Reader finds treatment for back pain

Dear Dr. Roach: I suffered a lower back injury in 2001, with crushed and bulging discs in the L2, L3, L4 and L5 vertebras. After over a year of physical therapy and drugs, my pain doctor tried an epidural injection, which did not work, and then suggested I try something new at that time called a radiofrequency ablation, also called a lumbar facet rhizotomy. It’s done as an outpatient surgery and may have to be repeated.

I’ve done so many that I opt for no anesthesia. It works great; I even get up and drive myself home! I’ve learned to limit my activities, so as to not cause more damage due to my disabled pain receptors.

I have been pain- and drug-free for almost 20 years. The treatment usually lasts 9 to 14 months, and when I feel the nerves starting to fire again and causing me pain, I just schedule the procedure and have them ablated again.

Whenever I see somebody walking funny with back pain, I mention this procedure to them. Several of them have come back and thanked me for saying something.

Doctors don’t seem to promote this procedure, and I don’t understand why. It’s clearly another option besides surgery and addictive medication. It’s been a win-win for me, as opposed to surgery.

Please help promote this wonderful, yet “unknown” procedure. I’m still living an active normal life at 64, 20 years after I was told I may end up in a wheelchair.

J.S.

Answer: Radiofrequency ablation of the nerves in the back has been used since the 1970s in people with intractable back pain. The procedure uses an electrode that heats the nerves in the facet joints of the back, stopping pain conduction.

This is done when the treating physician is sure that the pain is coming from these particular nerves, called the lumbar medial branch nerves. This procedure is not appropriate for all types of back pain. Typically, the physician will perform a block using an injection, and if this is successful, but short-lived, as is often the case, a radiofrequency ablation is considered.

When it works, a year of relief is typical (some shorter, a few up to three years) before the nerve fibers regenerate, at which point the procedure can be repeated. Burning or numbness around the injection site is the most common adverse effect.

Effectiveness rates in the published literature range from 50% to nearly 100% in small trials of carefully chosen subjects.

However, a large randomized trial of this procedure in subjects who were being treated with an exercise program and psychological support did not show a significant improvement in pain or function.

I agree with you that this procedure is safer than surgery, and while I’m glad it’s worked for you, the evidence of benefit from the highest-quality trials islacking.