• Reference Number: HEY-676/2023
• Departments: Pain Medicine
• Last Updated: 29 September 2023

Introduction

This leaflet has been produced to give you general information on your treatment. Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion.  If after reading it you have any concerns or require any further explanation, please discuss this with a member of the healthcare team.

What is thermal radiofrequency treatment/denervation?

A denervation is a procedure that aims to temporarily stop a nerve transmitting pain signals. The nerve is heated with an electrical current delivered from a special device called a Radio-Frequency Lesion generator.

This treatment is usually given when other treatments such as facet joint injections have been effective for a short period of time and is usually performed to manage Back pain and Neck pain.

Why do I need thermal radiofrequency treatment/denervation?

This treatment can be effective in the management of chronic pain.

Can there be any side effects or risks?

Some patients experience mild local tenderness at the site of the injection. This usually settles over the next few days following the injection.  Very rarely, the local anaesthetic may spread causing some numbness in your legs and other areas. This is temporary and will resolve.

Advice to read before having a pain relief procedure

The following information has been produced to ensure that you are able to have your pain relief procedure. It is essential that you read and follow the advice given below before you come to the hospital. If you do not follow the advice you may not be able to have your treatment.

Please contact the Pain Service if any of the following apply to you:

• If you are diabetic and take medication to control your diabetes. (See below on how to manage treatment sessions booked for the morning or the afternoon.)
• You have recently had an admission to hospital.
• You have tested positive for MRSA.
• You have an infection and are currently taking antibiotics.
• If there is any possibility you may be pregnant.

Continue your other regular medications including your pain relief. If you take any of the anticoagulants listed below, please notify the Pain Clinic at least 10 days before your appointment. You will need to stop taking these drugs at least 1 week prior to the procedure unless your doctor has advised against this.

• Warfarin (Marevan).
• Clopidogrel (Plavix).
• Dipyridamole (Persantin Retard).
• Phenindione.
• Pradaxa.
• Xarelto.
• Sinthrome.
• Asasantin Retard.

You may have to wait a while before your procedure, so please bring something to read or keep yourself occupied.

Please leave any valuables or jewellery at home. It is essential that after the procedure you arrange for an adult friend or relative to collect you by car or taxi. You will not be able to use the bus or train to travel home.

Hospital transport may be available if there is a medical need. If you think you may be eligible, please contact the Pain Service.

Sometimes radiofrequency lesioning is done under sedation (a drug is given to make you drowsy and relaxed but still conscious). You should not have anything to eat on the morning of your treatment, however you may have a drink (tea or coffee without milk) if you wish up to 2 hours before your appointment time.

Advice for diabetic patients only

If you are diabetic and booked to attend treatment in the morning, you should not have breakfast or morning medication but bring the drugs with you.

If you are booked for treatment in the afternoon please have your breakfast and take regular medications before 7.00am. Thereafter only drink clear fluids (not milk) for up to 2 hours before the procedure. Please inform the Pain Service staff as soon as you arrive that you are diabetic. The staff will then assess your diabetes and if necessary, take appropriate action to monitor and control your blood sugar while you are in our care.

What happens before the procedure?

You will be admitted by the nursing staff; they will ask for and record some information about you. Your blood pressure will be checked and you will be given a gown to put on. The doctor will explain the procedure and ask you to sign a consent form. Please make sure you have understood what has been said and feel free to ask any questions.

What to expect during the procedure

As a precautionary measure, a thin plastic tube (cannula) may be inserted into a vein in your arm or hand. A self-adhesive foil plate will be placed on your thigh. This is connected to the radio-frequency machine to make an electrical circuit.  After cleaning your back with antiseptic solution, local anaesthetic will be injected into your skin to numb it.

The procedure will be carried out under x-ray screening. A special hollow needle is inserted into the site of injection and a very thin wire is then threaded down inside the needle and attached at the other end to the machine. You will be asked to say when you can feel a tingling or twitching sensation as the doctor tests the machine on different settings. This is very important as it makes sure the tip of the needle is in exactly the right place.

The machine settings will then be set to destroy the nerve by heating it for a minute. You should not feel anything. This process may be repeated at different pain sites, if necessary.

What happens after the procedure?

You will be taken on a trolley to the recovery area where the nurse will check your blood pressure and pulse. You will be asked to rest for about an hour. After that you will be able to get up, but please check with the nurse before you do so.  Once you are mobile you will able to go home, accompanied by an adult friend or relative.

Please ensure that you have arranged for someone to drive you home after this procedure. Failure to do so will result in your procedure being cancelled. If you have had sedation, we recommend that you arrange for someone to stay with you overnight and that you do not drive for 24 hours.

What to expect when you return home

Take it gently for a few days but gradually build up your activities. You should continue to take all your usual medication / pain relief as the pain may be slightly worse until the treatment you have had starts to work.

Some people find that they get relief from their pain but, after a couple of months this wears off. Others may experience complete relief. However there is a chance that the pain will not improve, not change or will get worse.

During the pain-free period you should try to gently increase your exercise. Simple activities like a daily walk, using an exercise bike or swimming on your back will help to improve your muscle tone and strengthen your back. The best way is to increase your activity slowly.  Try not to overdo things on a good day as this may result in you experiencing more pain the following day.

How long will the pain relief last?

This is highly variable between individuals. Some might notice immediate pain relief where in others it may take up to 1 – 2 weeks. However, pain relief may last from a few days to several months. Some patients do not get any pain relief from radiofrequency lesioning.

Follow up

A letter will be sent to your doctor and you will be reviewed either by telephone or seen at the Pain Service in due course.

Points to remember

• You need to arrange for someone to drive you home after this procedure.
• Please bring your glasses if you need them for reading.
• Always bring a list of all current medication.
• Continue taking all your usual medication on treatment day.
• If there is any possibility you may be pregnant please inform the doctor or nurse.

Additional information

If you experience unusual symptoms such as a marked increase in pain/swelling around an injection site, fever, severe headache, new symptoms of pins and needles, new muscle weakness in your arms, or you are very concerned about how you feel after the procedure, please contact your doctor.

In the event of an emergency and outside normal working hours (9.00am – 4.00pm) of the Pain Clinic please contact your own doctor, Local Walk in Clinic / Minor Injuries Unit

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Pain Service, Outpatients Department, East Riding Community Hospital, Beverley Pain Service (01482) 478868

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.