Complications from Radiofrequency Ablation (RFA): A question for our EdPNS medical team

Joani, PB & anyone else who might be able to help :

My uncle recently had Radiofrequency Ablation for back pain and came out of it with a terrible, nearly unbearable burning & pain sensation in his leg, but his back feels better. He was supposed to go in last week to have the same procedure on the other side of his back, but didn't go out of fear that he would come out of it with the same horrible sensation in his other leg. When he called his doctor and told him about the sensation, basically his doctor blew him off (not too impressive).

I've been researching the risks and complications of RFA for him since and have come up empty-handed. I told him that my gut feeling was that a nerve or nerves were damaged that were not a part of the planned procedure and that he should keep his appointment and inquire with his doctor about that specifically, but obviously I am not a medical professional and that's just my gut feeling. Anyways, he chose to simply cancel the second procedure and appointment altogether. Obviously he is pissed at the doctor.

Does anyone know anything about this procedure, the risks or complications?

Thank you!

Never heard of it. Ablation is a process of "wearing away" isn't it?

We used to put Ablative paint on boats. Every once and a while, you would wipe the bottom of the boat... gently... and the outer part of the paint would scrape off (fouling the water), exposing fresh paint.

It sounds like it could easily damage a nerve.

riceme wrote:

Joani, PB & anyone else who might be able to help :

My uncle recently had Radiofrequency Ablation for back pain and came out of it with a terrible, nearly unbearable burning & pain sensation in his leg, but his back feels better. He was supposed to go in last week to have the same procedure on the other side of his back, but didn't go out of fear that he would come out of it with the same horrible sensation in his other leg. When he called his doctor and told him about the sensation, basically his doctor blew him off (not too impressive).

I've been researching the risks and complications of RFA for him since and have come up empty-handed. I told him that my gut feeling was that a nerve or nerves were damaged that were not a part of the planned procedure and that he should keep his appointment and inquire with his doctor about that specifically, but obviously I am not a medical professional and that's just my gut feeling. Anyways, he chose to simply cancel the second procedure and appointment altogether. Obviously he is pissed at the doctor.

Does anyone know anything about this procedure, the risks or complications?

Thank you!  

Rice, I don't know if you have seen this one or not but there is some interesting info on RFA. One of the side effects listed is leg pain and numbness.

http://www.webmd.com/pain-management/radiofrequency-ablation

Ghost_Rider1949 wrote:

Rice, I don't know if you have seen this one or not but there is some interesting info on RFA. One of the side effects listed is leg pain and numbness.

http://www.webmd.com/pain-management/radiofrequency-ablation

Yes, thank you GR, I did read that WebMD article (which says much the same as all the others), quoted below:

Quote :

What Side Effects May I Have After Radiofrequency Ablation?

You may experience the following effects after RFA:

Leg numbness: If you have any leg numbness, walk only with assistance. This should only last a few hours and is due to the local anesthesia given during the procedure.
Mild back discomfort: This may occur when the local anesthetic wears off and usually lasts two or three days, if it occurs. Apply ice to the area the day of the procedure and moist heat the day after the procedure if the discomfort persists. You may also use your usual pain medications.

The troubling part is that my uncle's pain is not at the injection-site (his back) but in his leg, and that it has lasted for at least a few weeks now. Also, it is much more than the "mild discomfort" described in all the articles I've read, but is very painful. He's no sissy and does not normally complain about pain at all, so I know that it has to really hurt like an SOB for him to even mention it. He is normally pretty active despite the pain he experiences from a back injury (the reason for the RFA), but has been laying on the couch watching tv with ice on his leg since he had the RFA procedure... that is not like him at all, and I'm pretty worried.

When I had my back pain nerve ablation was recommended.....3 of my physicians said absolutely not. With my condition....I was told as soon as the nerve regenerates  the pain would be worse. Of course it was an insurance doctor recommending the rhizotomy.


With the procedure sometimes you do not get immediate results...the nerve is irritated and will take a little while to settle down....but when it does and it is successful you can expect to get 6-7 months of pain relief.


Many back pain patients will tell you they can handle the chronic back pain but the leg pain is not tolerable.

Riceme...hopefully his leg pain will settle down when the nerve is less irritated.... Amitriptyline at night is used to treat leg pain secondary to nerve irritation, unfortunately, it takes about 3 weeks on the medicine before you notice any results.

Just saw this, Riceme. I don't know enough about RFA to give a solid answer.

The first thing I thought of, based on your description of his pain, was reflex sympathetic dystrophy, or RSD. Joani? Any thought on this?

Here is an article about RSD:

http://arthritis.about.com/od/rsd/a/rsd.htm

Diagnosing RSD is a complicated process of elimination...sounds like her uncle's pain may be a direct result of the ablation....with ablation if the nerve is not completely destroyed it can cause acute nerve hypersensitivity.  This could account for the extreme nerve pain.

THANK YOU so much, Joani. I just tried to call my uncle to tell him what you wrote above but couldn't reach him, so I'm going to shoot him an email with the details and a link to Amitriptyline for nerve pain, then he can call me back so we can discuss it.

I'm very relieved because it sounds like from what you wrote that it is not all that uncommon... I am not nearly as worried anymore, so I really appreciate your comments. I feel much better, and I'm positive that he will too. I am really pissed and disappointed in his doctor that he couldn't take the time to even explain this to him and just blew him off.

Oops, sorry... I wrote the above response late last night and neglected to hit "send" so I missed the comments in between until now.

Can RSD be caused by the RFA procedure? I don't want to mention that to him at all until I'm clear on that because I don't want to scare him... it sounds scary to me. I tried to Google it to find the answer to that question, but was only taken to a bunch of blogs, not anything from actual medical professionals, and even then I could not easily tell whether it was a cause or not.

Thanks so much, ladies!

Rice....I would be extremely surprised if it were RSD.

Amitripyline will take weeks for results ...Neurontin is another drug that is used. It is an anti-seizure medication but it can block the pain signals to and from the brain thus reducing the acute nerve pain.

He should ask the doctor if perhaps the nerve was only partially destroyed by the ablation....I don't think the acute nerve pain should linger this long.


RSD
http://www.piedmontpmr.com/rsd-the-misunderstood-pain-disease-feature-article/

riceme wrote:

Oops, sorry... I wrote the above response late last night and neglected to hit "send" so I missed the comments in between until now.

Can RSD be caused by the RFA procedure? I don't want to mention that to him at all until I'm clear on that because I don't want to scare him... it sounds scary to me. :(I tried to Google it to find the answer to that question, but was only taken to a bunch of blogs, not anything from actual medical professionals, and even then I could not easily tell whether it was a cause or not.

Thanks so much, ladies!

No, Riceme, I wouldn't mention RSD to your uncle. As Joani wrote, it is a diagnosis of exclusion, and can take months to diagnose. RSD was just the first thing that popped into my head other than self-limiting pain from the trauma of RFA.

RSD can be caused by many things (or nothing), so there is probably no literature out there that discusses a possible connection between RSD and RFA.

But yes, RSD in scarey. I've only seen a few cases of it in my career, but those cases are memorable.

How is your uncle feeling now? Any decrease in symptoms?

I asked him last night after he emailed me a couple of Herman Brood YouTubes (anyone remember him??) but he hasn't gotten back to me yet.

https://www.youtube.com/watch?v=Jv3JQLkYlvQ

https://www.youtube.com/watch?v=1K1fRY9Oe8U

*abandoning the YouTube video insertion since it's basically non-functional

Okay, heard back from UJ... his doctor prescribed him gabapentin and he would like you all's opinion with respect to all of this... Any thoughts?

My granny fell... ehh, actually my mom dropped her (ouch, I know... she feels horrible, so I prefer to say that Granny just fell) and Granny broke her femur head about a month ago and Mom has been staying with her ever since. I've been trying to get her to let me give her some relief and share in the responsibility, but she has only just now agreed. So, I'll be staying with Granny for the next couple of days at least starting tomorrow evening. But Mama got wireless hooked up there so that I can work and talk to you all from her house and whatall, so that's cool.

Joani,

I am at Granny's now and just walked across the street to say hi and check on Uncle Jack and he said that he found that Neurontin and Gabapentin are the same, so he went ahead and started taking it yesterday. He's really grateful for your help and advice .

Thank you!!

Rice....glad your uncle is on the medication and I hope it helps.

Hope granny is doing OK. Your mom dropped her...Did she have surgery or was it considered a grade 1 that is not affected by weight -bearing. Not sure if granny is ambulatory or not.

Thanks, Joani... Yes, Granny had surgury. She has about a week to go until she goes back to the OS to see if she's cleared to put weight on it. Right now she can get around fairly well with a walker and is allowed to only go to and from bed and the ladies' room using her right tippy toe & walker. I don't weigh that much more than my mom... maybe 10-lbs, but it's much easier for me to pick her up since I am 8-in taller than my mom and 10-in taller than Granny.

Weird thing about Uncle Jack's leg... I put one hand on each of his legs... the one on the injured leg is MUCH cooler than the other... and this is consistent. WTH??

It is possible for the ablation to cause a temporary thermal injury to other nerves....this would account for the cool leg. I still think the ablation was not complete.

Neurontin is a wonder drug, Riceme. It was Neurontin that helped me so much back on 2000 when I was hurting so badly from that neuromuscular disease. Neurontin got me up and walking again.

Lyrica, a compound made from Neurontin, is a life saver for me now. I gained a lot of weight on Neurontin (60 pounds) that I still have not shed, but I haven't gained any more weight since I started Lyrica a year or so ago.

Do warn your uncle about weight gain. Neurontin can make a person insatiably hungry.