Are you concerned about any new techniques? One of the things I get asked about quite often in terms of new techniques is radiofrequency lesioning, or burning the nerves in the spine, which has become over the last five to ten years a technique promulgated by pain management physicians.
The whole pain management specialty originated out of the narcotic epidemic in the United States. It was felt that, to help general practitioners be able to manage chronic pain patients, perhaps a subspecialty of pain management doctors would be appropriate. As it turned out, a lot of these pain management doctors were, in general, anaesthetists. Anaesthetists learned to put epidural injections into the spine, so apart from putting intravenous cannulas and breathing tubes into people, they have a skill set of putting needles into the spine. They’ve carried that into the spine by doing cortisone injections in various places around the spine and, more frequently, a procedure called radiofrequency denervation – inserting a needle into the body and heating the needle up to 80 or 90 degrees and performing a thermal injury on the tissue that’s being treated. To help with chronic pain, they’ve started doing this in the spine at various points, and it’s proposed as a treatment that gives some short-term relief for patients.
I find it quite a strange procedure to offer, because any neurosurgeon or any spine surgeon who’s done a significant amount of spine surgery knows that if you damage a nerve, you normally get nerve damage pain, which is like phantom limb pain, which is often worse than the original pain that’s been treated. The second reason I find it a little bit strange is that the nerve that’s burnt is a little branch of the nerve that goes to the joint at the back of the spine, so it’s not part of the spinal nerves proper. And the only pathological process that can be treated with this is symptomatic facet joint arthritis, which is incredibly rare.
This treatment is generally an outpatient or assisted-sedation procedure where the nerves are cauterised. I’d liken this a bit to, if you had a scrape on your arm, getting an iron out and ironing your arm as a way of somehow sealing over or controlling the pain. So I find it a puzzling procedure to have performed. They usually administer corticosteroids at the same time, and that gives a bit of short-term relief for the pain. But overall, I find the indications for this procedure baffling to say the least, and inappropriate to say the most.
