Nerve ablation, also called radiofrequency ablation, is a procedure that helps relieve chronic pain – one of the most challenging conditions to treat. About 84% of adults in the United States suffer from chronic low back pain at some point in their lives.
Nerve ablation uses radiofrequency currents to target the nerves that transmit pain signals to the brain. It helps relieve spine and neck pain, tumor pain, arthritic joint pain, and chronic lower back pain.
Healthcare providers, including pain specialists, anesthesiologists, and surgeons, can perform nerve ablation in a hospital or clinic.
Nerve ablation most often helps relieve facet joint-mediated pain—or pain that starts in the facet joints that connect the vertebrae in your neck, midback, or lower back. The heat energy targets the areas containing the nerves responsible for transmitting or regulating the sensation of pain.
Health professionals recommend nerve ablation when the condition does not improve with traditional treatments such as medication or physical therapy. A few conditions that nerve ablation can treat are:
- Pain in the spine and neck
- Arthritis joint pain
- Chronic lower back pain
- Facial pain from trigeminal neuralgia
- Tumor pain
There are different types of nerve ablation based on the specific characteristics of the nerve. Common types include:
- Thermal radiofrequency ablation: This is the most common technique. It uses radio frequency current to produce heat, which damages the nerve that transmits pain.
- Pulsed radiofrequency ablation: This technique delivers bursts of radio frequency current (20 milliseconds at 120 second intervals) instead of a continuous current flow.
- Cooled radiofrequency ablation: This technique uses a continuous flow of water to cool the current-generating electrode, preventing it from reaching very high temperatures.
- Cryoneurolysis: This technique directly uses cryoprobes, which produce ice pellets of various sizes at a very low temperature of about -94 degrees Fahrenheit (-70 degrees Celsius) to damage the targeted nerve.
Nerve ablation can be scary, like any other procedure. Talk to your healthcare provider to understand what to expect during the procedure. A few things to keep in mind are:
- Location: Nerve ablation is an outpatient procedure performed by pain management specialists, anesthesiologists, and surgeons in a hospital or clinic.
- clothes: You will need to change into a hospital gown for the procedure, so you may want to wear comfortable clothing and leave your jewelry at home.
- post: Your healthcare provider will let you know if you can have food or water or avoid consuming anything for a few hours before the procedure.
- medicines: Tell your doctor about all the medicines you are taking. They may recommend stopping anticoagulants, including aspirin and Coumadin (warfarin), because they can interfere with the procedure.
- Documents: You may want to bring photo identification and your insurance card on the day of the procedure.
- Emotional support: Ask your doctor if you can bring someone with you on the day of the nerve ablation.
- Insurance: Check with your insurance company to see if they will cover the cost of your nerve ablation.
During nerve ablation, a small needle is inserted into the nerve where the pain is occurring. An active electrode that sends current is inserted through the needle. The heat of the current destroys the surrounding tissues and nerves, relieving the pain. After the procedure, your healthcare team monitors you for several hours before you can go home.
Before the test, your doctor will ask about your medical history, as well as the location and severity of your pain. Providers often recommend X-rays or other imaging tests to identify what may be causing the pain.
They will then recommend a diagnostic block test, which helps identify the nerve causing the pain and predict whether you will get relief from nerve ablation.
Diagnostic block tests involve injecting a local anesthetic, usually lidocaine, into the region of pain. Results are positive if people experience 50% or more pain relief after the injection, and positive results often indicate that you will benefit from nerve ablation.
Your healthcare team also uses an intravenous (IV) line to give you fluids or general anesthesia (only when directed by your doctor).
During the Procedure
For the nerve ablation procedure, you will change into a hospital gown and get comfortable on the procedure table. Your surgical team will clean the skin and inject a local anesthetic to numb the area where the needle will be inserted.
A needle or cannula is then inserted through the skin where you feel the pain. The target area is determined using fluoroscopic guidance, which produces a continuous X-ray image on the monitor.
After insertion, the active electrode is passed through the needle. Painful symptoms are stimulated to confirm the target location. After that, a local anesthetic is sent through the needle, followed by a radiofrequency current.
The electricity produces heat that helps destroy nerves, transmitting pain signals to the brain. The procedure can last from 15 minutes to about an hour.
After the Procedure
After the nerve ablation, your healthcare team will monitor you for several hours. You can usually go home the same day the procedure is completed, but it is safest to arrange for someone to drive you home.
Your healthcare provider may prescribe pain medication at the treatment site. They will also give you instructions on how to clean the treatment site to prevent infections.
Nerve ablation is a low-risk and safe procedure that often does not lead to unwanted complications. Although rare, nerve ablation can cause several complications, including:
- Bleeding at the needle site
- Worsening pain at the needle site
- Infection at the needle site
- Nerve damage
- Numbness in the face
- Spinal cord injury
Pregnant women need to talk to their health care providers to understand if they can undergo the procedure.
Nerve ablation can effectively relieve chronic pain in the first four weeks of the procedure. One study found that nerve ablation can relieve facet-mediated low back pain for 6-12 months and up to two years.
Your healthcare provider can tell you how long your pain relief can last. The nerve can grow back, causing the pain to reoccur. In these cases, some healthcare providers may recommend repeating the nerve ablation.
Nerve ablation is a procedure that reduces pain by targeting the nerves that transmit or regulate pain signals to the brain.
Your healthcare provider uses a diagnostic block test to understand if nerve ablation will help relieve your pain. The procedure usually takes place in a hospital or outpatient clinic. You can usually go home the same day as the procedure.
Pain relief from nerve ablation can last up to two years. Follow up with your healthcare provider to understand how long it will take to relieve your pain.