Radio Frequency Injections???
 

Has anyone tried a Radio Frequecy injection. I'm going in on next Friday and am nervous because it is not a normal procedure for treating RSD.
It is suppose to deadend the end of the nerve to prevent the pain signal going to the brain. The nerve will refuse itself within six months so it is not permenant. Has anyone tried this?

Hi, I'm Greg. I'm my wife's caregiver and she's had this *&^%%^$ for14 years and has tried about everything. SHE's supposed to go in Wednesday for this procedure. I've done a little researching on this site and elsewhere and we've decided to forego the thing. IN fact she's on the phone right now canceling the appt. with her neurologist. Some people on here say RUN don't WALK away from this treatment. I see it as likened to lobotomies back in the 50's and 60's. Almost medieval. Of Course, She has gone totally full-body and we shy away from invasive stuff because that will make it spread even more. If you do get this procedure. please post your progress. Maybe it'll work, but we don't want to take a chance. Good Luck
Greg and Karen

I've never heard of this. But, I'm sure you've investigated it, and, your doctor's success rate!?????
Be sure.

I think we'd all love to hear the outcome, and, surely hope that is does something positive, for this nasty disease!

Pete
asb

Never heard of it either. I hope all comes out alright. I will keep you in my prayers....:)

I had an IME 2 months ago (wc), that Dr recomended my Dr do this procedure. They called it Radio Frequency Ablation. He said that since I responded to 6 stellate ganglion nerve blocks that it should help me. Btw, the nerve blocks only gave me 10 days of relief.After researching it and talking to my Dr I decided against it. My Dr said he didn't have good results and I could be left with Horner's Syndrome (droopy eye/face) until the nerves grow back, anywhere from 6 mo to 2 yrs. Also, the nerves will grow back and the pain may or may not come back....maybe worse. There is also the possibility the procedure will not help at all.

I have RSD in my left hand/arm so maybe results would be different for lower extremity but I am not willing to chance making this worse and having to deal with the Horners syndrome is just not something I am ready for. I am having a hard time accepting and understanding this as it is. I'm still waiting to wake up from this nightmare. I used to cry all the time, now even when I want to cry there are just no more tears.

stressedout, I agree with your call. And from what I understand, the upside is somewhat lower and the downside is far worse for folks with lower extremity pain, requiring a lumbar procedure.*

To get a picture of the possible downside, I would check out just one article written by an avowed supporter of the precedure, Laxmaiah Manchikanti, MD, "The role of radiofrequency in the management of complex regional pain syndrome," Curr Rev Pain 2000;4(6):437-44, free full text at http://www.rsds.org/2/library/articl...anchikanti.pdf

Pain Management Center of Paducah, 2831 Lone Oak Road, Paducah, KY 42003, USA.

The nomenclature, pathophysiology, and treatment modalities of complex regional pain syndrome (CRPS) are controversial. Thus far there are no specific, scientifically valid treatments for the management of CRPS. The numerous modalities of treatment range from sympathetic ganglion blocks, intravenous regional blocks, administration of a multitude of pharmacologic agents and behavioral interventions, to surgical sympathectomy. Minimally invasive radiofrequency lesioning for managing CRPS is a modality in its developmental stages. This article describes radiofrequency lesioning techniques in managing CRPS. [Emphasis added.]

PMID: 11060589 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

While even the abstract sounds out of date compared to a few other things that were being published that year (say, Schwartzman RJ, "New Treatments for Reflex Sympathetic Dystrophy," NEJM 2000:654-655, free full text at http://www.rsds.org/2/library/articl...tzman_nejm.pdf) the kicker is when Dr. Manchikanti discusses "Complications of Radiofrequency" at page 442, and in particular, those mentioned in Sub-Paragraph 5 - which I understand to arise primarily from lumbar procedures for lower extremity pain - including "spinal cord infarctions . . . paraplegia . . . that may develop secondary to inadvertant lesioning of the spinal cord or its constituants." Please, scroll down to p. 442 and check them out: http://www.rsds.org/2/library/articl...anchikanti.pdf

Swatgen27, were any of these potential complications disclosed to you?

And is it any wonder, when physicians of the relatively conservative Division of Pain Medicine, Mayo Clinic (Rochester and Jacksonville) published "Complex Regional Pain Syndrome," R.H. Rho, R.P. Brewer, T.J. Lamer, and P.R. Wilson, Mayo Clin Proc. 2002;77:174-180, free full text at http://www.mayoclinicproceedings.com...2/174.full.pdf, that no mention was made the use of Radiofrequency ablation?

Radiofrequency ablation is a blast from the past, and that's where it should stay.

Mike

*On this, check out "Interventional Therapies," Allen W. Burton, MD, in the RSDSA's Complex Regional Pain Syndrome: Treatment Guidelines, R. Norman Harden, MD, editor (2006) http://www.rsds.org/3/clinical_guidelines/:

Wilkinson43 reports the largest series of percutaneous Radio Frequency (RF) lesioning of the thoracic T-2 distribution sympathetic outflow (RF sympathectomy), with over 350 procedures performed with 86% signs of sustained sympathectomy at 3-year follow-up, without any assessment of clinical analgesic or functional outcomes (level 3 evidence for interruption of sympathetic activity in a prolonged fashion with RF techniques).43 Wilkinson reports difficulty with lumbar percutaneous RF techniques due to variability of the lumbar anatomy versus the thoracic ganglion. He also reports a low rate of postprocedure neuralgic syndromes (around 5%), although this is recorded in an unpublished data format within a book chapter.42 This author could find no published data yet on pulsed RF sympathetic ganglion techniques. [Emphasis added.]

Footnotes
42. Kim K, DeSalles A, Johnson J, Ahn S. Sympathectomy: open and thoracoscopic. In: Burchiel K, ed. Surgical Management of Pain. New York, NY: Thieme Publishers; 2002:688-700.
43. Wilkinson H. Percutaneous radiofrequency upper thoracic sympathectomy. Neurosurgery. 1996;38:715-725.

http://www.rsds.org/3/clinical_guide...rventional.pdf

Stressedout,
Thank you for the concern as I'm extremely concerned as well. In fact, I'm scarred s***less. Pardon my french....
I just don’t know what to do anymore, and I have run out of options as this is all I have left:
Manage it with medicine - and I find that 'medicine' does a poor job managing the RSD pain and I'm on a lot of medicine.
- Or -
Try one last thing (The R.F. injection) in hopes that I might feel comfortable in body again.
I know you said you did research and I have very little information on this procedure. In fact everyone here has told me more facts about this procedure than my doctor and the research that I have found.
You and your wife are in my thoughts and thank you for your advice.

Sarah

Thank you so much for the research information. My doctors and I discussed the risks a month ago and he did not mention the majority of those risks. In fact, he compared it to the nerve blocks that we have done and said that the risks were almost identical.
I know he has performed many of these and all his patients were able to walk away but that was my main concern..Mobility. It hurts a lot for me to move around but at least I can still do it..and the doctor said that my mobility would not be affected. Per the research you provided I now know different and this does not make me happy.
At this point, I will keep my procedure booked but now I have several different questions on my mind and those questions will have to be answered that morning prior to the procedure. If the answers I get don’t calm my ever increasing concerns than I won’t do the procedure. However, most likely I will try it because I'm desperate for just the littlest amount of

I had it done twice and it didn't work. When I had it done I had RSD in my right arm and shoulder. My RSD spread very quickly and now I wonder if the treatment helped the spread along. My RSD is full body.

Please know that we all wish you ease with your decision, however this turns out. Please recognize, however, that there is something of a disconnect between sentences 2 and 3, above.

Information alone can't comfort your concerns as a whole, it can only respond to the specific questions you put it to. More importantly, desperation is never a reason for rolling the dice, unless the option won't be around a month from know, should you decide to think it over. (And if that was in fact the case, I would think that someone was trying to pressure me.)

Were I in your shoes, I would bring (A) a printout of Dr. Manchikanti's article, including his list of "Complications of Radiofrequency," along with (B) a tape recorder with a 120 minute tape or similar recording device [in many states, it's your legal right, otherwise, explain that you want to ask about a number of things you have come across that were posted on the official RSDSA (Reflex Sympathetic Dystrophy Association of America) website, with which you are unfamiliar, and the tape is a more effective way of you attempting to retain information than simply taking notes] and (C) a close friend or family member for moral support as well as driving you home when it's over. Once the tape is running, I would:

1. Ask your doctor if he believes the list fairly summarizes the possible complications of your procedure, keeping in mind that lower body procedures appear to be trickier than those for the upper body;

2. Ask him what risks on the list can be ruled out in light of the procedure he's planning; and

3. As to each of the remaining risks, ask him. in a completely nonconfrontational tone, to explain the risk in terms you can understand, the approximate likelihood of the risk, and whether he has ever come across that particular complication, and if so, how many times, how did things end up, etc.;

4. Finally, I would ask him to estimate not only the length of time for which you could realistically expect relief, but whether, at the end of that time period, you would be likely be a good candidate to repeat the procedure with similar results, or whether there would be any expectation of declining results with subsequent procedures.

I suspect that with that information in hand, you'll be remarkably calm and confident in your decision, whatever it is. Good luck and remember we're always here if you need us.

Mike

PS I leave to your sole and complete discretion perhaps the most interesting question, which is why he had not previously disclosed these risks to you. :D

Hello everyone,

After a discussion with my doctor yesterday morning I went through with the R.F. injection. The procedure itself was horrific and extremely painful (cried through the whole thing and for about an hour after) and today I find myself in extreme discomfort. My back feels like I was beat with a baseball bat and my nerves in my legs are extremely irritated. I will not know the results until 4-6 weeks from the procedure and statistically (and since I'm an accountant I love my numbers) there is 20% chance of this working. The 20% may sound discouraging but that’s a 1 out of 5 patients have relief and I'm hoping I'm that I fall in the 20%. I have been fighting this for a couple years so I'm not naive but I am still hopeful.
Per other discussions with my doctor yesterday, there are other options but they are all extremely invasive so I don’t think I will be taking that path. For me, it’s either this works and I can cut down on my medicine or it doesn’t work and I will be stuck with my medicine for a long time. I will keep everyone posted as to any progress or lack of progress. I hope everyone is doing well.

Sarah

Dear Sarah -

So very sorry you had such a miserable time yesterday.

I am, however, equally troubled by your doctor's suggestions that the only other techniques are "more invasive." This sounds 15 - 20 years out of date, where there exciting research is being done with medications.

If and when you have the energy, I would urge you to read "Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: A double-blind placebo controlled study," Schwartzman RJ, Alexander GM, Grothusen JR, Paylor T, Reichenberger E, Perreault M, Pain 2009 (in press), FREE FULL TEXT at http://www.rsds.org/2/library/articl..._Pain2009.pdf:

ABSTRACT
Complex regional pain syndrome (CRPS) is a severe chronic pain condition that most often develops following trauma. The pathophysiology of CRPS is not known but both clinical and experimental evidence demonstrate the important of the NMDA receptor and glial activation in its induction and maintenance. Ketamine is the most potent clinically available safe NMDA antagonist that has a well established role in the treatment of acute and chronic pain. This randomized double-blind placebo controlled trial was designed to evaluate the effectiveness of intravenous ketamine in the treatment of CRPS. Before treatment, after informed consent was obtained, each subject was randomized into a ketamine or a placebo infusion group. Study subjects were evaluated for at least 2 weeks prior to treatment and for 3 months following treatment. All subjects were infused intravenously with normal saline with or without ketamine for 4 h (25 ml/h) daily for 10 days. The maximum ketamine infusion rate was 0.35 mg/kg/h, not to exceed 25 mg/h over a 4 h period. Subjects in both the ketamine and placebo groups were administered clonidine and versed. This study showed that intravenous ketamine administered in an outpatient setting resulted in statistically significant (p < 0.05) reductions in many pain parameters. It also showed that subjects in our placebo group demonstrated no treatment effect in any parameter. The results of this study warrant a larger randomized placebo controlled trial using higher doses of ketamine and a longer follow-up period.

(c) 2009 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

What's so significant about these results, as you can see reading the study, the study, is that no effort was made to limit the study participants to individuals who had been symptomatic for six months or less at the time of treatment: a group that is far more likely to benefit from any number of therapies than are those who have had this condition longer. And the out-patient treatment used by Dr. Schwartzman in this study is being implemented at a number of centers around the country. (I just can't have it because of pre-existing glaucoma.)

And on a different but also promising tract, please read "An Effective Treatment of Severe Complex Regional Pain Syndrome Type 1 in a Child Using High Doses of Intrathecal Ziconotide (Letter to the Editor)," Stanton-Hicks MD, Kapural L, J Pain Symptom Management 2006;6:509-510, FREE FULL TEXT (and a couple of amazing photos) at http://www.rsds.org/2/library/articl...32_6_pg509.pdf, which was followed more recently by "Intrathecal ziconotide for complex regional pain syndrome: seven case reports," Kapural L, Lokey K, Leong MS, Fiekowsky S, Stanton-Hicks M, Sapienza-Crawford AJ, Webster LR, Pain Practioner 2009 Jul-Aug;9(4):296-303:

ABSTRACT
Ziconotide is a nonopioid analgesic currently indicated as monotherapy, but frequently used in combination with opioids, for the management of severe chronic pain in patients for whom intrathecal (IT) therapy is warranted and who are intolerant of, or whose pain is, refractory to other treatments. There is a paucity of information regarding ziconotide use in patients with complex regional pain syndrome (CRPS). Seven cases in which IT ziconotide was used in patients with CRPS were analyzed. All patients (4 male, 3 female; age range, 14 to 52 years) had experienced inadequate pain relief with multiple conventional and interventional treatments. Three patients received ziconotide monotherapy exclusively; 4 patients received ziconotide monotherapy initially, then combination IT therapy. The mean ziconotide dose was 5.2 mcg/d (range, 0.5 to 13 mcg/d) at initiation and 24.7 mcg/d (range, 0.06 to 146 mcg/d) at the last available assessment. The mean duration of ziconotide therapy was 3.1 years (range, 26 days to 8 years). At ziconotide initiation, the mean visual analog scale (VAS) score was 89.3 mm (range, 75 to 100 mm); VAS scores decreased by a mean of 47.5% (range, 5% to 100%) at last assessment. Of the 5 patients who experienced substantial improvement in pain, edema, skin abnormalities, and/or mobility with ziconotide therapy, 2 have discontinued ziconotide and are pain free. Another patient experienced marked reversal of both edema and advanced skin trophic changes. Adverse events included urinary retention, depression, anxiety, and hallucinations. Adverse events generally resolved spontaneously, with treatment, or with ziconotide discontinuation/dose reduction. Although further studies are required, ziconotide holds promise as an effective treatment for CRPS.

PMID: 19500276 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

And note that the reported success rates in the foregoing studies were considerably better than the 1:5 you were quoted.

I apologize for laying all this on you. I just want you to know that there are kinder/gentler options out therebefore you return to your local butcher: even if he's on the faculty of a very good medical school, he's living in the past. So what I am suggesting is that before seeking further treatments from the same fellow, you seek another opinion. Since you live in Illinois, I would suggest the Cleveland Clinic, and specifically Michael Stanton-Hicks, M.D. Where he is now on senior status, I have been told by his department that he only sees patients with established cases of CRPS and then will do so only after first reviewing their medical records. Here's his directory page at the Cleveland Clinic http://my.clevelandclinic.org/staff_...taff_1175.aspx I believe the number for reaching his secretary is (216) 444-7246.

Finally, here's his departmental homepage http://my.clevelandclinic.org/anesth...t/default.aspx

And once again, I am so sorry for what you are going through.

Mike

RF injection -- Progress Report
 

It has been over a week since I had the RF injection done and I thought I would tell everyone how it is going....
Since the procedure I have had an increase in my leg pain (RSD in in both legs from hip to toes) and a lot of back pain and I usually dont have any back pain.
I have also had an increase in muscle spasms and my right leg feels tired when walking.
I have yet to see any benefit but the doctor said it will take from 4-6 weeks to get the full benefits.
As for week one, I have noted no benefits. I will let everyone know how week two goes... (I pray it goes better than last week.)

Week 2
 

It has been two long weeks since I have had the RF injection. The back pain has finally decreased but it took 12 days for that pain to go away.
I still am experiencing a large increase in my RSD pain. The pain has been unbearable, to the point of wanting to go to the hospital but I know there is nothing the hospital can do so I find myself just waiting for this nightmare to go away.
My toes have gone numb on the right side (The side that they treated) and I have extreme muscle fatigue in the right leg.
At this point in time, I would not recommend this treatment, in fact I would say stay away from any doctor that recommends it.

Still no benefits and lots of extra pain. =(

Hang in there. Sounds like absolute torture instead of treatment. I know this isn't a pleasant time for you, but if you can't stand the pain please go back to the doctor who gave you the injections and tell him/her that you have increased pain. I don't think more pain is what s/he was going for. It's the wrong outcome and you need to tell the doctor.

radiofrequency procedure
 

I am new on this site - not sure where to post, but I have questions on this procedure. My husband had radiofrequency ablitation done on his neck 2 weeks ago, C2 to C5. He has been in so much pain it has been a nightmare. The first 3 days he had spasms, those have subsided, but still his scalp and neck are so tender he can hardly sleep, and cannot fully turn his head because of the pain. Says his scalp feels as if it is on fire. Don't know what we will do if this continues. Anyone know of poor outcomes from this procedure. Dr.'s comments were ' ... he got a good burn... ' Nice comment from him.

Rf injections - very bad
 

I had the Radio Frequency injection done at least two months ago and I also had the same issue with the RF causing even more pain. Turns out the RF procedure can be such a shock to the body that it can set off every nerve in your body and that is what happened to me. I was actually throwing up the pain got so bad. The Dr told me that in rare cases, the RF causes every nerve in the effrected area to become inflamed, which causes the extra pain. They said that to treat this issue, I should go on steriods but instead we increased my pain meds because the pain never went back down. My pain levels have remained increased, the procedure was extremely painful, and now I have back pain that wont seem to go away. My advice, DONT DO THIS PROCEDURE!!! PLEASE, DONT MAKE THE SAME MISTAKE I MADE. If we all learn from my mistake than maybe I wont regret getting the procedure done and Maria, I'm sorry to say that I think you two will have to do damage control.

I really dont have anything else to say about this topic but I'm trying to upload my picture and i wanted to see if it worked so I'm doing a test posting. Sometimes I can be so weird...

Rf: More pain, no gain
 

Its bad enough to have ADD, DEPRESSION, and PANIC / ANXIETY disorders which are being treated with Class II medications, but with Chronic Transient Pain added to this noxious brew I should be on SSD. Since July 19 of last year I've been getting various treatments at a Pain Management facility here in Phoenix, AZ. Pain meds, epidurals to the neck, and now this Frankenstein RF. I thought it was just me, but after reading these posts I am obviously NOT ALONE in the relentless daily pain post-RF. Over a month and still in pain. Saw my PM doc the other day (cancelled next RF to discuss this horrible treatment) and he's used to seeing me smiling and maybe talking too much to the staff. That's all my meds, previous six needle epidurals, my daily laps in the pool and stretching talking. Then it all went to hell in a garbage bag with RF. Pain meds not as effective: he did not increase them, I did not request. Thought I made it clear I wanted previous injections. Left with refills and new appointment for next RF???? Too late, discuss at that appointment. If he insists, I want increased pain meds. Missed gigs (am a musician), interviews for jobs, church. I'm 50 (some might need to know but I don't even look it, not even close) and 20 years on opiates. They work so I'm all for 'em, but I refuse to deal with pain above and beyond my normal level. F!*?! RF.

MegaPain,

Here's a more recent thread on RF:http://neurotalk.psychcentral.com/thread156450.html

Time to at least consider firing your doc!