Lumbar Radio Frequency Denervation (RF) treatment

What is Radio Frequency (RF) treatment?

RF treatments may be performed when the injections you have had for your back pain have worked well but only for a limited time. It is hoped the pain relief will be longer with the RF treatment.

Current evidence suggests that pain relief can last for an average of 12 months. This means that some patients get more than 12 months of benefit and others less than 12 months.

What is injected?

The procedure is very similar to the injection you had previously. During the RF procedure, a special type of needle is used. After safety checks (see below), local anaesthetic is injected to numb the area.

An electrode is passed down the needle and an electrical current (in the radio frequency range) causes localised heating. This burns the target nerve which produces beneficial effects.

A small amount of steroid is injected at the end of the treatment to reduce any inflammation.

Are there any side effects?

RF treatment works by destroying a nerve.

Rarely, a nerve that is nearby can be burned accidentally. To reduce this risk, your consultant will carry out some safety checks including stimulation testing and X-ray checks.

The risk of permanent damage to a non-target nerve is about 1 in 5000 cases. It may result in lasting weakness, numbness, or altered sensation including pain.

About 1 in 100 patients get a small area of altered sensation on the skin of the back, which may be painful and/or numb. This is because the nerves that are destroyed send some feeling to the skin on the lower back.

If you have diabetes and are given steroids as part of your treatment, you may notice that your blood sugar levels are higher than usual for a day or two.

Where is the procedure done?

The procedure is carried out in the Chedworth Suite at Cheltenham General Hospital. An appointment will be sent to you by the pain clinic secretaries.

On Arrival

• You may be asked to put on a hospital gown
• You will be asked to lie on your front on an X-ray trolley
• X-ray images (pictures) may be used to guide the needle
• The area to be injected will be cleaned with antiseptic
• The consultant will numb the area with local anaesthetic
• You may feel some discomfort during the procedure. This is normal but you should speak to your consultant about it if you are worried

How long will I be in hospital?

The procedure lasts up to an hour, depending on how many nerves are targeted. You may be in Chedworth Suite for a couple of hours, so please come prepared for this. After the procedure, you will be offered a drink and allowed home shortly afterward.

Can I eat and drink?

You may eat and drink as normal unless your consultant has advised you otherwise.

Can I take my usual medication?

Take your prescribed medication as usual on the day of your treatment.

Blood-thinning medication (such as clopidogrel, apixaban, rivaroxaban and warfarin). These medicines are usually stopped for a period of time before the injection to reduce the risk of epidural haematoma, which is associated with paralysis.

Your consultant should have discussed this with you in the clinic but if you are in any doubt, please contact your consultant’s secretary.

The telephone number is at the end of this leaflet. It is advisable you do this at least one week before you are due to have the RF treatment.

If you have diabetes and your blood sugar is above 15mmol/l on the day of your procedure you may not be able to have your procedure.

If your blood sugars are above 15mmol/l leading up to your injection please contact the consultant’s secretary to discuss.

Can I drive home?

For safety reasons, you are asked not to drive yourself home. You should also have somebody with you for the rest of the day.

After the injection

In the days following your injection you may have:

• mild discomfort around the injection site; this is expected and should settle by itself
• an increase in your normal pain; this is usually temporary. You can take your normal pain relief to reduce any discomfort. If the pain is severe, please contact your GP for advice
• on infection at the injection site; this occurs in up to 1% of individuals and is more common where steroids are used. Please contact your GP for advice
• on an allergic reaction to the injection, which results in redness and itching around the injection site. This is not serious, although we need to know about it for future treatments
• of facial redness or flushing; this is a normal response to steroid injection treatment
• weakness and numbness in the limb or area that was treated. If it was safe to do so you may have been discharged home with these symptoms. Please take care to protect the area/limb until normal sensation returns
• If normal sensation does not return or the weakness is getting worse, please go to your nearest Emergency Department and show them this leaflet.
• Any dressings can be removed after 24 hours.

What happens next?

Your response to the injection will be assessed 6 weeks after the treatment.

Please provide your email address before leaving Chedworth Suite.

A member of our administrative team will email you in 6 weeks with a form to complete about the result of your injection treatment.

You will be asked to complete the form with your name, date of birth, hospital number and the name of your pain consultant.

You will also be asked to let us know how much pain relief was provided by the injection and what improvements you have noticed.

The improvements may include being able to sleep better, being able to do more physically, reducing medication, or improvements in your mood and general well-being.

If you do not have access to email - please telephone your pain consultant’s secretary 6 weeks after the treatment. The contact number is at the end of the leaflet. You will be asked for the same information that is requested by email.

The next step in your treatment will be decided according to your response to the injection treatment. Any further appointments will be posted to your home address.

If your pain has improved greatly, you will not need a routine follow-up appointment. Instead, you will be given a 6-month open appointment during which time you can contact your pain consultant’s secretary.

It is advisable to try and reduce your pain medications as a result of improved pain relief. Contact your GP or pharmacist to discuss this as soon as possible, unless you have already been given advice on this by your consultant.

Contact

For injection treatment follow up or to rearrange an appointment please contact your consultant’s secretary.

Dr Young’s secretary

Tel: 0300 422 3383

Dr Makins’ secretary

Tel: 0300 422 2558

Dr Harper’s secretary

Tel: 0300 422 3383

Dr Bodycombe’s secretary

Tel: 0300 422 3198

Dr Rea’s secretary

Tel: 0300 422 2804

Dr Patel’s secretary

Tel: 0300 422 2558

For all other queries please contact the:

Clinical Nurse Specialists

Tel: 0300 422 2976

An answer phone will be in operation at all times, please leave your name, contact number and message. We will return your call as soon as possible.

Monday to Friday between 8:00am and 4:00pm.