How can Pain Injections and Radiofrequency ablations help eliminate pain?
Injections are a tool that Dr. Justin Kruer uses to help diagnose a painful condition (diagnostic injections) and then to help treat a painful condition (therapeutic injections).
The evaluation process starts with a careful history: what causes your pain, where is the pain, how often is it painful, how does it affect your lifestyle? Imaging studies (such as MRI) may also be used in the evaluation. Dr. Kruer may prescribe diagnostic injections to confirm that his prediction of the pain generator is accurate. These are called Diagnostic Blocks, or Medial Branch Blocks (MBB).
The rationale is quite simple. If the doctor can inject the structure or joint that he suspects is causing your pain with a numbing medicine and the pain stops temporarily, then it confirms that this is your pain generator.
If you have a positive diagnostic block then a Radiofrequency ablation (or RFA, or Rhizotomy) procedure may be recommended to provide a long lasting pain relief effect.
What is Radiofrequency ablation?
Radiofrequency ablation is an electrical current produced by a radio wave and used to heat up or destroy the medial branch of the sensory nerve to block the transmission of pain signals from this area. This procedure is a non-surgical treatment with low risks for complications and can be performed on the cervical (neck), thoracic, and lumbar spine. It is also beneficial for post-surgical nerve pain.
Dr. Kruer performs this procedure along with other pain management procedures in a procedure room within the clinic setting. This is a cost saving to the patient in comparison to other facilities that perform this procedure in a surgical center.
What to expect with Diagnostic Blocks, or Medical Branch Blocks:
You will be positioned on an x-ray table depending on what body part is being treated. Dr. Kruer will sterilize the skin and then numb up your skin in the specified area. He then uses live x-ray image (fluoroscopy) to carefully insert and guide a needle into the joint(s) that has been identified as the possible pain generators, and releases the numbing medication. This is typically at 3 different levels/ joints. You will then sit for a few minutes to be monitored.
You will need two diagnostic injections to confirm the diagnosis. If you get 75% relief or higher after these procedures then Dr. Kruer can perform the longer lasting radiofrequency ablation.
What to expect with the Radiofrequency Ablation:
You will be positioned on the x-ray table the same as for your diagnostic injections. Dr. Kruer will sterilize your skin and then numb up your skin in the specified area. He then uses live x-ray image (fluoroscopy) to carefully insert and guide a needle-like tube (cannula) to the effected medial nerve. A small needle-like electrode (radiofrequency electrode) is inserted through the cannula. To confirm the electrode is in the correct position a very mild electrical current is delivered through the electrode to the nerve. If in the correct position, a numbing medication is delivered to the nerve in preparation for the treatment. Dr. Kruer then delivers the heat through the electrode to the nerve. The heat creates a lesion in the nerve and disrupts its ability to send signals about pain. The entire procedure takes 15-30 minutes.
The nerves will grow back over time but the procedure can then be repeated if needed. Pain relief typically lasts around 9-12 months. During this time of pain relief Physical Therapy is recommended to help you regain strength and flexibility so that you can resume your favorite activities.
The patient can walk around immediately after the procedure.
Please pay attention to your pain level and symptoms after your treatment and don’t over-do-it.
It usually takes 3-4 weeks for the treated nerves in the radiofrequency ablation to completely turn off. During this period your back may feel weak or different. You may experience pain until the nerves are dead.
Take it easy during the first 3-4 days, and use ice or heat to minimize any residual pain.
What pain can radiofrequency ablation help?
- Cervical pain
- Thoracic pain
- Lumbar pain
- Pelvic pain
- Post-surgical nerve pain to the knee (peripheral nerves), ankle, foot, hip, shoulder.
To schedule an appointment with Dr. Justin Kruer please call (406) 721-4436 or request an appointment online. If you have questions about specific pain management conditions that Dr. Kruer treats please call his orthopedic assistant at (406) 829-5583.