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  • THOUGHTS ❓facet rhizotomy ❓😨

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    Old 04-15-2016, 07:28 PM   #1
    frenchfri1003
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    THOUGHTS ❓facet rhizotomy ❓😨

    Has anyone ever tried facet rhizotomy , radio-frequency ablation and or radio-frequency neurotomy which are terms used interchangeably. All terms refer to a procedure that destroys the functionality of the nerve using radio-frequency energy. In this procedure, a heat lesion is created on certain nerves with the goal of interrupting the pain signals to the brain, thus eliminating pain. I have been dealing with various degrees of pain for so long and looking for a solution for the pain. If anyone has tried and had success I'd love to hear about the process.

     
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    Old 04-18-2016, 07:46 PM   #2
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    Re: THOUGHTS ❓facet rhizotomy ❓😨

    I've had this done twice to lumbar spine (no positive effect, probably due to not having facet issues at these levels) and 6-7 times to SI joint bilaterally (great response, though it would seem so due to having repeated it so often).

    My lumbar spine issues are due to sciatica, which isn't helped by RFA, obviously.

    SI joint issues are due to the auto-immune spondyloarthropathy. Definitely dealing with psoriatic arthritis and have a lot of overlap with ankylosing spondylitis. HLA-B27 positive, too. (On methotrexate, Mobic, Cimzia, gabapentin, oxycodone)

    Way back after getting referred to pain mgmt when my then-PCP didn't like to prescribe opiates, I had complained of low back and SI area pain, along with the plantar fasciitis that is very common in spondy patients and pain from a compression fx at T9. She tried an SI injection in the office without fluoro guidance. That got a couple of days of relief. I later asked if she would try the SI injection (steroid) again under fluoro guidance to see if that would help. She did so and I got about 2 weeks of relief. But she told me then that I was done getting steroid into the joint for another several months since she would only do it 3 times in a year. I knew that was a reasonable policy and resigned myself to more pain, though I was glad to know where the pain was coming from.

    On my next visit, I mentioned that the SI was still hurting a lot and she asked if I'd be willing to try something called RFA. By this time, I trusted her skills and decided to go along with it after doing a little reading about it.

    It's not easy like an epidural (not that an epidural is easy). The first time is probably the worst, due to there being no impairment to the sensory nerves that comes after having had it done before. But it's not horrendous, in my opinion. I had Fentanyl and Versed.

    My doc gave me those meds, then put a little Lidocaine into the area where she would be working, then inserted the probe that would be heating the nerve. She gave it a little test pulse to make sure it was next to the sensory nerve rather than the motor nerve, asking me what I felt. I felt pain like I had been feeling for weeks. Afterwards, she told me she would have felt twitching on the back of my leg had it been next to the motor nerve. On one of the later levels, I did feel the test as a twitch and said so. Hence the reason why you are not knocked out all the way. Communication. I usually remember all of the procedure, so she's not giving me a huge wad of either of them. I have very rarely asked for more, but she's usually on top of things and senses that I'm fidgeting and gives more without me having to say anything.

    Anyway, to do both sides of the SI joint, from L5 DPR, S1 down to S4, takes a little over 1.25 hrs on the table. On the very first time, I only had R side done, then the L side done 3 weeks later. Every other time, I've done it bilaterally in one visit. It's hard to get off work twice each time and I hate to recover more than once, though it was much worse on the first time for each side.

    As for the recovery--much worse on first time, though not a lot worse than the baseline pain I was dealing with on a daily basis. I iced it 4 times a day, put Voltaren gel on it 4x a day, took all my usual pain meds, rested as much as I could, took 2 FMLA days off work, walked around a bit in the driveway during good weather or in the house during bad weather. The worst was over in two days and working was just more uncomfortable for the first week afterwards. By the 3rd week after the procedure, I could tell that it was working. By two months afterwards, it was much improved. I usually get 5-9 months of relief from SI pain, with average of 6-7 months.

    I still get a few twinges of pain from R SI randomly during the time between procedures. My insurance only allows this twice a year at a minimum. I've scheduled it every 6-7 months because I don't like dealing with the pain if I can stop it somehow. When I was having it done early on, it was performed in the ambulatory procedure clinic at my hospital and ran about $10K to do bilateral SI. Other insurances would allow it to be done in the doc's office procedure room, meaning it cost a lot less than that. My insurance is a little weird about that, though. Now it's done at a surgery center and is a little less than the APC, but not that much.

    Since I've had it done so many times, it's not as painful to recover from. I still take 2 days off work to recover because I can. If it came that my lab manager (I'm a medical laboratory scientist) insisted that I had to be at work after one day off, I'd go ahead and work. The nerves grow back slowly and may actually have some permanent damage after all this, but they still grow back and cause me pain after 6 or so months. I read on one website that the nerves eventually don't grow back after having procedure enough times. Maybe that's true, but it didn't work that way for me.

    I don't know what sort of pain you are having, but if your doc is talking about this and your pain isn't well-controlled, this is worth trying out as long as your pain is from facet joints. Have you had the facet injections already? Some insurances require that facet injections have to be successful to have your RFA approved for a trial. But I've read that even if your facet injections didn't help, that doesn't mean your RFA won't help you. For me, it was a moot point since I was dealing with SI joint rather than lumbar facet joints. Let me know if you have some other questions. Good luck. (hope this wasn't too long.)

     
    Old 04-21-2016, 04:28 PM   #3
    frenchfri1003
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    Re: THOUGHTS ❓facet rhizotomy ❓😨

    Thank you for you informative and helpful information. Never too long. You have given me so much to think about. I'm not big on additional,pain but totally understand the need to be ale to communicate with the doctor. I remember the first epidural I received in the cervical area when they put the dye in to make sure they were in the right spot. The pain was far worse than childbirth. Thankfully it only lasted a short period of time. The pain I have in the cervical area is horrible. There are times I can not even wear a light scarf or a necklace. There are times even my hair on my neck bothers me. Pretty sad. I have lumber issues also along with RSD in my feet that swell and burn making walking hurt, sheets hitting them when I try to go to bed. Not sure how I am going to react. I am also not sure how many levels or if it will be one side or bilateral. It was mentioned along he spoke about a pulse method. I am going to have to do a bit more research and make another appointment to discuss it further. Thank you again for your insight .��

     
    Old 03-23-2017, 10:20 AM   #4
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    Re: THOUGHTS ❓facet rhizotomy ❓😨

    This is an old thread but yes! I had Rhizotomy 8 months ago and it's still helping! Success!

     
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    Old 03-25-2017, 03:53 PM   #5
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    Re: THOUGHTS ❓facet rhizotomy ❓😨

    WHere did you have tis done(neck or back)? Is this the same as the radiofrequency pulse of ablation?

     
    Old 03-25-2017, 03:57 PM   #6
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    Re: THOUGHTS ❓facet rhizotomy ❓😨

    Yes. I've had it done once and it was successful and I "got my life back". I had it done 7 months ago so am not sure yet how long it will last. I actually have another area that they will do the same procedure on April 20th and it can't come fast enough! Do the trials first to make sure you are a candidate it will work for. It was not painful but I did the icing as they proscribed.

     
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