Anyone Have Good Results with RF Rhizotomy??

I had low back pain for many years. One of the pain generators was a congenital Spondy at L5 S1 and I was very lucky to have that successfully corrected surgically by an outstanding surgeon in Denver, Dr. George Frey.  He used a micro approach, i have an inch incision and fused quickly with no complications.  

However, the years of instability and degenerative disc disease lumbar spine have caused a very common secondary problem - Facet Arthritis.  These tiny joints on the back side of each vertebral segment become terribly irritated from unstable spinal column support over the years.  The result is Facet Arthritis.  The "angry" joints can be seen on MRI or CT scan.  Once this progresses to moderate or severe it is a very serious pain generator.  Well, I'm there.  

Just FYI, for someone who have never felt or properly experienced this pain, mine is diffuse low lumbar and not very location specific.  If I had to describe it (not knowing what it was) I'd call it severe muscle spasms.  However it has taken me years and meds and injections to realize for myself this is facet pain.  It has progressed to the point where I must do something.  I am taking far too many meds, too immobile mornings and evenings and frankly nothing but rest and hot packs will even help a little.  I will not say this is severe and I am not able to be on my feet or at my desk all day.  

I've gone through the proper medical protocol of facet injections, medial branch blocks etc. in order to reach the point of discussing this procedure.  Radio Frequency Rhizotomy or a better term is "burning of the nerve" that transmits this particular pain.  (Thank God there is one, and we can get to it!!)  Pretty simple really, they go in just like an injection, ID the nerve and then burn the hooey out of it using radio frequency heat!  That little persistent nerve has a tendency to grow back within 6 months to a year and it typically has to be done again.  

Hey, at this point I would let them dive in there and do anything to get me out of this pain.  I've heard it is not much fun as they cannot have you under sedation for the procedure, but I am okay with that.  Just stop this unrelenting pain!!  

Many people have this done.  I have mine schedule for the 24th of March.  

I'd like to hear from anyone who has had this procedure and what results you experienced for a few months or few years.  I am very hopeful this will let me get back to normal functioning (and attitude) and maybe even put a few miles on the motorcycle this summer.  

I appreciate anyone's experience and or advice for heading in to have this done.  

[justmejen]

Hi Jim, I'm sorry I can't give you any answers but I wanted to wish you luck with the procedure. My hubby suffers from lower back pain & has for years. When he was a kid he accidently stabbed himself with a pick ax while digging for fishing worms....dr gives him T3 & has never even ordered so much as an x-ray....I finally spoke to dr about it & he is going to schedule a CT scan....anyway,good luck & I hope someone can answer your questions & give you some peace of mind.

Jen

[Mollyrae]

Hello:

You might want to send a PM to a member by the name of SHELLBELL79. She has had this proceedure done a few times. She has stated that it's a very painful proceedure and they can give you medications to semi-sedate you.

Please contact her....she may be able to help you.

My best,
Mollyrae

[Tuckamore]

Welcome Back Dr. Humphries,

I am so sorry to hear about your continued pain. I too have problems with several facet joints.

I have facet joint disease. I have had nothing done for this because my SIJ Dysfunction is so severe. The spasms are horrid. I do know what you are talking about. Diazapam is the only medication that helps relieve those spasms and not give me a hang over effect.

I know we have had many ppl ask the same questions you are asking. Some have claimed relief while others have not. I think that's about the way it goes for most procedures.

Please let us know how effective the RFA is for you. I hope it will bring you significant releif. Some articles I have read state that as the new nerves regenerate they may not be so painful and the pain synapse does not occur as severely or as often in them. I hope that will be true for you.

Best of luck and take care. Chronic Pain is a horrid condition to live with....it ended two wonderful careers for me....you have my empathy.

Take Care,
Tuck

[Jim Humphries, B.S., D.V.M.]

Thanks you all, yes I understand that while the thermal destruction of this tiny branch leading from the facet joint can be effective, it does grow back in time.  However, it is a damaged nerve and that often a second (or third?) ablation will damage the tissue enough it will not grow back.  

At this point I'll try anything.  

I would love to hear from someone who has had this AND had good to excellent outcome.  I know PeekAwho had this not long ago, but she is having additional back issues so it is hard for her to say the RF was a good solution.  

It is an interesting procedure.  We use a similar procedure in horses with a certain type of lameness.  However it is an actual "neurectomy" where we physically remove a segment of the nerve.  But it is also more easily accessible than this Medial Branch from the facet in the human spine.  

I'll report here my experience.  

I need THREE levels done (both sides) BUT of course the idiot 'suits" at the insurance company will only allow TWO.  SO I have to go back 10 days later to have the other level done.  Could easily all be done at one time, but the brilliant insurance folks will end up paying DOUBLE for the process because of a "rule".  Just one tiny example of why costs are out of control and how there is no such thing as common sense in medical insurance - makes me very happy I'm a veterinarian.

BTW: MANY of my physician friends say they are already looking for other work because of the coming destruction to the way medicine is practiced in this country.  Heck its pretty bad now, I can't imagine what this would look like under 'government run' insurance.  God Help Us!  

[Jim Humphries, B.S., D.V.M.]

Thanks Shellbell79 for all your advice.  Sorry you are having such bad problems with pain.  We are all pulling for you.

[Tuckamore]

Oh don't get me started on the "government run" insurance proposals. It is at the very least, terrifying!

There are many areas of our medical delivery system that in my opinion require clean up and re-vamping. Certainly the insurance companies practices need to closely investigated. In my opinion that's what need to be done instead of the current destructive proposals. I'll get off my soap box now and keep the remainder of my opinions to myself.

I do know another memeber that has had this procedure done. I will give her a shout and see if she will share her experience also.

Wishing You the Best,
~Tuck

[Jim Humphries, B.S., D.V.M.]

Just FYI:  I am having my RFA tomorrow morning up in Denver.  I'll report back how the procedure went as well as results after the initial inflammation.  This is a common procedure and it should be described and reported here, but very little info here.  I'll let you know best I can on how it goes, and the effectiveness.  I need 3 levels done (6 spots) but insurance will only pay for 2, so I have to go back yet again for the third level.  Double the cost for a procedure that could easily be done in one step.  Not only is the insurance industry out of touch, but this bama-nightmare will only make things worse.  Oh, you are right... don't get me started.  

[Tuckamore]

Thanks Dr Humphries for your update. I wish you the very best tomorrow.

You are correct that this is a common procedure. Our information on the treatment varies by the members that are currently active. Sometimes we have great information as we'll have a few members that have had the procedure done several times. They leave and with it their departure so goes the personal information.

I have never had the procedure done so my information only comes from text books and the internet. Your right there should be more information here. I am currently working on a general information page that will contain information regarding common procedure such as the RFA among other things. But due to my time restraints and multiple obligations and chronic pain it is taking me longer than I had hoped.

It's a shame that the insurance would not cover it as a one time treatment procedure. And they complain about costs!!  My best friend, an RN that approves or disapproves insurance payments could write a book about the ineptness of the medical insurance industry. They don't listen to the ppl that know. In part it's about their initial outlay costs today and not tomorrow. They seem to have no forward thinking...they don't look at the big picture. But again I must get off this subject!!  

We'll look forward to hearing from you after your procedure in Denver. Best of luck to you!

~Tuck

[nurseaudrea]

This is probably too late to let you know, but I also suffer from congenital Spondylolisthesis and had fusions done from L4-L5-S1, first anteriorly and then two years later posteriorly. I also suffer from facet arthropathy. It can be very painful. I had the RFA done about 5-6 weeks ago. It was wonderful. I do not remember the procedure at all. They sedated me first and then I suppose I woke up while finding the right nerve to let them know they were in the right spot. I do not remember anything of the procedure. The only thing I remember is going in and watching them give me something in the IV and the next thing I was waking up in the recovery room. It could not have gone any better. I do know the meds they gave me cause amnesia and they say I was awake and talking so I guess I have to go by what they say. That area feels so much better and now I am awaiting to have the same procedure done to my SI joints. Hope your procedure goes well.

[Jim Humphries, B.S., D.V.M.]

MY REPORT ON THE RF RHIZOTOMY!  I had this done yesterday and it was really no big deal.  I have written up a detail blog on this that you can find on my blog page here.  

for anyone needing to have a facet ablation done - read this!  http://www.medhelp.org/user_journals/show/179972/Facet-Disease-and-RF-Ablation-Rhizotomy--a-Patients-Perspective--

[Tuckamore]

Thank you for the update....and for the link.

I am glad that the procedure went well for you. So far, so good!! :)

~Tuck

[Robbie57]

I hope your RF Rhizotomy helped.  I had one done on my neck last month and it really helped, some pain for a couple of days afterward.  I had 2 done on both sides of my lower back about 2 weeks ago.  I did have problems with those,  I have had increased pain since I had it done.  The doctor said I'm one of the few that have problems afterward.  The doctor assures me that my back will get better.  I have missed 6 days of work in the last 2 weeks.  I can hardly walk or stand without horrible pain.  I have started using a cane since I had it done.  The doctor said to give it a couple of more weeks and if the pain is not gone they will increase my meds, which I don't want to do.  The doctor even suggested that I retire from my job which I can't financally.  Has anyone had this kind of reaction after an RF Rhizotomy?

[Jim Humphries, B.S., D.V.M.]

Hi Robbie:  I can say I was worried about the procedure itself and that is why I wrote the blog.  It was no big deal as you saw. BUT I have had increasing pain at the levels that were done now for 7 days since the burn.  I know those nerves are not happy about the insult, but I am ready for them to die and go away.  Now taking more meds than before.  He did say it can take 4-6 weeks for relieve.  I am SO ready.  So I guess I'll give it more time.  

[namnam46]

I too had 2 done on my lower back, the left side on March 28th and the right side on April 8, I have had a remarkable decrease in pain. Just hang in there I'm sure you will feel better soon. I had one problem I over did because the pain was almost completely gone and I learned NOT to over do. It hurt for a couple of days and is dying down now.

Just hang in there and I hope you will have great pain relief also!!

[TwinsMommma]

hi...i posted a comment on your RF journal and wondering if u r checking in from time to time?

[ChiariWolf]

Hello Dr. Jim!

I'm anxious to hear how you feel by now as we are considering doing this on both sides of my neck, to start. I'm supposed to give the doctor an answer this coming Monday as to if I will or won't help. They want to do this in several locations up and down my spine but begin with the low neck area to fight problems from Chiari Malformation.

Having been through this for a few weeks now, what is your personal advise? Would you go through it again?

Thanks

[Jim Humphries, B.S., D.V.M.]

Be aware that insurance will only pay for two levels - bi lateral - so most docs will only do that - they are afraid they will be denied payment if they do more.  that means for multiple levels you have to go in several times. AND the procedure has to be repeated.  It is NOT 100%.  it is an attempt to kill the nerve that transmits the pain.  

I am 4 weeks out with no relief.  I see the pain doc Monday for follow up and next steps.  Unfortunately RF is a bit of a last resort- short of fusion.  At this point I would have 3 higher levels fused just to get out of this daily, unrelenting, constant debilitating pain.  However, good surgeons must have a defendable reason for such a serious surgery.  They may recommend I have the RF repeated, which I would do as I know it takes time for these nerves to die off.  

as you can see there is no magic cure, the back is a terribly complex bit of anatomy and so many places where pain can occur.  

I will say, living with pain every hour of your life and never being able to get away from it, not even for a second, is very very hard.  Luckily the narcotic analgesics work for me pretty well, but I cann't take at night (I'm one of about 10% of people who can't sleep with narcotic analgesia).  However, a person cannot go on and on with these drugs as you need higher and higher doses to get pain relief and then you get into the GI slowing and all the fun that causes.  

I, like most pain patients, take the narcotic pain relievers on a PRN or as needed basis.  That is really not how they should be taken because you need to "Stay Ahead of the pain">  However, this does allow me to keep the dose less,l allows my GI to recover and decreases the amount of dose that works as I don't feel I built tolerance this way.  

I'll know more after Monday's consult. Hang in there everyone who suffers, keep trying all the different ways to fight chronic pain.  And educate yourself as YOU are the one in control of your care.  At least until the Government Takes over - then all bets are off!!

[ChiariWolf]

Thank You for your input Jim.

Unfortunately, I've had chronic pain since birth. Thus quite some time ago we reached a point where a choice had to be made between the pain killers and gi. There was no choice as by that point the pain killers only make me not care they didn't affect the pain any longer. I find more relief from controlling what I do and different foods, obviously that is not an answer but thinking your way through the pain can actually provide some relief, that is when the pain is not to the point where you can't think.

What this pain Dr is considering is doing the central block to see if it helps. If so, then doing the RF along with an additional injection to try and keep ahead of it until the nerves respond. I expressed to him my concerns that if the nerve is numb, will I or could I cause additional damage and not know it. What are your thoughts on that? Do you feel any numbness at this point; or is it just too soon to know?

Thank You Very Much for your sharing,

[Jim Humphries, B.S., D.V.M.]

An important thing to remember (and that makes this work) is that the Medial Branch (the one they kill with RFA) is a nerve that only carries pain sensation from the facet.  It does not stimulate any motor function and should not cause any numbness.  

[ChiariWolf]

Thank You Jim, I appreciate your explanation. It helps me to understand the Drs answer just a bit better.

Perhaps Monday we'll give the Dr the go ahead. I did note that you stated above that at this point your pain is worse. What the Dr intends to do will give me about a month before the actual RF procedure is preformed. If your pain does not start diminishing by then.... well then maybe you could note that here??? At any rate I thank you for helping me to better understand this procedure.

[TwinsMommma]

i am sorry too, Jim....you have been so helpful in providing information and i was hoping good things would come back to you!

my 2 medial block diagnostics went well...so i am scheduled for RF this friday...excited and nervous...

Jim, Shelly and braveheart2....were you guys prescibed additional pain meds for post inflamation (inflammation) pain ...that is meds in addition to what you may have been already taking...just trying to get my questions ready etc..etc..any other thoughts, suggestions or 'heads up'???  how much post RF pain do u think compared to the diagnostics...which was not much...but this one RF i guess causes inflammation flare i heard...i'm wondering if i should have a prescription ready just in case before friday...i see my PCP tommorow who takes care of my pain management (with approval from RF dr)...so i am do for my normal meds and wondering if i need something else 'as needed' type...i now take an ext release every 12 hrs w/ breakthru as needed as we are just on the first month of ER...any thoughts??

[kathy233]

I just had this done today--it wasn't as bad as I was expecting.  I had it done in the L5-S1 area by a certified pain management doctor/anesthesiologist, Dr. Mark Meyer, in Colorado Springs.  I had a steroid injection 6 months ago, with no improvement, I had been suffering with this back pain since August of 2012, almost a year ago.  Muscle spasms on the lower right side, almost above my buttock, sounds just like yours.  Excruciating, I went to PT for months and even had hollow needling done, which helped some.  I've been on Cymbalta for 6 months, it has helped tremendously I cut my use of opiods in halfMade it liveable. Can't take NSAIDS, because I'm in early stages of kidney disease.  It was somewhat unpleasant, but they do sedate you--just don't knock you out.  But the pain of the RF was nothing compared to the constant back pain I've been in.  He said it would take a week to start feeling improvement, I guess it takes that long for the lesion to grow over the burnt nerve.  It's not that bad, felt like the shots from the medial nerve blocks I had to diagnose the level.  I'm still feeling the muscle spasm pain at lower right, that's where most of my chronic pain is coming from.  But the left side already feels better from the arthritis (facet joint pain).  I'll repost in a week to let you know how much it's improved.  

[kathy233]

To Jim Humphries, I just noticed your postitng is really old, hopefully you had it done.  If so, please let me know if you see this posting how yours went!

[Phoebebb]

Has anyone tried Protandim?

[Susanna117]

Hi, I had RF for lumbar pain with excellent results!  I am thrilled and am completely medication free now.  I would recommend this procedure for anyone who had tried other treatments that have not worked.  I live in Grand Rapids Mich and my MD is Kevin Fitzgerald, who comes recommened by other medical professionals. ~Susanna

[MDWall]

I had The RFA a little over a week ago, spinal stenosis has been wreaking havock for almost 2 yrs now. I even had surgery, ( lamenectomy ) and still no relief. After reading about a lot of people's experiences with the RFA, at least I still have hope that it will give me some relief.
  From what I've been told, if the RFA is not successful, the only other alternative is a multi level fusion. I really don't want to have to go that route, as I'm only 47 and would really like to be able to go back to work for another 20 years or so.
I do hope you've found relief, as well as everyone else here, who's dealing with cronic (chronic) pain.

[Mariathelion9]

Oh government run insurance will be better! After 20 years of chronic pain, I finally went back to the VA for my healthcare. Sure it took 3 months to get a specialist appointment, but once there, the ball got rolling. The surgeon said my back was too subluxated to do laminectomies, so I asked about those new minimally invasive procedure? He thought about it a minute and said, "Yeah, okay. Let do that first." So a couple of days later I got a call from the patient outservice coordinator. I got to pick the pain clinic I wanted to go to. I already had researched UCSD as they have one of the most innovative and technologically current methods of minimally invasive surgeries (the birthplace I believe). In a few days I had my appointment.

My DR (Polston) and his colleague examinined me and felt it was NOT my disks at all, but the facet joints at the L3-4-5 & S-1. They did the medial block. If >50% pain relief, I'd be a candidate for RF. My immediate relief was 100%.  2/8/13(FRI). He told me if they don't call to schedule me to make an appointment on Tuesday myself so I can be seen next Thursday or Friday. (2/16 or 2/17). After 20 years of TRICARE insurance AND out of pocket expense (chiropractic) running into the thousands and my life & livelihood stolen from me by this pain, I LOVE Government medicine.

The best med service is usually a place like UCSD, where they have all the funding for the latest in technology and innovation, and the brightest students & docs. They are also NOT FOR PROFIT.  So the patient is #1 and the measure of your success, NOT the bottom line.

I am looking forward to not having this pain anymore even if it's just for a year. I am 52 and my QOLfor the past 20yrs has been so dismal. I lost two careers (ARMY & teaching) and have not been able to work at all for the past two years. I used to be very active (dancing, surfing, hiking, skiing). I haven't been able to do any more than watch TV and I've gained 12 pounds. I had a heart bypass in 2009, and maintaining my weight is crucial to my health. I can't even walk my dogs. (they got fat too!) They have turned on each other from the lack of stimulation & the outdoors they had become accustomed to.

I was ready for full on surgery 10 years ago but the docs refused. They all had to have a 80% certainty it would work. Didn't matter what my pain level was. Dozens of psychotic and narcotic meds later nothing ever really helped. Only trazadone for sleep and alcohol ineebriation during the day on the worst days. Narcotics OXCONTIN & vicodin off and on so as not to get addicted.

Te RF has given me hope, but it only treats the symptoms and not the cause. Anyone know if there is a "cure" for facet joint disease?