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ONE WEEK ON FROM MY RADIOFREQUENCY ABLATION PROCEDURE TO MY SACROILIAC JOINTS…

It is now a week since I had my Radiofrequency Ablation procedure for the pain in my sacroiliac joints.

Most sites said the average time for the pain relief to kick in is about two weeks or sooner.

My pain lifted on Day 7.

On Day 6 it was very hot so we decided to go to the beach as I had been in isolation for a week after the surgery. I did check with the nurse if going to the beach would be ok and she said it was fine. She said it is more to stop me from mixing in crowds more than anything else.

I found it quite uncomfortable on the lounger on the beach but my wound was still sore and bruised so it didn’t surprise me but I enjoyed getting out into the fresh air.

I have been doing my exercises every day and I can feel I am getting stronger. My physiotherapist said it was essential for me to build up my core after this procedure.

Not needing lots of medication is absolutely brilliant. I am still taking paracetamol and nortryptyline but if it continues as good as this I should be able to cut down on those as well.

The one thing I am really struggling with the most is fatigue. I have had an afternoon rest for years and years as this was part of my pacing technique which I know has always helped me but that nap isn’t hitting my fatigue at all at the moment.

I am sure the hot weather does not help but I am waking up after a good night’s sleep feeling exhausted and even if I sleep a couple of hours in the afternoon I do not feel any better.

I am very excited about the fact that this procedure has worked so far and I hope this will encourage others in this sort of pain to look into having the radiofrequency ablation technique.

Some of the best sites to look into this procedure include Spine Universe, NHS, Med

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MY NEXT TYPE OF INJECTION FOR PAIN IS BILATERAL SACROILIAC JOINT RADIOFREQUENCY ABLATION…

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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SACROILIAC JOINT DYSFUNCTION & LOW BACK PAIN…

“The most common symptom of sacroiliac joint dysfunction is low back pain with or without buttock pain. Sacroiliac or SI joint pain may spread (radiate) into the groin, hips, back of the thighs, and feet.” writes Spine Universe.

Sacroiliac joint dysfunction and pain can be difficult to distinguish from pain originating in the hip joint or lower back which is a bit of a problem for me. Although I was treated with injections for my SI Joint Dysfunction the pain came back and in particular on the right-hand side. Fortunately, my consultant had sent me for a right hip MRI before I had the injections as I had mentioned my right hip was giving me a lot of pain. The MRI showed I have degenerative wear in my hip which is obviously contributing to the pain from SI Joint Dysfunction.

The most common symptom of sacroiliac joint dysfunction is low back pain with or without buttock pain. Sacroiliac, or SI joint pain may spread (radiate) into the groin, hips, back of the thighs, and feet.

Like other types of pain, each patient does not experience the same symptoms. Pain may be described as a minor ache, and the intensity of pain can range from mild to severe. Symptoms may be episodic, infrequent, brought on by everyday activities, or constant (chronic).

Bipolar Radiofrequency Neurotomy (or Radiofrequency Ablation) is a minimally invasive procedure performed to help relieve symptoms related to SI joint dysfunction which is offered if steroid injections helped the pain in the first instance.

The sacroiliac joint is located on either side of the sacrum, which is in the low back and the pelvic areas. The SI joints are a pair of joints that connect the sacrum to the ilium, the large pelvic bone. Unlike other joints in the body, the surfaces of the SI joint are covered in two types of cartilage; one slick and the other spongy. The movement of the SI joint is minimal and results from stretching and is sometimes described as a gliding joint unlike the knee (hinge-type motion) or hip (ball and socket) joints.

Bipolar Radiofrequency Neurotomy is a minimally invasive procedure that disables and prevents specific spinal nerve branches from transmitting pain signals. Bipolar radiofrequency is a modified version of a procedure termed Radiofrequency Therapy (RT), also called Radiofrequency Ablation (RFA), a procedure developed more than 30 years ago. Bipolar radiofrequency is still fairly new, but more pain management specialists are performing this procedure to treat painful sacroiliac joints.

Like its predecessor, bipolar radiofrequency applies a precisely targeted electrical field to create a lesion (change in the body’s tissue)—in this case, in small branches of spinal nerves, rendering them incapable of transmitting pain signals. The difference with the bipolar radiofrequency is that two needles are used to guide the electrical energy in a line between the two needles. This allows the pain specialist to “mold” the location and shape of the lesion to exactly match the SI joint. The applied electrical field can then target these tiny nerves just as they enter the SI joint.

My consultant would like to do this procedure when I feel ready to go ahead with the procedure and explained that for many patients who suffer chronic low back pain, bipolar radiofrequency of the SI joint is an effective treatment that may provide relief for months or longer. Even when the target nerves regenerate (grow back), pain relief may continue. If the patient responded well to the first bipolar radiofrequency, a second may be considered if pain resumes. Of course, each patient is unique and it must be remembered that what works well for one person, may not work well or at all for another. I am definitely going to give this a try as my 8 weeks of pain-free time (from the steroid injections) gave me a taste of what life is like without being in constant pain.

The entire procedure is performed using fluoroscopic guidance. Fluoroscopy is similar to a real-time x-ray and allows the physician to see the patient’s anatomy while guiding and positioning the special radiofrequency needles.

I had a visit from a Physiotherapist before my last procedure who commented that a trochanteric belt, which is a supportive brace that can help with the pain. It is an effective device that is designed to stabilize the pelvis and prevent excessive movement of the SI joint. The terms trochanteric belt, trochanter belt, and sacroiliac belt all mean the same thing and are often used interchangeably. I had already got a lumber support belt after some previous surgery so I decided to give this a try. Unfortunately, I woke up and it had slipped down so I have obviously not got the correct support and I will look into buying another one. The trouble is there are so many different types on Amazon that it is quite hard to decide which one to buy. A trochanteric belt is designed to limit movement of the SI joint in order to reduce painful symptoms.

The SI joint has to move in order for the pelvis to tilt and rotate, but its range of motion is meant to be very limited. Strong ligaments help keep the joint in proper alignment and prevent excessive movement when walking, running, or simply standing. Although these ligaments keep motion in check, they stretch just enough so that the joint can carry out its complex combinations of rotating, sliding or tilting during weight-bearing activities. When the ligaments fail to provide adequate support, destabilization of the SI joint and pelvis can occur. Conditions that can place undue stress on the Si joint and contribute to destabilization can include arthritis, inequality in leg length, sacrum tilted out of normal anatomical position, pregnancy – widening and hypermobility of the SI joint or in my case could have been caused due to all my previous lumbar surgeries.

Most people suffering from SI joint dysfunction find it difficult to remain in one position for any length of time. Pain is generally felt at the base of the spine and is often described as “gripping” or “stabbing.” Difficulty walking or climbing stairs, and pain while lying on one side (especially at night) are common symptoms. I find getting off to sleep extremely painful and uncomfortable and it can disturb my sleep most nights.

For lots more details on SIJ Dysfunction check out the articles on the Spine Universe website.

Source: Spine Universe