Axon pain management centre, hyderabad RADIOFREQUENCY IN PAIN MANAGEMENT Definition: Radiofrequency nerve (RFN) ablation is a treatment that

uses radiofrequency energy (high frequency alternating current) to interrupt of alter nociceptive pathways of various sites. Modalities Continuous radiofrequency radiofrequency Pulsed

Continuous radiofrequency---continuous radiofrequency current is used to produce thermal nerve in a target nerve. Pulsed radiofrequency---short bursts of radiofrequency are delivered to target nerve producing effects on signal transduction to reduce pain. Mechanism of action Radiofrequency current (low energy, high frequency)

Oscillation within the molecules

Friction between molecules

Heat production

Blockade of nerve transmission

Radiofrequency generator One arm-large plate attached to body needle electrode Second arm-

Continuous radiofrequency: Frequency- 100 to 500 Hz, Duration- 60-90 sec

Continuous current

Heat is produced transversely along the active tip of the needle Temperature- 65-75 degrees

Needle should be placed parallel to nerve

Interrupt conduction of nociceptive signals

Lesion=1-1.5 times of the electrode diameter

Blocks pain transmission

Duration of effect depends on time required for regeneration of coagulated nerves

Nonselective destruction of nerve fibers (motor and sensory)

Pulsed radiofrequency Current: 50 kHz in 20ms

Alternating current

Long pauses between impulses

Heat dissipation convection and conduction

Temperature< 42degrees

Current is delivered distal to tip of electrode

Electrode is placed perpendicular to the nerve

Mechanism of action: poorly understood - May involve altered signal transduction of pain pathway. -Increased expression of c-Fos an early activator gene. -Increased expression of activator transcriptor 3, marker of cellular stress in neurons.

Patient selection History and examination Diagnostic local block of target nerves Preparation NBM hours- 6 hours, clear fluids upto 2 hours Consent

Procedure Local anesthesia is infiltrated in target site, Using X-ray; guide the needle to the exact target area. A microelectrode is then inserted through the needle to begin the stimulation process. Once the needle and electrode placement are verified, a small radiofrequency current is sent through the electrode into the surrounding tissue, causing the tissue to heat. Postoperative notes -Not to drive or operate machinery -24 hours after the procedure. -Resume normal diet. -Not to engage in any strenuous activity -24 hours after the procedure. -Not to take a bath for 1 to 2 days after the procedure. Specific indications Trigeminal neuralgia: The needle electrode is passed under fluoroscopic guidance through foramen ovale to trigeminal ganglion that lies close to cranial opening of foramen ovale. Cervical cordotomy: Creation of lesion in lateral spinothalamic tract on contra lateral side of pain. This

reduces pain sensation but retains temperature and proprioception which are carried by dorsal columns. Cervicogenic headache: ablation of third and greater occipital nerve. Spinal pain: median branch neurotomy supplying the facet joints. Groin pain and orchalgia: radiofrequency ablation of genitofemoral, ilio-inguinal nerves and nerve roots. Miscellaneous syndromes: deafferentation, plexus avulsion, post-surgical neuropathic pain, spinal radicular pain, post surgical thoracic pain. Complications -Pain or discomfort around the injection site -Numbness of skin covering the injection site -Worsened facet or sacroiliac joint pain due to muscle spasm in the area of the injection -Permanent nerve pain -Allergies or reactions to medications used -Infection

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