Question Re: RF success?

[slipnslide]

Hi all & Happy holidays!,

I've gone back through my old posts from Jan '07 through the present to try to find info on my own experience's with the RF's. I was able to find that I was told to give 5-6 weeks for Cervical, and 3-4 weeks for Lumbar RF's before being able to notice an improvement in pain levels. My question is, does anyone know how long a person should give it before noticing relief when the RF is done in the abdomen/hip on the ilioinguinal nerve, genitofemoral nerve, & lateral femoral cutaneous (I'm not sure if that was the third name of the nerve or not...:confused: ). Should the pain and burning increase following the procedure? I really wish I could remember what i was told the last time I had this done, but it's been so long ago that I can't remember. I'm hoping someone might know, or share their experience.

Thanks,

Kim

[lobelsteve]

RF on these nerves is not well studied.

A lot depends on what temperature and time were used to lesion, or was it a pulsed RF procedure, and what sensory and motor thresholds were used or if none were used.


Wish it were easier.

If things were done to the best available technique based on accepted guidelines: There could be a 2 week dysesthesia period before the pain goes away. Most folks feel relief within 3 days when the post procedure soreness dissipates.

[slipnslide]

Prior to the procedure I requested that he just totally fry the nerves once and for all!...lol...but I was told he would turn it up to 160 because 180 can burn the person bad and leave nasty scars. I'm thinking it was pulsed because he just turned up the "heat" and left it there for something like a minute and a half at each of the locations. I honestly have no clue what motor or sensory thresholds are, so I can't answer that one....lol

This is not my first time having had this done. The first time it worked very well. And, after having had it done again, I'm sure that fluoroscopy was not used when doing these nerves. When i had it done in the C-spine and lumbar, fluoroscopy was used, but last time and again this time, he just used his eyes and finger to find the exact location of where he was going to place the probes/needles. He asked for my responses as to what I was feeling and where. All I do know for sure is, that it hurt alot more this time than it did the first time, and the first 5 days following the procedure has kicked my butt with increased burning and pain. I'm just glad that someone got on here to tell me that it could take alot more time, I was starting to get nervous.

Thanks,

Kim

[gizmogirl]

If it were pulsed RF, the doctor would tell you ahead that the results only last 6 - 18 months. In pulsed RF there is no frying done at all. By targeting the nerve with only n milliseconds on and nX100(?) ms off, the nerve gets stunned but not damaged.
I'm glad you have had success in the past. I have done pulsed many times with only barely noticeable improvement.
Good luck, I bet you feel like you were hit by a truck!

[slipnslide]

Thanks Gizmogirl,

The pain, burning, and stabbing has increased, so i'm not feeling my best, but if it works as well as it did the first time, then it's worth it.:)

As it was explained to me, Radiofrequency ablation or lesioning is a
term used when radio waves are used to produce heat to destroy tissue, usually a nerve. When successful, enough damage is done to the nerve to allow for the pain signals to not get through, and therefore pain relief is felt until the nerve regenerates enough to start sending the pain signals through again.

MMGlobal had posted what I feel was a good description of what it is.

http://brain.hastypastry.net/forums/showthread.php?t=6307&highlight=ilioinguinal


Earlier this week, I went with a client to a neurologist for an RF ablation (of different nerves... not a facet rhizotomy.) He has a very unusual presentation and a difficult case, but that is not what this discussion is about and it will be up to him to share his case if he wishes... so please don't ask me questions about him.

I was fortunate enough to be present in the OR for this treatment and learned a great deal about this procedure and much more (which I'll post later in another thread.)

I had always thought of RF ablation as burning through the nerve and have images of RF, laser and bipolar application of energy that I've seen in many, many surgeries. It sometimes looks like barbecue time with charring of tissue, vaporization of tissue and some real serious cooking going on.

Instead, what I saw was, after local anesthetic, very careful placement of the RF probe on one side of the channel that the nerves run through. After proper placement was verified (with flouroscopic imaging on the coolest, most modern c-arm I've ever seen), energy was applied to the probe for 90 seconds. The area was only heated to 80 degrees C. They are not burning the nerve. They are not destroying or immediately ablating tissue. After a burn, the probe is repositioned a mm or so to march across the channel to make sure that the entire nerve pathway is treated. There were a total of 5 or 6 applications of energy and in moving from one side of the channel to the other, additional application of local anesthesia was needed.

The application of energy does not immediately ablate the nerve. It damages them so they'll eventually die. To me, this sounds like spraying Roundup on weeds. They look the same when you are done spraying, but they are damaged and will die. It explains why people have pain caused by the procedure for some period of time... usually a few days, often as much as 10 or more. It's supposed to feel like a sunburn as that's essentially what's happened. As with all things spine, responses are all over the place... some people have little pain that fades quickly, while others have more pain that fades slowly.

I had asked about the potential for partial ablation being problematic. The doctor explained that it is possible, but it's not usually a long-term problem. By definition of the procedure, you've partially ablated the nerve and you are waiting for the ablation to become total as the nerve damages progresses in the days following the procedure. If the ablation never becomes total, it may be painful longer as the 'sunburn' will take longer to fade, but eventually you'll be as you will be in the future anyways... as the nerves will grow back in 6 to 18 months (my numbers... not the neurologist... I could be wrong here.) This phase of the nerves growing back is just like the partial ablation as the nerves are dying or of the ablation was not complete. The procedure can be repeated if needed.

I do not know how this procedure compares to a facet rhizotomy... look forward to learning more as I spend additional time in the OR with more varied procedures.

I believe that this neurologist is excellent and may have much to offer many of the people I know who are having difficulty getting a proper diagnosis. I'll post much more later as I learned a ton about different treatments and diagnostic techniques. I look forward to working with him:

Dr. Sheldon Jordan, Santa Monica, CA

More to come...

Mark

[Kathi49]

Kim,

I am sorry you are having to endure this. :(

But I did want to say pulsed RF is different...so "the nerve gets stunned" is correct. My first PM wanted to try it; of course I never had it done. The actual RF ABLATION was done in my lumbar and worked well. I think I need it done again though since in January it will be one year. :) And, as you know, I did NOT end up getting an RF at the C2/C3...just didn't and haven't needed it yet. The injections I had are holding up well at this point...I think they just calmed the facets down. And if I need an RF in the future, you know me, I will say...just fry those things! :D I definitely wouldn't hestitate for the lumbar. The cervical worries me a bit..but that's just me. :rolleyes: As for the femoral nerves and such...I have no clue. You mentioned you thought it was "pulsed". Can you call the doc's office and ask if it was pulsed or actually ablated?

Hang in there and I hope your pain decreases!

[slipnslide]

According to the temperature used, I'm assuming it wasn't "pulsed"!:o ....for the pulsed, a lower temp is used. Going by my experience's with the RF's in the cervical and lumbar spine, and comparing them to the one's in the hip/abdomen, they're a different sensation. The RF's in the hip/abdomen felt more like a constant burning sensation like being stabbed with a hot poker which generated mild to moderate pain, whereas the RF's in the cervical and lumbar spine were a "static" feeling and not really painful at all.