain sufferers

Today, chronic pain doesn’t just affect older adults or individuals who have been severely injured. It affects professionals, young adults, and athletes, with career hiccups, sleep disruptions, mobility problems, and mental health issues as a result. Chronic pain is one of the most common reasons for visiting a doctor, and yet, there is still insufficient information to support efforts to manage it. Patients often find themselves on a cycle of medication and physiotherapy, with little long-term benefits. Many use short-term pain relief (medication, etc.) rather than finding a long-term solution through treatment option. This is, where, perhaps, Radiofrequency Ablation (RFA) can step in.

What is RFA?

Radiofrequency Ablation (RFA) is uniquely suited to bridge the gap between short-term relief and long-term sustainable solutions in pain management today. RFA is performed using a non-invasive, non-surgical approach for the treatment of pain: it does not mask the pain as medication does, instead, it targets the pain generator. RFA uses heat generated through the use of a radio frequency generator to accurately deactivate the nerve responsible for sending a persistent pain signal to the brain. The procedure is performed under real-time imaging guidance (fluoroscopy and/or ultrasound), allowing for accurate targeting of the nerve while preserving surrounding healthy tissue.

RFA is valuable because of its ability to provide pain relief for an extended period (typically between nine months to two years). In comparison, steroid injections or medications provide pain relief for only a few weeks. Patients who receive RFA can experience real comfort, mobility, and functional improvement for longer periods of time, and can often return to performing daily activities that they may have stopped doing over time.

Who is useful for?

RFA has been found to be particularly effective for patients with chronic neck and low back pain due to facet joint degeneration, spondylosis, or sacroiliac joint dysfunction. These types of conditions are increasingly prevalent among people who lead sedentary lifestyles, spend a significant amount of time on screens, and exhibit poor posture. In recent years, RFA has also been used to treat arthritis-related pain in large joints such as the knee, hip, and shoulder, and has allowed many patients to postpone or avoid joint replacement surgery.

RFA doesn’t just address musculoskeletal issues; it also can alleviate complex neuropathic pain syndromes including trigeminal and occipital neuralgia, and various forms of pain associated with cancer. For these patients, who typically do not respond well to traditional outpatient medical management techniques or to large doses of controlled substances, the precision of RFA provides targeted pain relief with much less reliance on medication.

One key benefit of RFA, is with respect to the use of long-term pain medication, particularly opioids and the effects they can have on the body. Chronic medications can cause a number of health issues including gastric and renal complications, as well as dependency and cognitive behavioural side effects. Since RFA interrupts the pathway of nerve conduction of pain, many patients can significantly reduce the total number of medications taken on a daily basis. This, in turn, benefits their overall physical well-being and quality of life.

How is the procedure done?

The procedure is fairly simple for patients. . The treatment usually takes place at an outpatient centre. A local anaesthetic is used; thus, there is minimal downtime after the procedure. The use of diagnostic nerve blocks prior to the actual treatment is crucial to accurately identify where the patient’s pain is coming from. By confirming the site of pain before the procedure, the patient benefits from appropriate treatment and may expect good results from their intervention. Most people will be able to resume their daily activities within 24 to 72 hours after the treatment.

RFA is not a permanent, one-time-only solution. Because the nerves that are ablated will also regenerate over time, RFA can be repeated if pain returns; therefore, it can be a sustainable option to manage chronic pain versus just a temporary solution.

Enhancing pain management

Many chronic pain sufferers experience not only physical pain and discomfort but also the emotional fatigue of dealing with their condition and the loss of their independence, which can lead to social withdrawal from friends and family. Several patients talk about experiencing the feeling that nobody is listening to them. Precision pain interventions such as RFA are helping to change that narrative by providing patients with relief from pain that is measurable, meaningful, and lasting.

As medicine evolves towards targeted and personalised treatment approaches for patients, RFA represents a strong link between conservative care options and major surgical intervention. Pain management is about more than a reduction in physical pain, it is about helping patients regain motion, self-respect and return to performing normal activities.

(Dr. Manish De is an interventional pain specialist with CK Birla Hospitals, CMRI, Kolkata. manish18y@gmail.com)