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Health Matters 12-12-11

Dr. Dave Eichman


Neck and low back pain are problems that affect millions of people every year.  It is estimated that low back pain alone affects over 54 million people in the United States.
Determining what is causing the pain can be complex since beneath the skin there are layers of muscles, bones, nerves, and other tissues that can each be a source of discomfort.
Different therapies are directed towards each source of pain and range from simple medications to complicated surgical procedures.
A patient may be told that they have arthritis in their spine causing pain.  This can have a few different meanings.
However, when a patient has arthritis affecting the joints in the spine, this is termed “facet arthropathy.” The facet joints are involved in connecting the bones of the spine together.
These joints are subjected to wear and tear through out a patient’s life, which leads to arthritis and pain.   The initial treatment for this typically involves over the counter medications such as acetaminophen or ibuprofen, followed by physical therapy.
Should these methods not work, physicians specialized in pain management can perform a low-risk, outpatient procedure that takes about thirty minutes. The procedure is termed “radiofrequency lesioning” and has been used for more than 30 years with success.
The treatment is directed towards those nerves in the spine termed “medial branches” that only serve to send pain signals. This can often lead to prolonged pain relief in these specific locations.
A series of steps are involved to determine if a patient is a candidate for this intervention.  The doctor will start with a series of questions and an examination of the patient’s neck or back. Next, some kind of imaging study (such as an MRI) will be ordered.    If these combine to suggest facet disease as a main source of pain, a set of nerve blocks under x-ray at the suspected levels will be performed.
These can provide the patient with temporary pain relief and tell the doctor if this is where the pain is located. The patients that get good relief from these injections are candidates for the radiofrequency procedure.
Radiofrequency lesioning involves placing a special needle at each previously identified level using x-rays.
Next, a series of safety checks are performed to further assure correct needle placement with involvement of only the target nerves.
Once a physician is satisfied with the location, heat is used to stop the pain signal from the nerves.  Numbing medications are used to prevent any pain from the heat, and some facilities can provide sedation as well for increased comfort during the procedure.
The patient is able to go home after a brief period of observation in the recovery room.   Relief can be expected for approximately six months; the procedure can be easily repeated when the pain returns.
Facet arthropathy is a relatively common cause of neck and low back pain.  Carefully selected patients can benefit from radiofrequency lesioning.  This is a safe and effective procedure with a long history of providing pain relief.  Those with good results are more able to enjoy their daily activities with less pain and less medications.
Dave Eichman, M.D., is a physician with Carolinas Medical Center-Lincoln Pain Center at CMC-East Lincoln Medical Plaza, located at 1585 Forney Creek Parkway in Denver.

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