WHAT IS “NERVE BURNING”?
In the treatment of chronic pain, we often reach a point where we need to block or destroy the source of the pain. With pain, the source is located within a nerve. There are numerous approaches to treating pain at the nerve. Some procedures simply block the nerve and provide temporary relief, while others can actually destroy the nerve. In this article, we will discuss nerve burning, also known as radiofrequency denervation.
The first step in nerve burning is to identify the source of the pain and isolate those nerves. Then, the physician performs a temporary nerve block through the use of a local anesthetic. By numbing the nerve we can see how much relief will be provided by destroying the nerve and also how the area will feel afterward. If the level of relief is adequate and the remaining sensation is not unpleasant we can consider destroying the nerve.
Many techniques have been tried over the years including surgically cutting the nerves and destroying them with powerful chemicals. The safest and most effective technique has been found to be utilizing high frequency alternating current passed through a needle to generate heat and create a small thermal lesion (“burn”) on the nerve. This procedure is called a radiofrequency denervation.
WHAT NERVES CAN BE TREATED?
Most nerves control both sensation and movement in a portion of the body. When destroying nerves, it is vital that we do not destroy motor nerves that supply important muscles. For the most part we can treat nerves that either do not have any motor function or nerves that supply muscles that we can do without. There are many nerves in the neck, face and chest region that can be treated using radiofrequency. A similar but non-destructive technique called pulsed radiofrequency denervation can sometimes be used to provide relief from pain that involves nerves with both significant sensory and motor function.
WHAT CONDITIONS CAN BE TREATED?
Chronic neck and low back pain that has been localized to the small facet joints in the spine is the most amenable to radiofrequency denervation. The pain may be due to underlying arthritis, degenerative disc disease or an injury. Sacroiliac joint pain may also respond to radiofrequency denervation. Certain types of non-cardiac chest wall pain and facial pain may likewise respond well to this technique. Pulsed radiofrequency can be used on many other nerves.
IS THE NERVE DESTROYED PERMANENTLY?
With time nerves regenerate (regrow). Fortunately, the regeneration process is very slow. The relief associated with a successful radiofrequency procedure generally lasts from six months to two years. If the underlying cause of the pain has not improved or resolved the procedure may need to be repeated.
Radiofrequency denervation procedures in carefully selected patients and conditions can be tremendously successful with a very low complication rate and discomfort similar to a nerve block. In many cases complex surgery can be delayed or avoided.