Radiofrequency Thermocoagulation

Radiofrequency Thermocoagulation

What is radiofrequency thermocoagulation, its purpose, and how does it work?

Starting from the 1960s, radiofrequency thermocoagulation has been developed to destroy specific nerves in parts of the body. Radiofrequency thermocoagulation (RF) involves cutting nerve transmission by generating heat using radiofrequency energy. In pain treatment, this method is used to deactivate pain-conducting nerve fibers. The current, similar to radio waves and sent at very high frequencies like 500,000 Hz, can cause damage at a single point without causing any disruption in the surrounding area. Nerve transmission is typically blocked for a duration ranging from 3-18 months. The fundamental mechanism in radiofrequency is the increase in tissue temperature due to friction. Over time, the method has evolved and become much safer.

Radiofrequency device

Types of Radiofrequency

Conventional Radiofrequency: This type is entirely heat-based, sending temperatures of 70-80 degrees Celsius to the nerve.

Pulsed RF: Intermittent current up to 42 degrees Celsius is used. Its mechanism is different, altering the working mode in nerve cells.

Cooled RF: This type relies on cooling the nerve region between currents.

Bipolar Radiofrequency: Applied simultaneously with two electrodes.

In which type of pain syndromes radiofrequency can be performed?

RF applications can be used for various types of pain.

These pain syndrdmas include:

• a. Severe facial pain called trigeminal neuralgia.
• b. Glossopharyngeal neuralgia.
• c. Headaches unresponsive to medications, especially cluster headaches.
• d. Pain arising from the facet joints in the neck.
• e. Pain originating from the facet joints between the back and lumbar vertebrae.
• f. Pain stemming from the sacroiliac joint.
• g. Disc pain.
• h. Pain arising from the hip joint.
• i. Pain originating from the knee joint.
• j. Pain arising from the sympathetic nervous system.
• k. Cancer pain.

What preparations are required before the procedure?

• Ask your physician to explain the procedure to you in detail. Your physician will require written consent from you as required by law.
• Inform your physician about all other illnesses, medications you are taking, and any agents or medications that cause allergies if any.
• It's advisable to consult your relevant physician since all blood-thinning medications except Aspirin need to be discontinued. Herbal medicines like Vitamin E, glucosamine, garlic, and ginseng can also cause bleeding.
• Take all your previously done tests, MRI, CT scans, and lab findings with you when going for the procedure.
• Wear comfortable clothes and leave your watch, rings, and other jewelry at home.
• Stop intake of water and food at least 4 hours before the procedure. However, necessary medications for other systemic diseases can be taken with a small amount of water.
• Since a superficial anesthesia process called sedation will be applied during the procedure, you will not be allowed to return home alone. You should come with an escort. Also, the local anesthetics used can cause temporary weakness and numbness in the legs, so you won't be able to drive.

How is the procedure performed?

• Radiofrequency thermocoagulation takes about 20-30 minutes depending on the number of areas being treated and is performed under operating room conditions.
• The patient lies face down on the operating table for the lumbar region and face up for the cervical region.
• An IV line is established. The patient is connected to a device to monitor heart rate, pulse, blood pressure, and respiration rate. Sedatives and pain relievers are administered through the IV.
• The skin is then cleaned with an antiseptic solution and the application area is covered with sterile drapes.
• The intervention area is identified with fluoroscopy (imaging), and a local anesthetic is applied to the skin area above it.
• Under imaging guidance, needle-like electrodes reach the diseased level (facet joint, disc, herniated area)
• Then, small electrical stimulations are sent through the electrode connected to the radiofrequency device with a sterile cable to confirm once again that the needle is in the right place.
• At this stage, it is asked whether the patient feels an electric sensation. Thus, the location of the needle is confirmed twice.
• The radiofrequency device can also measure tissue resistance and temperature. After all these verification processes, radiofrequency current is sent, and the procedure is completed.
• At the end of the procedure, the electrode is removed, and the entry point is closed sterily.
• The patient is awaited to come around.
• The needle entry point is covered in a sterile manner. After the procedure, the patient is taken to their room for monitoring, and after an average observation period of 2-3 hours, they are discharged.

What should I do after the procedure?

• You should rest for  3 days following the procedure.
• Bed rest is recommended except for essential needs like using the restroom, bathing, eating and drinking.
• At the end of the rest period, you will be called in for regular check-ups, and if necessary, you will be included in an exercise program.

 What should I expect from the procedure?

• After the procedure, some patients may experience an increase in pain. Therefore, strong analgesics are given to relieve your pain after the procedure. This pain decreases within 7-10 days.
• The success rate of the procedure is generally 70-80%. If effective, a reduction of 50% or more in pain is expected in the first week after the procedure.
• A period of 5-6 weeks is required for the completion of the treatment. Local anesthetics, steroids, and sedation effective drugs are used during the procedure. Local anesthetics may cause temporary loss of sensation or strength in the arms or legs depending on the area where the procedure is performed.
• This situation ends in 6-8 hours.
• Steroids are administered to prevent inflammation in the area. Although effects start immediately, it takes 6-10 days for the effects to settle in.
• Although the data on this subject are not clear, the effectiveness of the procedure varies between no benefit at all to a pain-free period of 2-5 years. This situation shows personal differences.

How many times can the procedure be performed?

• If the first procedure does not provide enough pain relief, a second procedure is performed based on your examination findings in the check-ups.
• Many patients who do not benefit from the first procedure reach an adequate therapeutic level with the second procedure.
•  As the nervous system is a tissue that can renew itself, these methods are not permanent and can be repeated if the pain resumes.

What are the side effects and risks of the procedure?

• The procedure is generally safe. Very serious precautions and verification methods are applied during the placement of radiofrequency needles, which reduces the risk of complications. The risk of complication development varies individually.

The most common ones are:

• Increase in pain and other complaints. There may be an increase in pain due to the affectation of these tissues as the needles have to pass through the skin and subcutaneous soft tissue to reach the target tissue.
• Infection. Although there is a risk of infection in any intervention applied through the skin, this risk is quite low compared to open surgical operations. Additionally, since the procedure is performed with sterile disposable materials, this risk is minimal.
• Bleeding. This risk increases if the patient is using blood thinners like Plavix, Ticlid, Coumadin, or has a genetic disorder like Hemophilia.
• Nerve damage. This risk is almost negligible due to the control of the electrode’s position both by imaging and radiofrequency devices.
• Temporary loss of strength and numbness can be seen.
• An allergic reaction to any medication used during the procedure can occur.
• The occurrence frequency of these complications is very low like 1/5000.

Is there a 100% guarantee for the procedure?

• There is no 100% guarantee for any treatment in medicine. Radiofrequency thermocoagulation shows a 50% reduction in pain in 60% of headache patients,
•  a 50% reduction in pain in 57% of trauma-related pains,
• a 50% relief in 60% of patients who have not undergone any surgery before,
•  a 50% relief in 40% of patients who have undergone surgery.

Who should not undergo the procedure?

• The procedure should not be performed on patients who are taking blood-thinning medications,
•  or have a serious active infection in any part of their body. T
• herefore, inform your physician  about all the medications you are using.