Treatment of back pain arising from the facet joints may include radio frequency denervation of the nerves supplying the affected joints. As the nerves supply more than one joint, it is necessary to treat more levels than those directly affected. This is usually very effective and may last nine to twelve months. The treatment can be repeated if required. The denervation is performed by a pain specialist and involves applying electric current to the nerve to cauterise it.
It is not unusual for this painful condition to affect different areas of the spine e.g. neck and the lower back. Also severe low back pain may arise from the sacroiliac joints below the spine. This may be felt in the buttock/s and the legs and be mistaken for sciatica. Radio frequency denervation is also used to treat this type of pain.
Radio frequency denervation is done in an operating theatre under sedation or light anaesthetic. X-ray or fluoroscopy is used to identify correct electrode placement and local anaesthetic with a steroid drug is injected to assist in post operative recovery.
Normally you can expect to be discharged several hours following the procedure but in some situations a night in hospital is needed. Moderate pain can be expected and agents such as Panadeine or similar should be available. Pain may take up to two weeks to settle fully.
Does it work?
Like every medical treatment, there is no guarantee of success.
A Cochrane Review, considered to be a ‘gold standard’ in reviewing medical evidence, concluded that: radiofrequency denervation can provide short-term pain relief for a small proportion of people with specific joint problems in the neck. There is conflicting evidence about effects for low-back joint pain, and some evidence that it does not relieve pain from low-back disc problems. It is not clear what ‘short-term’ means!
It is more likely that you will have a positive outcome if you have responded to corticosteroid injections to the facet joints.
Although the duration of benefit from denervation is longer than with steroid injection, there is a chance the denervation may need to be repeated.