Pain Management Community

The facet radio frequency ablasion (aka rhyzotomy) must be done largely without the benefit anesthesia. There will be some slight local anesthetic at the needle insertion site. But, there will be no anesthesia deeper, through layers of fat, muscle and tendon. You see, the physician must ask how it fells at various junctures throughout the procedure. Thus you need to remain awake and alert. Unfortunately, that also means that you will feel the deep penetration of needles the size of knitting needles. They go virtually all of the way to your spine.

I'm told that I have a very high tolerance for pain. Yet, my wife could hear me far down the hall from radiology in the waiting room.

Now, some people report significant pain relief from a rhyzotomy. Some report no help at all. And a few, like me, had an increase in pain. I do not presume to have the research numbers, assuming they exist. Suffice it to say, many people experience worse pain after a rhyzotomy.

One bright spot is that it seems that the incidence of temporary or partial paralysis is low. So, it's painful. It might work. It might not. There is a small chance it will be worse.

Oh mercy, when I had my epidurals, it was fine, but when I had the facet injects I have to admit the needles were pretty thick and now I know why, the first one he used was to freeze then he use the big ones to go into the facet joint,. I have a high pain tolerence also, I have had 3 kids with nothing, not even and IV, because I hate needles, I was in a hospital, but refused the IV and epidural they thought I was crazy. But the facets were tough to take and they were high up in my neck, my daughter said she could see the holes even 4 days after, plus I was bruised that long. I don't think I can handle that Rhyzotomy, espesially if its not a sure thing. The epidurals were all for nothing and but I had to pay for all three sets, the facets worked but only short lived. I hate to think I have to get a neck fusion. But I can't get any more injections with steriods now. Your wife must have been cringing when she heard you, I can't imagine how horrible it was for you with needles that big. I don't think I can handle it, would you do it again?

Would I have another facet rhyzotomy? Are you kidding? The first one made me worse and caused enough agony to make me believe that the Gestapo invented it. The success rate is low and many who report relief say it's temporary. No, I would not do it again. After four failed spine surgeries, I'm done with invasive procedures with low success rates. That includes the spinal cord stimulator and the intrathecal infusion pump. Thanks anyway, but I'll stick with my narcotics, biofeedback and off-label medications.

hi, was just reading your messages and thought i'd reply. I have a rhyzotomy every 6 months for chronic back pain, yes it is uncomfortable while they are locating the nerve root, and for me it does increase the pain for 4-6 weeks after but then i manage really well. I'm a nurse and do a fairly physical job and after the 4-6 weeks i manage without painkillers - something i wasn't doing with the epidurals and the discectomy. I have to say thats its better than having a spinal fusion esp when they cant be sure that it will work as have nerve damage, so although its painful for a few minutes while they locate the nerve root, i think its worth it.

Hope this was some help

Sarah

I'm glad that you obtain relief from a rhyzotomy, Sarah. However, be advised that the large diameter rhyzotomy needles create their own fibrosis (scar tissue). When I saw my first myelogram after a rhyzotomy, I was amazed at all of the long scars that penetrated to my spine. I couldn't believe what I was seeing. So, I asked the radiologist. He told me it was from the rhyzotomy.

Scar tissue can impinge upon a spinal nerve root, creating sciatica, referrant pain and allodynia. Although rhyzotomy needles do not create the same damage (and fibrosis) that a scalpel creates, they nevertheless create potentially damaging scarring. Do not believe that one can go about having multiple rhyzotomies without the potential for having more pain that you had in the first place. Yes, it's better than having spinal fusion. But, these are not carefree steroidal injections or epidurals. Any invasive procedure carries some risk of morbidity.

Where did you have the procedure done? I want to make sure I don't go there. I have to have done multiple different treatments. The last being a bi-lateral cortizone injection in my sacrealic joint, and an injection in my L5. They both worked for a few weeks but the pain is starting to come back., so I went back to the South Eastern Spine Inst.. They have now prescribed the Facet Rhizotomy. On paper this treatment sound great. Now I am concerned. I want to research the doctor and the place. If anyone knows of a doctor that i reputable please let me know.

"Watertoys," here is the latest research on rhyzotomies and most other common spinal treatments www.painphysicianjournal.com/2009/july/2009;12;699-802.pdf. As you will see, the success rates for a rhyzotomy (at 12 months) are 40% to 60% (higher with no prior surgery). The research also reveals that if injections (including rhyzotomy) do not help, or do not last very long, then future injections are pointless and risk nerve root impingement.

You can go to the Cleveland Clinic, Mayo Clinic or Johns Hopkins; it won't make any difference. The rhyzotomy has low morbidity, but also a low success rate. If it helps, great. If it doesn't help, beware that additional iterations are just as likely to fail.

Good luck!

I had one on my neck and it didn't help me. I have to agree with most on here and say that it's not a pleasant procedure. It is painful and I felt worse pain for at least the next week. What felt really strange was touching the skin of the treated area. It's like you can somewhat feel your fingers touching your skin, but then it also feels numb. Imagine when you've had dental work and they've numbed your gums. It feels like that, but (at least for me) only on the surface of your skin of the treated area. in my opinion, it was a waste of time and there wasn't really any pain relief. It's also something that may have to be done again, as the nerves can sometimes grow back.

Charles, My doc is sending me back to the spine center in Mlps.Mn. to see about some facet injections. I saw the surgeon there last fall and was told that there are some spurs that he could clean up as well as some stenosis. Also the c-4 c-5 disc looks compressed. He said he could go in to take care if the spurs and sten. but if the disc is bad he will take it out and fuse. I have already had the c-5,c-6 fused. He tells me that if I end up with a 3 level fusion I can basically kiss my job good by so I am thinking of having the injections. I am still working so my meds are kept at a min. 60 lor-5s a month. They actually last only about a week and a half to two weeks. Getting ready to make some important decisions that will effect my family and my future. At the point where I cant take much more of this. Also dealing with a thoracic problem which doesn't help matters. Do you think the facet inj. will help, or should I just bite the bullet and have the surgery. I've been reading some of your posts and I like your straight forward and frank insight to the issues that are posted. perry k.

Hi Perry. Sorry about the confusion. I didn't read down far enough to see your original message.

If your medications aren't helping, tell your doctor. Most of us do much better with a long-acting narcotic, saving the short-acting drug for breakthrough pain. It sounds to me like you are under medicated.

You should always try the least invasive treatments before going under the knife. Spine surgery has a success rate of 50% for pain (80% for improved function). I would most definitely go for nerve root and Facet injections and even a rhyzotomy, before surgery. Save that for a last resort option. If the injections don't help, you can also try TENS, biofeedback, a spinal cord stimulator and an intrathecal infusion pump - all recommended before surgery.

Finally, I encourage you to seek out at least two other opinions from spine surgeons (note, this is not an ordinary orthopedic surgeon or neurosurgeon). Try to find fellowship-trained spine surgeons in your area. They are far more well trained and talented than anyone else. For example, leading edge cervical spine surgery for disc herniation involves disc replacement. Disc replacement offers the stability of traditional fusion with the rage of motion of a microdiscectomy. And, your have your osteophytes removed at the same time. Spine surgeons can be located at or near teaching hospitals.

I think your surgeon might be giving you some BS about fusion ending your working career. I had multilevel fusion and continued to work for 15 years. Does he perform disc replacement? Just one more reason to obtain more opinions from the very best - spine surgeons. You deserve to have the most talented physicians. Meanwhile, you could manage your pain with better medication. Have you enrolled in comprehensive pain management? If not, ask for a referral. There are dozens of non-invasive and minimally-invasive treatments that can help you better manage your chronic pain.

Good luck, Perry. And, please keep us informed.

Ya I'm bouncing all over the place still trying to figure out how this all works. I wrote in the chronic pain section under "working with meds" why the doc is under medicating. Cant have any in my system while operating equipment which is part of my job. From what I've been told the Spine Center is one of the best, so not sure what to do.Just looking for some advice. I wrote to you in another post "Charles" that goes in to greater detail. Again I apologize for bouncing back and fourth.Still learning. perry k.

We all have to make our own choices, but I would not bother with the injections or surgery. I would see a PM doctor and get an a more aggressive medication treatment plan. Just take a short acting opiate for pain is fine after an acute injury, but for a chronic pain situation, I would ask about long acting opiates on a set schedule with short acting ones to take as a break through med.

I had a C5-6 discectomy in 1992 when I was losing function in my hands, and then six months later I was rear-ended at a stop sign and the next disc herniated. I opted to leave that one alone and avoid surgery as I only had pain, but no loss of function. That worked best for me. Surgery only has about a 50% chance of working for pain relief. My neurosurgeon would only mess with discs if ones function was bad. He said the odds for pain relief were not worth the risks. I am reading the same stats these days for pain relief with spinal surgery.

I would also ask about an antidepressant and a seizure drug to add to the mix. Often by taking a cocktail of drugs and doing biofeedback, cognitive behavioral therapy, PT, etc. you can live fairly comfortably for years.

You did not mention any meds except the lortabs, so I don't know if you have already tried other things or not.

Take care, Annette

Quote: Cant have any in my system while operating equipment which is part of my job.

I'm not for sure this is correct, once your prescribed pain medication you should be able to do any job, for most people with chronic pain the medication only works to stop your pain and doesn't interfere with your job, no matter what your doing, driving, working with heavy equipment ect... you do have rights. I'm been in Pain Management for years and its helped me become a much more productive person. I really don't think a job can fire you for taking prescribed medication, no matter what kind of medication it is. If you have problems have your PM doctor call your job and explain to them what the medication is for and that its to help you. I've never had any problems before but I've known people that have been fired only to be re-hired after they find out they can be sued for this kind of discrimination. Good Luck.

I am sure that with a commercial drivers license if you have an accident and have anything in your system it is the same as a D.U.I. If there are injuries or fatalities there is an automatic blood an urin sample taken. Take in mind we are held at a different standard than a person with a regular operators permit. I dont drink alcohol but the legal limit in Minnesota is .08, but with my class "b" it is at .04. I have had some close calls with drivers that will not respect the plow truck, luckily no incident in 9 years, but all it takes is that one. Thank you for the response.perry k.