Pulsed Radiofrequency Neuromodulation (PRFN) of Suprascapular Nerve of Shoulder

Why am I having a PRFN?

Traditional radiofrequency techniques utilize high frequency electrical energy to create a heat lesion. This can be applied safely to some nerves, such as the medial branch nerve, providing effective treatment for facet joint pain. In this situation, the heat lesion seems to be the factor that provides pain relief.

Some nerves, however, are less suitable for heat lesioning, as this would affect other nerve functions such as sensation and movement. Application of high frequency electrical energy in brief pulses (PRFN) prevents the development of heat and can therefore be safely applied to most nerves.

PRFN has been established as an effective treatment for shoulder pain that is caused by arthritis or injury. The suprascapular nerve arises from the brachial plexus and runs from the neck to the upper end of the scapular and into the shoulder. The suprascapular nerve is targeted with this treatment.

A diagnostic suprascapular nerve block with local anaesthetic being may be performed prior to undergoing a PRFN to confirm that the suprascapular nerve is the source of your pain.

How is the procedure performed and does it hurt?

During this procedure, your Doctor may wish to talk to you to obtain your feedback 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, you will have a small needle (cannula) placed in a vein in your hand or arm so that sedation can be given as necessary. Once the area has been cleaned with antiseptic solution, the area to be treated will be covered with sterile drapes. You may feel a sharp sting as local anaesthetic is injected to make the skin area numb. An X-ray machine is used to help guide the needle into the right position. Once your 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?

The average duration of benefit is 9 months, but this is variable. If the procedure needs to be repeated in the future, the success rate is high.

What are the risks?

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

Common risks and complications:

• Bleeding or bruising
• Shoulder pain due to the muscle being aggravated by the needle
• Temporary arm weakness due to local anaesthetic.

Less common risks and complications:

• Not able to perform the procedure due to medical and/or technical reasons
• Infection requiring further medical treatment
• Allergies
• Damage to surrounding structure needing further treatment
• Temporary side effects from steroid medication (if it is used) including insomnia, nervousness and nightmares.

Preparing for your procedure

Please advise your pain specialist at least two weeks before your procedure if you:

• Are taking blood thinners including fish oils 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) to pick you up after the procedure and stay with you overnight.

Please make arrangements to ensure you do not drive or make important decisions for the first 24 hours following your procedure.

Day of procedure

• No food within 6 hours prior to your procedure; however, you may take water up to 2 hours prior, but no more that 200mls per hour.
• Take your regular medication with a small sip of water.
• Shower the morning of your procedure.

After discharge, if you notice:

• Swelling
• Bleeding from the site
• Changes in sensation
• Difficulty with movement of arms
• New symptoms or difficulty passing urine

Please contact Interventus Pain Specialists during office hours, your general practitioner or your nearest Emergency Department.

What happens next?

You will need to return to the clinic to determine if the pain relief provided by the PRFN was meaningful. This information will help us to guide you with a comprehensive pain- management plan and enhance the outcomes of your procedure.