Radio frequency ablation
 

Has anyone had a radio frequency ablation?

Just run those three words - in order - in the search function . . . and stand back!

Sounds painful but does it work for rsd

Let's just say that 20 years ago, a lot of doctors thought it did/might. Now it's only mentioned by a few and they are generally older guys. In terms of the currant view, this abstract may sum it up:

Cervico-thoracic or lumbar sympathectomy for neuropathic pain and complex regional pain syndrome, Straube S, Derry S, Moore RA, McQuay HJ, Cochrane Database Syst Rev. 2010 Jul 7;(7):CD002918.

Abstract
BACKGROUND: This review is an update on 'Sympathectomy for neuropathic pain' originally published in Issue 2, 2003. The concept that many neuropathic pain syndromes (traditionally this definition would include complex regional pain syndromes (CRPS)) are "sympathetically maintained pains" has historically led to treatments that interrupt the sympathetic nervous system. Chemical sympathectomies use alcohol or phenol injections to destroy ganglia of the sympathetic chain, while surgical ablation is performed by open removal or electrocoagulation of the sympathetic chain, or minimally invasive procedures using thermal or laser interruption.

OBJECTIVES: To review the evidence from randomised, double blind, controlled trials on the efficacy and safety of chemical and surgical sympathectomy for neuropathic pain. Sympathectomy could be compared with placebo (sham) or other active treatment.

SEARCH STRATEGY: We searched MEDLINE, EMBASE and The Cochrane Library to May 2010. We screened references in the retrieved articles and literature reviews, and contacted experts in the field of neuropathic pain.

SELECTION CRITERIA: Randomised, double blind, placebo or active controlled studies assessing the effects of sympathectomy for neuropathic pain and CRPS.

DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and validity, and extracted data. No pooled analysis of data was possible.

MAIN RESULTS: Only one study satisfied our inclusion criteria, comparing percutaneous radiofrequency thermal lumbar sympathectomy with lumbar sympathetic neurolysis using phenol in 20 participants with CRPS. There was no comparison of sympathectomy versus sham or placebo. No dichotomous pain outcomes were reported. Average baseline scores of 8-9/10 on several pain scales fell to about 4/10 initially (1 day) and remained at 3-5/10 over four months. There were no significant differences between groups, except for "unpleasant sensation", which was higher with radiofrequency ablation. One participant in the phenol group experienced postsympathectomy neuralgia, while two in the radiofrequency group and one in the phenol group complained of paresthaesia during needle positioning. All participants had soreness at the injection site.

AUTHORS' CONCLUSIONS: The practice of surgical and chemical sympathectomy for neuropathic pain and CRPS is based on very little high quality evidence. Sympathectomy should be used cautiously in clinical practice, in carefully selected patients, and probably only after failure of other treatment options. [Emphasis added.]

http://www.ncbi.nlm.nih.gov/pubmed/20614432

And for anyone who's interested, a PDF copy of Management of Lower Limb Complex Regional Pain Syndrome Type 1: An Evaluation of Percutaneous
Radiofrequency Thermal Lumbar Sympathectomy Versus Phenol Lumbar Sympathetic Neurolysis—A Pilot Study, Management of Lower Limb Complex Regional Pain, Manjunath PS, Jayalakshmi TS, Dureja GP, Prevost AT, Anesth Analg. 2008 Feb;106(2):647-9, the study referred to above, can be found here http://www.anesthesia-analgesia.org/...2/647.full.pdf

Mike

Hi,

I had the radio frequency abliviation procedure done a few years ago and the procedure caused my crps to spread and increased my pain levels. Also, the procedure itself is extremely painful as you have to be awake. I wish I never did that procedure and recently I saw an article by Dr Schwartzman in which the article discussed how the radio frequency abliviation causes spread. I hope this helps you to make an informed decision as when I participated in the treatment I blindly trusted the Dr that recommended the procedure. After the treatment I left that Dr because he had nothing left to suggest after the RFA treatment caused the spread.
Sarah

I had a Pulsed Radio frequency Ablation. I wasn't awake, I had that MAC sedation. It did not work and i woke up in more pain. I had a spinal cord stimulator implanted and have had great success with it. 50-75% relief from that burning nerve pain! Still have tremor, get cramps and aching pain but other meds help keep them bareable.

Thank you. I will speak with my doctor and let him know I don't wish to go forward.
Anita

Thumbs down on this treatment from everything that I've read as well......

Quote on this from Dr. Hooshmand:

Because the Radiofrequency damage causes high temperature in the adjacent areas of the target, it also destroys the adjacent normal nerves causing a much larger lesion and scar formation with spread and aggravation of pain in a permanent fashion.

Not enough good data / results and way too much risk to consider this treatment in my mind. :Noooo: And you are hearing less and less about it as time goes by.

BE AFRAID--VERY AFRAID of this procedure.

I had this procedure performed in Camarillo, CA by Dr. Wolfsohn maybe 7 years ago? It was explained as if it was just another stellate ganglion block and exacerbated my RSD to a degree that is hard to explain. When did wind become like knives? The door closing in a car, a major life problem? Sound and lights, overwhelming? After RF!

Years later I found the explanation by Dr. Hooshmand that confirmed I wasn't crazy...

NEVER EVER HAVE THIS PROCEDURE!!! I would not take 20 million dollars to have this thing performed.

I really liked Wolfsohn in many ways, but I could never trust him after that procedure, or his refusal to acknowledge that it made me worse. I'd seriously question a relationship with any doc performing such an outdated procedure.

Think of it this ways: Your doc fires up a GRILL, takes your damaged nerves and COOKS them. Yes, it'll destroy some, but it'll make others even more dysfunctional than they already were!

Why memory of the weeks after that procedure was that I cried for hours every day and rocked back in forth in bed fantasizing about chopping off my own hand. My baseline pain level never went back to pre RF level.

Thanks so much for sharing your experience. I found Hooshmand's website very soon after I was diagnosed and his views have saved me from many bad treatments.

Hoping better days are ahead for you!