According to evidence-based consensus guidelines published online in the journal Regional Anesthesia & Pain Medicine, the use of radiofrequency ablation—targeted heat from an electrical current to relieve nerve pain—may help treat chronic neck pain, but only in patients who meet specific criteria.
The neck is a vital part of the body, and it depends on the muscles only. Any disorder in muscles trouble one with a lot of pain in routine activities. Chronic neck pain can be removed with the help of surgery which is considered as the last option for one’s wellbeing.
Only Some Patients With Chronic Neck Pain Need Intrusive Operations
Over the last two decades, the usage of therapies such as joint injections, nerve blocks, and radiofrequency ablation to relieve chronic neck pain has increased dramatically. However, their diagnostic and therapeutic efficacy is debatable, and each entails a risk of consequences.
To cover a variety of relevant and difficult themes, the committee drew on over 400 publications. The role of the medical history and physical examination; imaging findings; conservative (non-invasive) treatments; anatomical details; diagnostic indicators; procedure approaches; the requirement for anesthesia; and safety precautions were among the topics discussed.
While nerve blocks are likely to be far more useful in identifying these patients than steroid injections into the joints, only one block, rather than the two required by the guidance, is required, according to the guidance, which was developed by an international panel of 22 experts representing 18 professional societies and government bodies.
They also looked at the value of clinical signs and imaging in selecting patients for specific procedures, as well as the diagnostic and prognostic value of procedures, as well as several aspects of radiofrequency ablation, such as how to minimize complication risks and when the procedure should be repeated.
Because acute neck discomfort generally fades on its own, the guidelines urge using non-opioid pain relievers and physiotherapy for six weeks before considering nerve blocks to avoid unnecessarily intrusive operations and related healthcare expenses.
Physicians should also inform patients about the common adverse effects of radiofrequency ablation, which include discomfort, tingling/burning sensations, numbness, dizziness, and loss of balance/coordination, which can last anywhere from a few days to a few weeks.
None of the research cited in the guidelines supports the use of pain alleviation thresholds higher than 50%. Even lower levels of discomfort are required to label a treatment as successful, according to international guidelines used to conduct clinical drug studies and evaluate invasive treatments like spinal cord stimulation.
While most patients who have the surgery repeated will experience pain relief for another 7 to 20 months, the advantages may fade over time, and the operation should not be performed more than twice a year, according to the guidelines.
Patients should also be informed that radiofrequency ablation isn’t always a cure, according to the guidelines: pain alleviation normally lasts 6 to 14 months. Another important concern addressed in the guidelines is whether repeated radiofrequency ablation in patients with whiplash and neck discomfort unrelated to trauma is beneficial.
Other important suggestions include:
• When injecting into the upper neck joints or after radiofrequency ablation, only use soluble, short-acting steroids to avoid nerve inflammatory pain.
• Using needles and electrodes that are smaller than those used for the lower back
• Increasing the efficiency of nerve and muscle stimulation while lowering the risk of problems
• Taking precautions to avoid interfering with implanted electrical devices like pacemakers.
Dr. Steven Cohen, Co-Chair of the Guidelines Committee and lead author, comments: “It is precisely because neck pain and cervical spine procedures are so common, and there is so little high-quality evidence to guide care, that consensus guidelines are needed.”
