Pain after RFA on spine done

[Rita732]

It's been two weeks since I've had RFA done on my lower back.  I'm still in pain but only in the area of where the RFA was done.  I'm seeing my doctor today.  Is having pain two weeks after procedure normal?

[AmyAff]

I had RFA done last monday on my T2, 3 4 and 5 I am in so much pain truly can't take much more. I don't understand why the pain is this bad. Issue with weakness in my left arm.  Anyone have any thoughts. I am s frustrated and i pain.
thanks
Amy

[MiZero228]

I just had the RFA done 4 weeks ago today.  I have been in much worse pain than before having it done.  I take pain meds (I had such big plans on being able to ween off of those).  I go back to the doctor in 2 days.  I can't wait to see what he says.  It obviously did not work at all.  I just can't understand why it is so much worse than before.  I'm not young (I'm 56) and I just can't take this pain much more.  My back pain started when I was 16!  I just don't know what to do now.  I work but I'm fortunate to have a mostly sit down job (even sitting hurts if I do it too long).  I've got great support at work.  They know I cannot lift at all or stand at all.
I am glad to know that I am not the only person with this experience.  I'm just so frustrated and just don't know what to do.
My coworker's husband had that Nerve Simulator installed into his back (as he has chronic back pain).  To me, it does not seem that it works very will but she says it does.  He has had it about one year now.  I think I am going to see if I am a candidate for that.  Not sure though.

Thanks for listening to my story.  

[Pam5411]

Thank you. I had it done yesterday

[philnoir]

I have severe spine disease including lumbar spinal stenosis that causes pain whenever I move, and even if I lay still for tool long.

Every once in a while, I too wonder if surgery will help.

My surgeon is a smart man and I trust him. He's one of the guys who operates on only 5% or so of his consults.

Some surgeons operate on over 50% of their consults.

Anyway, my surgeon says this:

"Surgery, however, a last resort to be chosen only if conservative measures fail to provide sufficient relief."

I'll add this -- if your spine or one or more of your nerve roots in is jeopardy, then have the decompression surgery if those conservative methods -- manipulation, steroid injections, oral steroids, etc. -- have not resolved the problem. You must protect your nervous system, or your circulatory system if that is in jeopardy.

Paralysis or permanent dysthesia and pain are the consequences of not having surgery in these situations.

However, if you are under medicated, seek more medication, not surgery.

Have you tried everything?

Find out.

[stressedshaz]

I'm about to have this procedure done and after reading these comments I'm really scared.  It's sort of damned if you do and damned if you don't.  My pain started during high school but is now constant for the past 10 years.  Some days it's so bad I just want to take a trip to a Swiss clinic and I'm only 46.

[philnoir]

Hello Ce2438 and welcome to the spine forum.

The controversy over paraspinal muscle atrophy* after medial branch neurotomy is on going. There is just not enough research to demonstrate causality of mutifidous atrophy from medial branch neurotomy (via RFA, or other means).

Paraspinal muscle atrophy refers to weakness in the deep muscle layer near the spine. Two important muscles that support the spinal column and allow us to bend at the waste are the mutifidus and ileopsoas complex.

The problem in establishing causality is twofold.

First and foremost, people with chronic spine disease and LBP also suffer from paraspinal muscle atrophy.

This study examined multifidus atrophy after traumatic injury, and surgery. Atrophy does occur quickly after both nerve lesioning and disc injury, so we have a "chicken and egg" problem her -- was the muscle atrophied before or after the injury that precipitated the procedure?

http://www.medscape.com/viewarticle/551813_4

The other reason establishing causality is difficult is due to both a lack of evidence, and a full understanding of mutifidus is innervation.

The initial controversial linking multifidus atrophy with medial branch nerve lesioning began with a study involving five patients who underwent unilateral RFA (medial branch neurotomy) resulting in facet deinnervation.

An average of 21 months after the procedure, independent radiologists were asked to evaluate the lumbar mutifidi via MRI in these five patients. The radiologists found evidence of mutifidus atrophy in all patients, but they could not accurately determine the side and segments lesioned by RFA, meaning the multifidous atrophy could not be associated directly with the RFA.

http://www.ncbi.nlm.nih.gov/pubmed/19695523

A 2000 study discovered that the multifidus is innervated by mutiple segments. Researchers, by EMG examination performed in the L2-5 multifidi both before and three weeks after the a medial branch neurotomy found evidence of partial deinnervation in the multifidi at levels L3-L5 after the neurotomy that only involved the L3 medial branch.

http://www.ncbi.nlm.nih.gov/pubmed/11155540

I include this evidence to explain why your doctor assigned such a low risk of complication to this procedure. For a great majority of people, greater than 99% of those who receive RFA do not report the severe complications you are experiencing. I don't doubt that something went wrong after your RFA treatment, but I cannot say what, based on medical research.

I have a similar thing going on that involves deep pain in areas that could be related to the psoas or the outer edge of the mutifidus -- I really don't know. This pain and muscle spasm appeared only after I began to get medial branch neurotomies in the lumbar spine. I have had, to date, 4 of these procedures, bilaterally.

For me, the RFA removes about 50% of my LBP and is therefore an essential source of pain reduction for me. The deep myofascial pain is an annoyance that flares to level 5 or 6, but is managed with muscle relaxants, opioids, and exercise.

So, I settle for the less of two evils to manage my pain and will get another RFA in the next year or so -- whenever my nerves regenerate. Without these procedures, life would not be worth living.

PT and muscle relaxants work well for me in treating the myofascial pain. Also, behavioral changes are required. For example, I have to limit my sitting time. It is for this reason that I am disabled -- I can't sit for more than an couple of hours without severe pain.

If you haven't discovered the muscle relaxant called dantrolene, I suggest that you ask your doctor for a trial. The pills are unlike any other muscle relaxant, as they work on relaxing the muscle fibers, and not the motor nerves that cause contraction.

Best wishes for a speedy recovery.