Why me?
You have been scheduled for this procedure because your pain pattern has some of the characteristics of pain that can originate from the facet joints. The facet joints are the joints in the back part of your spinal column that allow your back to bend. Your doctor can show you these on a model of the spine. Like any other joint in the body, the facet joints can begin to show deterioration or arthritis with age. Pain can be brought about by problems in these joints.

What is “Facet Pain”?
Typical features of pain originating from the facet joints include, but are not necessarily limited to, pain in the back which can radiate to the back of the thighs, side of the thighs, front of the legs or the groin. The pain is frequently exacerbated by movement of the spine, particularly with extension and rotation of the spine,

What should I expect from the temporary procedure?
The procedure takes about 30 minutes to perform. It involves a series of carefully placed needles. Once the needles are correctly located near the nerves that go to the facet joints, a small amount of local anesthetic (numbing medication) is placed on these small nerves and the needles are removed. The medicine is similar to the medicine that the dentist uses to numb your teeth. It will temporarily block the nerves and will wear off later in the day.

What will I do for the rest of the day?
Try to perform activities that you would normally perform. This will let us know if the procedure helped your everyday pain. You may be asked to keep a “Pain Diary” for the remainder of the day after your procedure. You should note your pain level with activity and with rest and your perceived change in function. It is important to focus on the change in your baseline or “normal” low back pain and to try to ignore any pain you feel from the needle puncture sites. This pain diary will be the basis for further decision making with regard to the next step in your care.

If it does help, what next?
If you have what you and your doctor feel is a significant reduction in your pain from the temporary block, another temporary block may be performed to confirm your response. After which, a radiofrequency denervation may be performed in an attempt to provide a longer duration of relief.

Radio-frequency denervation

Patients who have a significant reduction in their pain following a temporary posterior primary ramus (facet) medial branch nerve blocks may be candidates for radio-frequency denervation. Many of the patients with back pain that had relief from the temporary block will have long term relief from the more permanent procedure.

What is the goal of this procedure?
The goal of this procedure is to decrease your overall level of pain, to improve your daily function, to help you return to work or work more hours if applicable, and to decrease or eliminate your usage of pain medications.

How is it done?
The more permanent procedure involves the use of a highly specialized radiofrequency current generator. This technology allows your doctor to selectively destroy the small nerve branches that go to your facet joints. These are the same small branches that were temporarily blocked with the local anesthetic numbing medication.

The procedure takes about 1 hour and requires your cooperation. During the procedure you will be asked what you are feeling and where you are feeling it. Your answers allow your doctors to place the probe in the exact location to treat your pain while reducing the risk of injury to other nerves. Once the probe is properly located the small nerve branches will be destroyed.

What should I expect after the Radiofrequency procedure?
You have essentially undergone a minor operation on your spine. After the procedure it is very common to have low back pain and possibly muscle spasms for several days to several weeks. During the healing period you may require several days of pain medication to treat the post-procedure pain. Many of the patients with back pain that got relief from the temporary block will have long-term relief from the radiofrequency procedure.

What are the risks?
Radiofrequency denervation of the posterior primary ramus medial branch nerves is a very safe procedure. It has been in use since the 1970’s and many studies have not shown any significant risk to your long term health or well-being. However, anytime you have a procedure performed near your spine and its nerves, there is a small risk of bleeding, infection, worsening of your pain, allergic reaction, nerve damage or injury to your spinal cord. Your doctor will discuss the procedure, the risks and potential benefits with you.

What should I do about activity after the procedure?
You should initially limit your activity after the radiofrequency procedure while your back heals. After 2-3 weeks you should begin to increase your activity level, with guidance from your doctor or physical therapist. You will have a follow up appointment with your doctor 1-2 weeks after the procedure.

Will I see a physical therapist?
You may be referred to a physical therapist for instruction on back care. Back pain is a chronic problem that requires a lifetime of commitment to overcome. The therapist will instruct on proper body mechanics to help decrease the recurrence of your back pain.

What should I do if I still  have significant pain?
If your pain does not resolve, or resolves and then begins to return, call Johnston Pain management and schedule an appointment to see your doctor. You may need the procedure repeated, or another treatment tried for your remaining pain. This procedure can be safely repeated if necessary and the medial branch nerves will usually regenerate.