RFA T9-10 following discectomy questions

[homenet]

I am a 54 yr old woman with multiple levels of spinal injury (cervical C5-6, 6-7, thoracic T9-10, lumbar L1-2, 2-3, 4-5). Most are bulging, C6-7 encroaches a nerve, L4-5 is torn, and the worse one T9-10 herniated and indented the spinal cord. Radicular pain down L arm, L leg, both hips, and pain that wraps the rib area with gut pain and nausea - all following a rear-end collision 2/10. Conservative therapies were done for nearly a year as well as 5 epidurals. Jan 2011, discectomy of T9-10 done endoscopically in NYUmed Ctr. I have been treating with multiple pain meds following the surgery. It feels as though the surgery was incomplete or there is scar tissue still pressing on both sides of T9-10 b/c I still have rib pain, actually worse than prior to the surgery now 5 mos ago. The band is complete on the right side but only more near the front on the L side. The gut pain and nausea has subsided (a third of that disc was removed). My surgeon tells me this occurs in 10% of pts who have this surgery and that RFA (radio frequency ablation) is needed. I've avoided this procedure b/c it sounds painful to do, my pain doc says it is risky (tho internet articles say there is low risk), and it may not help me. I need to know what T9-10 innervates (ie like important organs, will it affect my lungs to numb this nerve?).  Is it as risky as the pain doc says?  Do patients do well with RFA in this area as far as pain control? I have been taking tramadol, savella  (new cymbalta type drug), lidoderm patches (very expensive and I use 3/day on the ribs), and gabapentin at night. I wake in horrible pain and can hardly turn and I groan at night. During the day I move ok, can work only 4hr shifts as an RN in a doctor's office, use warm packs or ice when it hurts a lot. I can't continue like this. My son marries late Aug. I am not sure if I should try the RFA prior to the wedding or wait until after to give this a try or if I should try it at all. I realize you can not tell me to do it or not. I am asking your opinion based on what you know about RFA. Will I need several levels done above and below T9-10 as the band of pain seems thick?  Thank you to anyone who has had this done and can help me and to any expert who can give any ideas about this.

[mizmary9]

I'm new to this site, and I know it's been a year since you posted about the RFA procedure and was wondering if you went through with it?  I had several car accidents when I was a teenager and then had an injury at work.  I've been seeing a pain management doctor since 2007 and have had numerous injections, medial branch blocks and finally the Radio Frequency Abalations and it lasted at least 3 years for my neck (herniated disc at c4-c7).  But the worst pain is at t7-t9 with sharp pain shooting around the left rib to a very painful spot under the left breast.  The first RFA lasted for about a year, and then the last two have done nothing to relieve the pain.  I've done PT, Chiropractor, ice & heat, stretches, tens unit, patches, epsom baths, even mediation but nothing is working and I'm thinking of going to a surgeon as a last result.  Sorry for the saga but my family is tiered of hearing about my pain that has lasted over 5 years.  My work is extremely physical and something I've wanted to do all my life, and it's getting harder to due because of the pain.  It's driving me a bit batty!  Just wondering how you are doing after the surgery, and if your pain has subsided.  Good luck to you.

[nurseaudrea]

I had the RF done in my lumbar region last Sep and it was a God send. It worked so great I am having it done again. This time I have to have the C5-C6-C7 burned. I have a severe radiculopathy and am hoping it will help with the pain in my neck. I am losing Range of Motion in my neck and decided it is time to get it done. I don't want to have any more surgeries after the 4 I had on my lumbar region and will do anything I can to avoid it. The RF ablation really helped to alleviate the pain I was having in my lumbar region so I am hoping it will help the cervical pain as well.
I don't know why your doctor was saying it was so dangerous. Has he told you why? I am curious to know. Sounds like you need another opinion.
I agree with the poster above. If you are having pain that is worse than before your surgery, something is not right. Have a fresh set of eyes check it out.

Whatever you decide, good luck.
Audrea.

[homenet]

Thank you so very much for responding to my post. Your thoughts are very helpful. I am so glad to hear of someone who has been helped with RF. Most have not been helped or felt worse afterwards. That was a little disconcerting to me. You got a year too...fantastic! I am still a bit chicken about this. I've heard thoracic sufferers do better and also worse. I think it is an individual thing, honestly. I have a decent pain tolerance and wasn't using pain meds much prior to the surgery, managing with chiro and PT mostly. I am highly considering another opinion about the pain from a surgeon point of view. I think I will show the PM doc the follow-up MRI as I don't think he saw that yet. I've not really seen a whole lot of change with the savella, tramadol, and lidoderm patches. It is expensive though. I have another appt with him next week. Thank you for taking such time to tell me about your thoughts.
Because I have a wedding coming up, I am torn b/w maybe getting help from the ablations and also feeling worse. My husband wants me to wait.... we'll see.
Homenet

[namnam46]

Hi homenet,

First, I want to welcome you to the PM (Pain Management) Forum and let you know that we are glad you found this Forum. We are all CP (Chronic Pain) Patients that help each other with our own expertise and experiences that we have developed through our own CP Issues.
I need to be sure that you understand that there are no Doctors on this Forum, since you asked for an expert's opinion also.

Wow, I'm really sad to hear of all the pain that you are having since your surgery occurred!!
I've had several RFA's done with great success, but it's been in the Lumbar region and not the Thoracic.  Therefore, I can't talk for that area at all, that being said, there shouldn't be that much of a difference. After my experiences, I wouldn't hesitate to do it in the Thoracic, if it were me.  However, I swear by the RFA's as they have taken away almost 100% of my pain from the Lumbar. The pain stayed away for over a year.  :)

Please understand that I'm not suggesting that there is anything wrong, but I really think that you might want to get a second opinion as far as all of this goes, your last surgery included.  The reason that I say this is because I had a 2nd hip implant that was done incorrectly and was loose for 4 years.  My Surgeon, of course, told me that nothing was wrong but clearly it was and my internist is the one that discovered it. Since you are in such severe pain, even more, in some cases, than you were before the surgery, I think you might want to get a 2nd set of eyes to check this out.

Now, I can't predict how you will do, but I can tell you that I didn't have any pain with it. Some Doctor's offer a light anesthetic but I didn't get it with mine and I did great without it.  That way I didn't need a designated driver, either, for the procedure. There's a little discomfort, but as I said I felt no significant pain at all.  Of course, everyone's different and you will have to be the one to decide for yourself what you will need.

I don't know what your Doctor is talking about the dangers involved as I haven't heard of that either. That's another reason that you need to have a 2nd opinion. The dangers of them burning the wrong nerve are low as they stimulate the nerves prior to burning and you have to tell them how each one is feeling and that way they are assured of burning the correct nerve.  It's really very simple!! :)  You don't feel the burning or at least I didn't.  Now, I do have a very high pain tolerance so I don't know how much that plays a part in it. The other thing is the possibility of bleeding, but that is offset by stopping all blood thinners a week prior to the procedure.  I had to do this as I take Plavix. You also, have to do this with an epidural, as you know, whenever you are having a needle inserted into you.

I hope that this has helped you in some way.  If you have any questions at all please feel free to ask my anything.  I know that I will definitely be having this procedure again as soon as mine wears off.  I love this procedure!!  Just be sure that you have complete trust in your Doctor !! If you don't, then you need to find one that you do trust.  As an RN, you know how very important that is!!

I wish you the very best and I hope that you will keep us updated on your progress and what you find out!!

Please know that I'm thinking of you and will be looking for your updates.......Sherry  :)