For hard-to-treat, unresponsive pain in your middle and upper back, thoracic medial branch radiofrequency ablation can help. This procedure uses a mild electrical current to create a lesion on your medial branch nerves that then prevents pain signals from reaching the brain. For many people, this procedure provides long-lasting, complete pain relief in a minimally-invasive, outpatient procedure. Pain-free living is within your reach. When you are ready to explore how thoracic medial branch radiofrequency ablation can help you, reach out to the team at The Pain Experts of Arizona. Or, for more on how thoracic medial branch radiofrequency ablation (RFA) works, watch the following video or keep reading.
The stable, strong bones of your thoracic spine have a very important job. These 12 vertebrae connect ten ribs to the sternum in the front of the body, creating a rigid, protective structure for our vital organs. Because of this job, the middle and upper back do not have much mobility. Instead, their main task is to provide stability, not movement.
Even so, it is possible to develop unresponsive, chronic pain in this area of the spine. Each vertebra is connected to the one above and below by facet joints. These joints are wrapped in medial branch nerves that transmit sensations to the brain. If the facet joints are damaged due to injury, trauma, or excessive wear, they can press on the medial branch nerves. Thoracic medial branch radiofrequency ablation can help dull these nerves while the facet joints heal or are rehabilitated.
Other conditions that can cause pain in the thoracic spine include:
Chronic chest wall pain
Chronic middle back pain
The thoracic medial branch radiofrequency ablation procedure most often begins with another minimally invasive procedure: a thoracic medial branch block. This is an injection of an anesthetic medication over the pain-signaling medial branch nerves. For some patients, this is the first and only treatment they need for pain relief, so they can start other treatments like physical therapy.
For others, this block relieves pain but quickly wears off within days or even hours. That it works, though, is a sign that you are a good candidate for a thoracic medial branch radiofrequency ablation procedure.
To begin, position yourself face down on the examination table. Your doctor administers a local anesthetic to make you more comfortable. They may also offer a mild sedative if you are nervous or concerned about pain during the procedure.
As with the thoracic medial branch block, your doctor uses X-ray guidance to position a hollow needle in the epidural space near the targeted medial branch nerves. They might again inject contrast dye to ensure proper placement. Once the needle is in place, your doctor sends a tiny electrode through the hollow needle to the end of each targeted nerve. A wave of radiofrequency current travels through the electrode to burn the nerve ending.
These burns take about 90 seconds and are repeated on multiple nerves in the targeted area. Depending on whether or not you receive sedation and how many nerves they target, the entire procedure takes between 15 and 45 minutes.
Once your procedure is complete, you will rest in recovery for a variable length of time, and then head home to relax. As your nerves do have the ability to regrow and heal, you may need this procedure multiple times. Often, though, patients go months or even years between procedures.
The thoracic medial branch radiofrequency ablation recovery period is short and generally easy. As always, talk to your doctor for their specific recovery recommendations.
After you return home, commit to resting for 24 hours. This gives you time to notice changes in pain levels. You may experience a slight increase in pain as the anesthetic wears off. This generally lasts for a few days. If necessary, you can relieve this discomfort with over-the-counter, non-steroidal anti-inflammatory drugs, as approved by your doctor. If you experience soreness and swelling at the site of the injection, ice packs can help. Apply them in a 20-minutes-on, 20-minutes-off pattern until the swelling eases.
Most people can resume their normal activities on the day following their thoracic medial branch radiofrequency ablation.
Thoracic medial branch radiofrequency ablation is a remarkably safe and effective procedure for treating unresponsive middle and upper back pain. As with any medical procedure, there are side effects and risks to consider.
Some potential thoracic medial branch radiofrequency ablation side effects include:
Swelling at the injection site
A minor increase in pain (followed by a decrease)
Bruising or bleeding at the injection site
Increased sensitivity in the area of the procedure (hyperesthesia)
Rare but more serious thoracic medial branch radiofrequency ablation risks can occur. An allergic reaction to the injected medication can also occur. To prevent this, tell your doctor if you have ever had a reaction to an anesthetic.
Infection is another rare but serious risk. After your procedure, if you are feeling unwell; have a fever over 101; or notice excessive swelling, oozing, or pain at the injection site, check-in with your doctor.
Other thoracic medial branch radiofrequency ablation risks can include:
Neuroma (thickening of the nerve)
Numbness in the legs
Damage to blood vessels and nerves surrounding the targeted nerves
Many of these potential side effects and risks can be avoided with proper nerve targeting using X-ray guidance. Also, work with a pain specialist with advanced experience performing this procedure.