My PM who gave me a facet block at L5 late December wanted to do an RFA tomorrow. I spent the weekend online googling and reading whatever I could find.

I was surprised to find no long term studies at all, and only 3 studies that were at all reasonable. Most are very short term, maybe a month or two months. Nobody has studied or written on patients 5 years out. There are NO articles reporting side effects or bad outcome. I found all this unreasonable. I found guidelines for reimbursement by insurance companies, and some excluded people who had had prior spinal surgery.

There was one review article, and the abstract concluded that there was no evidence that Lumbar RFA is better than sham treatment. The email address of the authors was on the abstract on pubmed, so I sent him an email, and asked if he'd send the entire article, and, if he'd learned anything new since 2003 when he wrote the article.

HE CALLED ME. He said there is one more study, in Europe, done after his review, and it showed, again, that lumbar RFA does not work better than sham. He said there are definite risks, even though nobody has written on them. Some people ARE in worse pain when the nerve grows back. Many people are in pain again as early as 2 months, if they've had a "good" response. But specifically, he wanted me to know that the best evidence AGAINST RFA is with spinal surgery patients. There it absolutely never works.

He explained why. He said that the needle is put in to get the medial branch of a nerve, and that they can hit that nerve because they know pretty exactly how it travels. He said since you can't see it, you count on it being where it's supposed to be. But if you've had lumbar surgery, he said, the nerve is moved by retractors, and it's impossible to know exactly where it is. So doctors who say they are injecting the medial nerve in lumbar surgery patients are full of hot air. They have no idea where they are injecting.

So he thought it very important to call me and tell me not to get it--it's full of risk and no benefit.

I told him I'd gotten a facet block that worked; isn't that the predictor that they know it will work? And he asked me exactly how the block was done. I told him I got injected into both facets and the joint space. Aha, he says, that's what everybody's doing and saying it predicts RFA will work; there's a very specific protocol, and that''s not it.

He's an anesthesiologist in the pain group at Mayo.

(I then told him I have 6 loose screws in addition to the facet pain, and he suggested I talk to their spine department; five minutes later my phone rings again. He talked to the head of spine, who says nobody should be walking around with 6 loose screws and no plan. There's all sorts of tissue damage that could result. So they took the liberty of booking me for March 3.

The appointment is there; mine to cancel, he says. But the spine guy wasn't happy that I'm without a plan.)