Ablation Techniques for Pain Relief

Treatments for herniated intervertebral disks are most common, but many other treatments exist for acute and chronic neck and low back pain.  In my last posting I discussed the anatomy of the spine.  The point was that there are a lot more pain sensitive structures than just the inverterbral disks.  There are muscles, bones, nerves, joints, and other supporting ligaments and tissues.  I discussed how once a diagnostic anesthetic block has positively determined the cause of the pain, more permanent treatments can be used to produce long lasting benefit.

So what are some of these treatments which exist?  There are several ablation techniques,  they are:  cryoablation (cold), radiofrequency ablation (heat), or chemical ablation.  The latter are less commonly utilized.  However one example is the use of Botulism Toxin for chronic muscle (myofascial) pain.

Botox “permanently” [nerve tend to regenerate over six months] prevents firing at the neuromuscular junction (where the nerve innervates the muscle).  It therefore can be used for chronic muscle pain, and has in the last few years been used to treat chronic muscle tension headaches with very good success.

I have used Cryoablation, the freezing of tissue for many different ailments.  It can be used in any soft tissue.  I have successfully treated pain from muscles, ligaments and joints.  Applicable areas include neck, shoulder, inguinal (groin), knee and ankle pain.  The joint pain must be determined to be extra-articular (not due to a problem within the joint).  But for example, I’ve had patients who have had knee and ankle surgery, with persistent pain, who benefited from freezing of the painful areas around the joint.

Finally radiofrequency ablation is the most common treatment utilized by pain interventionalists.  It uses heat generated through a fine needle to ablate localized areas.  It is most utilized for painful joint conditions in the spine.  The facet and sacroiliac joint are the amenable treatments to this technique.  I also used it for shoulder and hip conditions which successfully prevented the patients from having to undergo surgery.  Other technologies do exist which can help treat degenerative disk abnormalities.

The goal of these treatments is to find out what is causing the pain (the “pain generator), and use minimally invasive therapies to result if a long lasting benefit to the patient.

Author
Dr. Todd Koppel

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