Taking a hot shot at back pain

January 27, 2011 8:36:04 PM PST
A targeted procedure that does not require surgery may provide relief for some types of back trouble.

Radio frequency ablation, or RFA, has been around for years. It's been used to help treat many different types of pain. What makes it so appealing is that it's commonly performed as an out-patient procedure and does not require a large incision. For back pain, some doctors say it's now effective because the technique has been improved.

Barbara Koscielski loves the library, but until now she couldn't sit and read to save her life.

"I couldn't sit, not for long periods," said Koscielski.

Pain sprouted in her lower back, her sacroiliac joint where the base of the spine meets the pelvis. When pain injections didn't work, she considered surgery. "Things that people take for granted, I couldn't do," Koscielski said.

It's estimated that 85 percent of American adults suffer from back pain and a fair amount of that pain may come from the sacroiliac joint or inflamed facet joints, which connect vertebrae to each other and allow motion of the spine.

"I couldn't walk down to the end of the block," said Koscielski.

Doctors decided to try RFA or radio frequency ablation for Koscielski's sacroiliac pain.

"What we're basically trying to do is take away the sensory nervous system supply to that joint," said Dr. David Maine, pain specialist, Mercy Medical Center, Baltimore.

A six-inch probe is heated to 176 degrees. Inserted through a small incision, it disrupts sensory nerves going into the joint. No nerves, no pain. It is an out-patient procedure and patients are usually awake while it is being performed.

Dr. Timothy Lubenow is a pain specialist at Rush University Medical Center.

"Radiofrequency definitely has a place for people with back pain, assuming you can demonstrate the majority of the back pain is coming from a particular structure such as a facet joint or the sacroiliac joint or even now most recently this same technique can be applied to treating certain types of degenerative disc disease," said Dr. Lubenow.

While it may not relieve all of the pain, studies show with specific nerves it usually reduced it by more than 50 percent. RFA is only a temporary remedy, typically lasting between three and 12 months, sometimes longer.

And while this procedure isn't new, Dr. Lubenow says recently improved techniques are allowing specialists to destroy more nerve fibers making it more effective.

"This newly revised approach is promising so there have been some early studies done that suggest when you apply this treatment concept to disc related pain it works better than some of our older approaches," said Dr. Lubenow.

He suspects we will be hearing more about RFA in the next couple years.

For now, Barbara Koscielski says it did the trick for her back pain.

"I could tell within a few days that that initial pain was gone," said Koscielski.

Many doctors stress that the cause of back pain often involves several trouble spots. So, taking care of nerves in one area may not resolve all of the pain.

Dr. Timothy Lubenow
Pain Specialist/Anesthesiologist
Rush University Medical Center
Pain Center at Rush

Rush Professional Office Building
1725 W. Harrison Street, Suite 550
Chicago, IL 60612
Baylis Medical

Dr. David Maine
Center for Interventional Pain Medicine
Mercy Medical Center
Baltimore, MD