Pulsed Radiofrequency Lesioning
What is Pulsed Radiofrequency neuromodulation (PRF)?
PRF is a neuromodulatory therapy in which radiofrequency energy is introduced around nerves. PRF alters how nerves function and transmit electrical impulses. The energy levels can be adjusted to either cause no or microscopic damage. This is different than standard radio frequency (RF) procedure where high temperatures are generated, and targeted tissue damage is the goal. With PRF, no or minuscule tissue damage results from the procedure.
For which conditions is this useful?
This technique is accepted to be helpful in peripheral joint pain (studied mostly in knees and ankles but also in joints as small as fingers) and pain caused by specific peripheral nerves. If a nerve block was useful to reduce your pain for a few hours, PRF may be able to elongate that pain-free period.Â
PRF should be considered when nerve blocks alone have failed to reduce symptoms or for otherwise hard to treat pains like radiculopathy aka sciatica, post-herpetic neuralgia or persistent post-surgical pain.Â
A few specific regions and nerves are inguinal/ilioinguinal nerve, pudendal neuralgia, chronic headaches/occipital neuralgia, shoulder pain/frozen shoulder and even severe painful syndromes like trigeminal neuralgia and complex regional pain syndrome.Â
This technique is less useful than conventional radiofrequency (RFL) for pain associated with spinal osteoarthritis.Â
How much does it cost?
MSP covers the physician fees for delivering pulsed radiofrequency (PRF) medical therapy.Â
There is an upgrade fee of $300.00 which covers the costs of medications (local anesthesia, steroids, anti-inflammatories or phenol compounds) and specialized equipment used to deliver the service. This is not covered by MSP. Â
If delivered in the hospitals, these costs are covered by the hospital. Â
Typically, these are done with recycled probes. Â
In the community, access to these probes are difficult, and therefore specialized disposable probes are used to ensure access to the service.Â
Pulsed Radiofrequency Lesioning (PRF) FAQs
PRF is performed by placing a needle, under either ultrasound or X-ray guidance, through the skin and as close to the target nerve or nerves as possible. After the needle is in proper position, the target nerve is usually numbed, and a specialized probe is placed in the needle. An electrical current is then applied for anywhere from 2-20 minutes. During the procedure, the patient may feel a pulsating sensation, which is not painful but may feel unusual. Once the PRF procedure is completed, the needle and probe are removed. The procedure takes about 30 minutes depending on which and how many nerves are treated.
When a pain condition is chronic, there are changes that occur in the central nervous system that are not easily altered. PRF offers many patients significant relief, but frequently they will need intermittent treatments or, depending on the condition, treatments directed to various nerves that may require more than one session. Your physician will tailor a treatment regimen that is appropriate for your specific condition.Â
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Post-treatment patient adviceÂ
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The patient usually feels better immediately after completion of the procedure due to the injection of local anesthetic onto the affected nerve. When the effect wears off, the patient may begin to feel sore. They may continue to feel sore for the first week, better the second week, and that the full effect will usually take three weeks to develop. During this time, it is not required that the patient restrict activities, except as needed due to pain. Deep tissue massage once a week for the first three weeks following the procedure may relieve soreness due to the procedure itself, as well as chronic myofascial trigger points which may have developed over the course of the disease.
We ask that you someone is available to take you home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform the activities as tolerated by you.
The following patients should not have this injection:
- If you are allergic to any of the medications to be injected
- If you are on a blood-thinning medication (e.g. Coumadin, Plavix),
- If you have an active infection.
- If you have not responded to local anesthetic blocks, you may not be a candidate for this procedure.
Unlike continuous radiofrequency lesioning, which is (rarely) associated with neuritis-like reactions, motor deficits, and the risk of deafferentation pain, PRF seems to have few side effects. There are no known reports of any serious or long-term complications associated with PRF.Â
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There are complications anytime the skin is broken with a needle and those remain with PRF, including bleeding or infection at the site of insertion.
Ask your Medical Doctor or Nurse Practitioner for a referral to have a consultation with one of our Pain Specialists.
GALLERY
