Nerve Block และ Radiofrequency Ablation (RFA) กับการรักษาอาการปวดกล้ามเนื้อ กระดูก และเส้นประสาท

One of the common health problems among working-age adults and the elderly is back pain, which can arise from various causes such as muscle inflammation, spinal joint inflammation, herniated discs pressing on nerves, or disc inflammation. Each case results in different types of pain symptoms. Many people avoid seeing a doctor or think it is just general back pain, or even after the cause is identified, they may not be ready for surgery. Fortunately, nowadays there are treatment options to relieve pain without surgery, namely Nerve Block and Radiofrequency Ablation (RFA).
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<h2>Functions and Importance of the Spine</h2>
The spine is a long, continuous bone structure extending from the base of the skull, starting from the cervical, thoracic, lumbar, sacral vertebrae down to the coccyx. It supports body weight and allows flexible movement such as bending, stretching, or twisting, with intervertebral discs helping to absorb shocks.
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The spine also protects the spinal cord, a crucial part of the central nervous system. The spinal nerves are located within the spinal canal and serve as pathways for nerve signals between the brain and the body.
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If the spine is injured or damaged, it can affect the function of the spinal cord and nervous system, leading to pain or paralysis.
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<h2>What Causes Back Pain?</h2>
Back pain can generally be divided into two main categories: caused by muscle abnormalities, such as tightness or pain from overuse or maintaining improper posture for long periods in daily life, muscle inflammation from heavy use, injuries from trauma or repetitive strain, or stress-related causes.
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The other category is pain caused by the nervous system and spine, such as degenerative or herniated discs pressing on nerves, spinal joint inflammation causing bone spurs, spinal canal stenosis compressing nerves, scoliosis or spinal deformities, osteoporosis leading to fragile bones and fractures, tumors pressing on the spine, or infections in the spine. All these affect the spinal nervous system, causing back pain.
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Back pain accompanied by numbness, weakness, or radiating pain to the legs or arms is often related to the spinal nervous system. Diagnosis requires physical examination and additional tests such as X-rays, MRI, or CT scans, as well as Nerve Blocks and Radiofrequency Ablation (RFA) for diagnosing lesions and treating pain. These techniques help locate pain points and provide effective treatment, reducing patient pain.
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<h2>What Are Nerve Blocks and Radiofrequency Ablation (RFA)?</h2>
Nerve Blocks and Radiofrequency Ablation (RFA) are diagnostic and treatment methods for pain without major procedures or surgery, used to manage acute and chronic pain. They can be applied to two types of pain:
<ol>
<li>Nociceptive pain refers to pain caused by tissue damage, resulting in localized back pain or post-surgical pain due to tissue injury, including knee, hip, shoulder joint pain, and muscle pain.</li>
<li>Neuropathic pain is pain caused by nerve damage, with symptoms varying by location and cause, such as:</li>
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<li style="list-style-type: none;">
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<li>Radiculopathy is pain caused by compression or irritation of spinal nerve roots, often due to spinal bones or discs pressing on nerves, causing pain, numbness, weakness, or tingling in the affected nerve area.</li>
<li>Trigeminal Neuralgia is a condition caused by compression or irritation of the trigeminal nerve, which controls facial sensation, resulting in sudden, severe facial pain that occurs in episodes or during activities like talking, chewing, washing the face, or touching the face.</li>
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</li>
</ul>
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<h2>Pain Treatment with Nerve Blocks and Radiofrequency Ablation (RFA) Without Surgery</h2>
Nerve Blocks and Radiofrequency Ablation (RFA) are medical techniques used to treat chronic pain related to nerves by reducing pain sensation through blocking nerve signals that cause pain in the nervous system, muscles, and bones. They are often used when other treatments are insufficient or when rapid pain relief is needed, and are options for patients who do not want surgery. The two methods differ in details as follows:
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1. Nerve Blocks or Local Anesthetic Injection into Nerves
Nerve Blocks involve injecting local anesthetics (and sometimes steroid anti-inflammatory drugs) into nerves to temporarily relieve localized pain by stopping pain signals to the brain. Local anesthetics provide short-term pain relief, while steroids can extend relief for 2-3 months depending on the type of block. Benefits of Nerve Blocks include:
<ul>
<li>Reducing or temporarily relieving localized pain, especially from inflammation of joints, spinal joints, or herniated discs pressing on nerves.</li>
<li>Treating lower back pain, neck pain, chronic back pain, arthritis pain, and degenerative disc disease.</li>
<li>Helping diagnose or identify the painful nerve location; if pain significantly decreases after nerve block injection, the targeted nerve is likely the pain source.</li>
<li>Sometimes used as short-term treatment or as a step before RFA to confirm that the pain originates from a specific nerve.</li>
<li>May be considered for patients with chronic headaches and facial pain with trigger points suspected to be migraine, cluster headaches, trigeminal autonomic cephalalgias, trigeminal neuralgia, or cervicogenic headaches, when X-rays, MRI, or CT scans do not clearly identify the cause.</li>
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2. Radiofrequency Ablation (RFA) or Partial Nerve Tissue Destruction Using High-Frequency Radio Waves
RFA is also a non-surgical method where a high-frequency radio wave generates heat at the tip of a needle inserted near the nerve causing pain. The heat destroys part of the nerve tissue, stopping pain signals to the brain for several months or years. It is a good option for chronic pain patients unresponsive to other treatments, providing longer-lasting relief than Nerve Blocks. It is suitable for patients who respond well to Nerve Blocks but need longer-lasting treatment. RFA is performed for the following purposes:
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<li>Treating chronic pain related to joints and spine or nerves unresponsive to other treatments, such as pain from degenerative spine conditions, facet joint pain, or degenerative discs causing chronic back or neck pain.</li>
<li>Treating nerve-related pain conditions such as postherpetic neuralgia (pain after shingles) or trigeminal neuralgia (facial nerve pain).</li>
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RFA may not directly diagnose or locate pain points, but doctors may use nerve blocks to confirm the diagnosis. If nerve blocks are effective, RFA may be considered as a treatment option.
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<h2>Conventional and Pulsed Radiofrequency Ablation (RFA)</h2>
Pain treatment by partial nerve tissue destruction using high-frequency radio waves (RFA) is divided into two types based on treatment goals:
<ul>
<li>Conventional RFA uses heat at 80-90°C to permanently destroy nerve tissue. Doctors use this to destroy nerves supplying joints permanently, often before surgery.</li>
<li>Pulsed RFA delivers heat in short bursts at 42-45°C. This method does not permanently damage nerves but reduces pain signal transmission while preserving nerve function. It is used when nerve function preservation is desired, such as treating trigeminal nerve pain (main nerve for facial sensation) or Complex Regional Pain Syndrome (CRPS), which involves severe, chronic pain from injury, often in hands, legs, or arms, with symptoms like swelling, skin color changes, and temperature changes.</li>
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In summary, &#8220;Nerve Blocks&#8221; and &#8220;Radiofrequency Ablation&#8221; (RFA) are useful for identifying pain sources and relieving or treating both acute and chronic pain. They are treatment options for patients not ready for surgery or when other treatments have failed. The choice between these two methods depends on symptoms and disease severity, with neurosurgical specialists collaborating with patients to achieve the best, safest, and most appropriate treatment outcomes.
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Dr. Ekaphot Jitpan
Neurosurgeon and Spinal Surgeon
Phyathai 1 Hospital

Nerve Blocks and Radiofrequency Ablation (RFA) are options for treating back pain and herniated discs compressing nerves without surgery.

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Nerve Block and Radiofrequency Ablation (RFA) for the Treatment of Muscle, Bone, and Nerve Pain

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