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I am going back to the hospital next week for a different type of injection for the pain in my sacroiliac joints called radiofrequency ablation which I am having in both sacroiliac joints.

I have previously had facet joint injections, trigger points, and nerve blocks to name a few but radiofrequency ablation is quite different from any of these.

A radiofrequency ablation (RFA) of the sacroiliac joint (SI joint) is a procedure that uses radio waves to heat and destroys the nerves. These nerves carry pain signals from the injured sacroiliac joint to the brain. Radiofrequency ablation of the sacroiliac joint is often recommended for patients who have received short-term pain relief after injecting the SI joint with numbing/steroid medicine but have had unsuccessful results with later therapy.

The best pain relief I have ever had was my after my SI joint steroid injections last December. I had not felt such pain relief for years so my consultant knew that we had hit the right spot and hoped it would last a long time. Unfortunately, the pain relief only lasted for a couple of months but because it had worked initially it meant my next procedure would be the radiofrequency ablation procedure.

The sacroiliac joint is a large joint in the lower back joining the iliac bone to the sacrum. You have two joints, one on each side. Inflammation or arthritic changes in these joints can cause pain, either in the back, or referred areas around the back, side in the buttocks or lower limbs.

The treatment involves…

  • A small needle is placed in the back of your hand for sedation or emergency drugs.
  • SIJ RFD is performed lying face down.
  • Your back is cleaned. The skin is numbed with some local anaesthetic.
  • A special X-ray and a radiofrequency generator machine will be used by the doctor to identify the location of the nerve.
  • Electrical tests will enable the tip of the specially designed needle to get close to the nerve. The final electrical test is done to make sure that the needle tip is well away from the main spinal nerve to your leg, thereby improving the safety of the procedure.
  • When the doctor is happy with the needle position, local anaesthetic is injected before a high frequency (radiofrequency) electrical signal is passed down the needle for 90 seconds.
  • After each lesion, the area is injected with a mixture of local anaesthetic and steroid, to help reduce discomfort afterwards.
  • I am being put to sleep for this procedure but with a heavy sedative and not a general anaesthetic. Some patients just have a mild sedative.

Of course, no surgery comes without possible risks but at only 1% it is well worth giving this a try.

The risks include:
• Allergic reaction to the medication
• Nerve damage
• Bleeding and bruising at the injection site
• Pain at the injection site or during the injection
• Infection
• Injection of medication into a blood vessel
• No improvement or worsening of your pain in some cases

I have been told that on the day after the procedure, I can cautiously return to my regular activities, but most require an additional 2 days of rest. My back and buttock will usually be very sore during the next few days. The pain will slowly improve over several weeks. This pain is usually caused by muscle spasms and irritability while the targeted nerves are dying from the heat lesion. Pain relief usually is not experienced until about 2-3 weeks after the procedure when the nerves have completely died. My back may feel odd or slightly weak for several weeks after the procedure. There is a rare chance (less than 5%) that you may have increased nerve pain following the procedure for 1-3 months.

The nerves can grow back over a period of months eventually causing the pain to return. If this happens the procedure can usually be repeated or another alternative is to have your sacroiliac joints fused.

Source: Spine Universe, NHS, Med


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