Nonsurgical Remedy

For delivering long-term relief from arthritic joint pain.

Low-back pain first introduced itself to Walter* in 2009. Starting quite suddenly, without an instigating injury, it soon became his constant companion and further aggravated him by traveling down his left leg to the back of his knee.

Dr. Sunil Panchal of National Institute of Pain, which has locations in Lutz and Riverview, discusses a long-term treatment for pain called radiofrequency ablation.

After radiofrequency ablation, people can get back to their active lifestyles.

Walter’s pain switched from dull and achy to sharp and piercing depending on his position. It increased when he stood or walked and let up whenever he sat or lay down. His doctor prescribed physical therapy, but that made matters worse, the therapy only intensifying his already disabling pain.

At that point, Walter’s doctor believed his patient would benefit from treatment by a pain management specialist. He recommended Sunil Panchal, MD, a board-certified interventional pain specialist. Dr. Panchal is president and medical director of National Institute of Pain, which has centers in Lutz and Riverview.

“People such as Walter tend to use the term sciatica when talking about their back issues, particularly when the pain radiates into some area of the leg,” notes Dr. Panchal. “That’s not very specific. The pain could be going to the buttocks or hip, or down to the knee or ankle. Patients use that term very broadly.

“As specialists, however, we try to be more specific and look at the pattern of the pain. There are certain patterns associated with the joints and other patterns associated with pinched nerves. Walter’s pattern of pain radiating from his lower back down to his knee is a classic pattern associated with arthritic spinal joints.”

From Walter’s description, Dr. Panchal suspected the arthritis could be found in Walter’s facet joints and sacroiliac (SI) joints. Facet joints are the small, stabilizing joints located between the spine’s vertebrae that connect the vertebrae to each other. The SI joints connect the spine to the pelvis. Their job is to absorb the shock that builds between the upper body and the pelvis and legs.

“To confirm this diagnosis, I performed an x-ray-guided injection of a local anesthetic to temporarily numb the joints,” states Dr. Panchal. “Walter got excellent relief when we numbed the facet and SI joints. He got ninety percent relief, so that confirmed that those joints were involved.

“After that, we tried treating his pain by injecting those joints with steroids, a powerful anti-inflammatory medication. This approach does not make the joints numb, so he achieved less relief than with the local anesthetic, approximately forty to fifty percent relief.”

Dr. Panchal notes that steroids are a short-term treatment anyway. They stay in the body for a maximum of two weeks. Walter had relief from the steroid injection for about five days. Dr. Panchal then selected a longer-lasting option for his patient in pain.

Getting to the Source

After having limited success with steroid injections, Dr. Panchal decided he could provide Walter with long-term relief using a nonsurgical procedure called radiofrequency denervation or ablation. During this procedure, done under fluoroscopy (continuous x-ray) guidance, the doctor uses radiofrequency energy to deactivate the nerve endings in the joints, which relieves the pain.

“During this procedure, we use an insulated needle,” describes Dr. Panchal. “We place an electrode through the needle, and that electrode measures the temperature at the tip of the needle. It automatically adjusts the radiofrequency energy output to maintain the heat settings we’ve programmed into the equipment ahead of time.

“Using radiofrequency energy is much more precise than using a laser. If I leave the laser on an area an extra second or two, it’ll deactivate a large area. With the radiofrequency generator, I have complete control of the temperature, so there’s a predictable area that I’m heating. Because it’s much more precise in terms of control, it’s safer than using a laser.”

The heat from the radiofrequency energy cauterizes the nerve endings in the treated joints, which are the source of the patient’s pain. As a result, patients achieve pain relief for a longer period of time than with an injection of local anesthetic. Inflammation is also reduced with ablation, and it lasts longer than a steroid treatment.

Radiofrequency ablation is a good treatment option for pain from the facet and SI joints, but it can be used to treat pain from other joints as well.

“Many people have pain in the neck radiating to the head or out to the shoulder blade area,” observes Dr. Panchal. “These people might get diagnosed with headaches or migraines, but the pain is actually coming from the facet joints in the cervical spine. Those structures can be treated with radiofrequency ablation.

“Patients with problems in their thoracic facet joints will get mid-back pain. Patients may also get pain from their hip and knee joints. The nerve fibers in those joints can also be treated with the same technology. It provides relief with a nonsurgical approach.”

Lasting Relief

Radiofrequency ablation cauterizes the nerve endings in the facet and SI joints, so relief lasts until the nerve endings grow back again, which takes a long time to occur.

“Research on this procedure only followed patients for a year, so I give my patients a conservative estimate of how long their relief will last,” relates Dr. Panchal. “I tell them we have data suggesting the procedure should give them relief for about a year.

“However, I’ve had a significant percentage of patients who have gotten relief for two to three years or even longer. I also have personal experience with approximately forty people who have gone six or seven years pain free.”

Dr. Panchal initially performed a radiofrequency ablation procedure on Walter’s facet and SI joints in 2010. The result was complete relief of his pain, which in his case lasted for a full seven years. Last October, however, he began to experience some of his symptoms again and returned to National Institute of Pain.

“Walter told me his symptoms were just as they were before, and the physical exam confirmed that the pain was in the same location as before,” reports Dr. Panchal. “We decided to repeat the radiofrequency treatment, but this time only on his left facet and SI joints. He experienced the same response – one hundred percent relief.”

Another benefit of the radiofrequency ablation procedure is that it stands as a viable alternative to opioid medications for people in serious pain.

“The treatment’s long-term relief is especially beneficial in our society, where people are concerned about opioid addiction,” comments Dr. Panchal. “In my twenty years of experience with the treatment, I’ve found the procedure can reduce or eliminate the need for medications.

“This procedure is an injection. It’s not surgery, even though we may perform it at a surgery center, where the equipment is located,” stresses the doctor. “Radiofrequency ablation is a simple, short, outpatient treatment that gives prolonged results in terms of pain relief and improved function.”

*Patient’s name withheld at their request.
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    • National Institute of Pain

      We treat each patient individually, using the latest equipment and various innovative procedures to diagnose pain and determine your care needs. We then assemble the appropriate interdisciplinary team of health care professionals who can best... Read More

    • Sunil J. Panchal, MD

      Sunil J. Panchal, MD, is board certified by the American Board of Anesthesiology in interventional pain medicine. He earned his Bachelor’s degree in Biology from Rensselaer Polytechnic Institute in Troy, NY, and earned his medical degree from... Read More