Dr. Wei Lan is a Consultant Pain Physician
Pulsed Radiofrequency Treatment (PRF)
What is Pulsed Radiofrequency
Pulsed radiofrequency (RF) is a well established treatment for joint and nerve pain. The procedure differs from radiofrequency neurotomy (RFN) treatment where the probe is heated. Pulsed RF treatment applies an intermittent electrical pulse to the probe, thereby avoiding heating the nerve. This in turn, minimises further nerve damage. RF treatment doesn’t cause weakness or loss of normal sensations, and has been shown to reduce pain.
What Conditions does it treat?
Pulsed RF can be used to treat:
- Radicular pain (neuropathic pain from the spine)
- Occipital neuralgia (pain in the back of the head or base of the skull)
- Post-surgical neuropathic pain
- Suprascapular nerve for shoulder pain
- Medial branch nerves for facet joint spinal pain
- Pudendal neuralgia
How should I prepare for the procedure?
You should avoid eating or drinking for six hours prior to the procedure. We also advise that you have a responsible adult to look after you for the 24 hours following the procedure. During this 24 hours, you shouldn’t drive, or make important decisions. If you are diabetic or take or blood thinning medications, you should discuss this with the doctor.
What happens during the procedure?
RF treatment is performed under sterile conditions in an operating theatre using mild sedation and / or local anaesthetics. Fluoroscopic x-ray guidance allows the operator to accurately position a needle (probe) near the site of the affected nerve or joint.
How will the PRF treatment help?
A number of studies have been performed on the efficacy of RF treatment. Pulsed Radiofrequency (RF) Epidural Pulsed RF (PRF) at the dorsal nerve roots and dorsal root ganglia (DRG) can be used to treat radicular neuropathy. Epidural placement enables treatment of multiple spinal levels via a single needle, and target of nerves inaccessible due to normal anatomy, foraminal stenosis, or hardware. Temperature control at 42°C limits thermal effects and ensures safety. The average duration of pain relief is between four and 26 months, depending upon which nerve is being treated. However, pain relief may range from anywhere between four weeks to 18 months. In some cases, there is no benefit.
What to expect after the procedure
Generally, you will be discharged from the hospital within two hours and may resume normal activities on the following day. Simple analgesics are often required for a few days. If you’ve been using stronger analgesics, you may require stronger analgesia for a few days.
What are the side effects?
Like all procedures, RF treatment carries some risks, including: • Allergic reaction to the medications used in the procedure or sedation is possible but can be treated on the day: nausea is not uncommon following sedation. • Infection is extremely unlikely with the possibility minimised by the use of sterile techniques in an operating theatre. The needles are all disposable. • It is uncommon for even a day of work to be lost; however, if there was an infection or excessive pain, there is a possibility of some time off work. Some soreness after the procedure is normal and may last for 24-48 hours.
Can anyone have a PRF?
Most people are suitable for a PRF. However, because the procedure is done under X-Ray guidance, you cannot have it if you are pregnant, as it could damage your baby. You must be 100% certain that there is no possibility of pregnancy when coming in for procedure.
Also, if you have an infection or open wound or burn of any kind, have recently had surgery or the flu vaccine or have very high blood sugars or blood pressure your procedure may be cancelled. If you are on blood thinners of any kind you must discuss this with the Pain Doctor well in advance of your procedure date.
When the pain is improved and with the approval of your doctor, we very much encourage you to start regular exercise and activities as this will help with your overall pain management and mood. – Remember, to do so in moderation and to increase activities and exercise gradually.
When can I resume normal activities/medications?
Activity:
Procedure Day: You are advised to rest on the day of your procedure.
Day2: Return to 25% to 50% of your usual activity level
Day 3: Return to 50% to 75% of your usual activity level.
After that, you can resume your normal activities as tolerated.
Medication:
Continue to take your usual pain medication until you notice some improvement in symptoms. Link in with your GP with regards to any medication changes.
Resume anti-coagulants the first day after the injection or follow your doctor’s specific advice.