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.

4 Thoughts on “Ablation Techniques for Pain Relief”

    • Thank you for such an incredible suroerce for pain related issues. I’m new to your site but I don’t think there’s anything like this on the internet. This is the first place I’ll peruse when I have that difficult and unusual case to see if you have anything to say about the issue. By the way, I see you have some prolotherapy references. I know you don’t know me, so whatever it’s worth, I’ve been doing prolo on patients for the last 11 out of the 20 years I’ve been in my pain practice and it is the real deal. For the last three years I have performed prolo on about 30 football players at LSU (currently the #1 football team in the US). You can believe that if prolo is a sham the LSU athletic trainers would not waste their time on this treatment approach. There’s too much at stake with these players. There are several reasons, economically, politically and otherwise why prolo isn’t mainstream yet, but most of these have little to do with does it actually work. If you put aside the economic/political issues the technical issues have to do with:1) It is virtually impossible to have a reasonable placebo in prolo studies since the needling alone causes an injury/inflammatory response thus invalidating the placebo arm of the studies. Indeed, the prolo research otherwise appropriately done are plagued by high placebo responses. (Just because normal saline is injected doesn’t mean it is an adequate sham treatment)2) Unlike with corticosteroid treatment, prolo only works in an extremely localized fashion necessitating very precise needling technique. Additionally, despite what the orthopaedic paradigm presumes, referred pain is fairly common and with prolo as with many other treatments, injecting an area of referred pain will not work.3) Probably the biggest barrier to prolo becoming mainstream is that there are no possibilities of any patents in the present form of the technology. No patents No research money. We have witnessed several competing technologies lately; e.g. Platelet rich plasma, whole blood, various growth factor injections and recently in Europe bone marrow aspirate injections. However, someone needs to compare all of these to the gold standard in proliferative therapies prolotherapy. Other than having various patents associated with these newer technologies, they all may offer only slight or no advantages over the patent-less prolotherapy.Your thoughts would be appreciated. Thanks again for the incredible site.Paul Kramm MDBaton Rouge, La. USAYes, prolotherapy is helpful I prolotherapied my own thumbs when they became too hyper-extensibile from manual work I did Came back from a CAOM conference where they are using testosterone instead of sugar and am eager to try it. admin

    • Thank you for the article on chinorc pain after hernia repair. Since I had the surgery twoyears ago, I have been in constant pain. Some nights I’ve only slept 30 minutes. A few months ago a pain management specialist diagnosed nerve entrapment. He has been giving me injections into my abdomen, but today told me that I may have reached max improvement because I couldn’t tell a difference after the last injection. I won’t accept that what I feel now is an indicator of what I can expect for the rest of my life. While I really like my pain management doctor, I’ll find someone who’ll try the tens on me. One more thing: Last month I started using Tiger Balm and it has given some relief. It’s worth a try to anyone who reads this who is having pain especially in the thigh area.

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