Pulsed Radiofrequency Neurotomy

Everything you’d like to know about having Pulsed Radiofrequency Neurotomy to manage your pain.

Interventus Pain Specialists conducts Pulsed Radiofrequency Neurotomy (PRFN) to help manage a range of persistent pain issues in our patients. Find out about how the procedure is performed, the benefits and risks, and what you can expect when you come to hospital.

Why do I need PRFN?

Traditional radiofrequency techniques use high frequency electrical energy to create a heat lesion. This can be safely applied to some nerves, including the medial branch nerve, providing effective treatment for facet joint pain.

Heat lesions aren’t suitable for most other nerves, however, because nerve functions such as sensation and movement would be affected. In these circumstances, high frequency electrical energy is safely applied in brief pulses, preventing the development of heat.

PRFN has been established as an effective treatment for neuropathic pain, such as radicular pain (sciatica), shoulder pain, knee pain, neuropathic pain after surgery and occipital neuralgia. When PRFN is applied to the dorsal root ganglion, where the nerve root exits the spine, it can improve neuropathic pain for several months and has a general success rate of over 50%.

How is the procedure performed?

• During this procedure your Doctor may need to talk to you about what you are feeling so your Anaesthetist may keep the sedation at a low level while keeping you as comfortable as possible
• Before the procedure starts, a small needle (cannula) will be inserted into your hand or arm so that sedation can be administered as necessary
• The area to be treated will be cleaned with antiseptic solution and then covered with sterile drapes
• Local anaesthetic will be injected to make the skin area numb and you may feel a sharp sting
• An X-ray machine is used to help guide the needle and when your Interventus Pain Specialist is happy with the location of the needle, a small amount of electrical stimulation will be used to test the needle position. You may feel a tingling or twitching sensation
• Your pain specialist may ask you questions during this part of the procedure. It is important that you remain as still as possible and answer the questions as best as you can
• After the procedure, you will return to the recovery area where the nursing team will carry out observations, give you something to eat and drink and make sure you are safe to go home.

How long will the relief last?

On average, patients can experience pain relief for six months, however, this does vary. If the procedure needs to be repeated in the future, the success rate increases.

Are there any risks?

All medical procedures carry a risk of side effects and possible complications.

Common risks and complications for PRFN include:

• Bleeding or bruising
• A temporary increase in pain that may last for up to two weeks
• Localised pain due to the muscle being aggravated by the needle
• Temporary leg or arm weakness due to local anaesthetic

Less common risks and complications include:

• Bleeding or bruising
• Not able to perform the procedure due to medical and/or technical reasons
• Infection requiring further medical treatment
• Allergies
• Damage to surrounding structures that may need further treatment
• Temporary side effects from steroid medication (if used) including insomnia, nervousness and nightmares

How do I prepare for my procedure?

At least two weeks before your procedure, inform your Interventus Pain Specialist if you:

• Are taking blood thinners, including fish oils, turmeric or aspirin
• Are diabetic
• May possibly be pregnant
• Are allergic to iodine, betadine, chlorhexidine, shellfish, local anaesthetics or steroids
• Have a temperature, feel unwell or possibly have an infection

You must have a responsible adult (over the age of 18) collect you after the procedure and stay with you overnight. You must not drive a vehicle or make important decisions for 24 hours following your procedure.

What happens on the day of my procedure?

• Please have no food within 6 hours prior to your procedure
•  You may drink water up to 2 hours prior to your procedure, but no more that 200mls per hour
• Take your regular medication with a small sip of water
• Shower the morning of your procedure

What do I do after discharge?

• Take it easy for 24 hours
• Resume your usual diet and drink plenty of fluids
• For procedural pain, use cold packs and simple analgesics such as paracetamol
• Gentle mobilisation is recommended
• Usual activity may be recommenced as you feel up to it
• Avoid bathing/soaking until the injection sites have healed

It may take two to four weeks before you start to notice an improvement in your pain.

After discharge, if you notice:

• Swelling
• Bleeding from the injection site
• Changes in sensation
• Difficulty moving your arms or legs
• Any new symptoms
• Difficulty passing urine

Please contact Interventus Pain Specialists during office hours, your GP or present to your nearest Emergency Department.

What happens next?

• Please call Interventus Pain Specialists to make a follow-up appointment
• Your Pain Specialist will determine the effectiveness of the procedure and develop a tailored and comprehensive pain management plan