Radiofrequency is a percutaneous, minimally invasive technique that under fluoroscopic or ultrasound guidance is indicated in the treatment of chronic pain through nerve neuromodulation.
The rationale for “continuous radiofrequency (RF)” with thermal injury is the change in pain resulting in a reduction of nociceptive input. “Continuous RF” in back pain or lumbago is indicated in the treatment of arthrosis pain of the nterapophyseal joint and/or sacroiliac joints.
Radiofrequency
On the other hand, “pulsed radiofrequency” sends short bursts of high intensity, not reaching damaging temperatures (42°) with neuromodulatory mechanisms related to the exposure of nerve tissue to a pulsing electric field and produces antalgic effects not attributable to thermal injury.
The main targets of ‘pulsed radiofrequency’ are the dorsal root ganglia of the spinal cord, which are affected in cases of herniated discs in lower limb radiculopathy, also known as lumbosciatica or sciatica.
“Pulsed radiofrequency” is also used in the treatment of chronic neuropathies/neuralgia, such as postherpetic nerve pain caused by the herpes zoster or diabetic neuropathy.
Dr. Giuliano Lo Bianco, a medical specialist in pain therapy, performs radiofrequency treatments in Palermo. The treatment is performed while the patient is awake, under local anaesthesia, with real-time X-ray guidance and produces no scar.
NEUROMODULATION WITH CRYOANALGESIA
In the therapeutic landscape of chronic pain, there is an innovative modern treatment known as cryoanalgesia that uses cold as an analgesic.
It is a minimally invasive technique that, unlike radiofrequency, does not damage the myelin sheath of nerves. It is indicated in all types of chronic peripheral neuropathies and for phantom limb pain.
Cryoneuromodulation is a micro-invasive procedure that is performed in the operating room under day surgery. After performing local anaesthesia, under X-ray and ultrasound guidance, a small needle to which a small tube is connected is introduced at the base of the nerve conveying liquid nitrogen at a temperature of -78°C, thus forming ice crystals that anaesthetise the source of pain by causing temporary cellular damage.
It is a highly efficient procedure as there is a reduction in pain that can last from 6 months to 2 years. It is a repeatable treatment and the patient can quickly resume his or her activities.
DENERVATION OR NEUROMODULATION OF SACROILIAC JOINT
Sacro-iliac pain is a pain that radiates in the lower back, at the height of the pelvis, and increases with movement, palpation, holding a sitting position for a long time, or in bending movements of the spine. This pain results from inflammation of the sacro-iliac joints (sacroiliitis), which are the contact point between the pelvis and the spine.
There are several minimally invasive techniques to resort to, one of the most common being DENERVATION, the interruption of the nerve pathways that transmit pain.
The purpose of radiofrequency thermolesion of the sacroiliac joint is to partially and temporarily interrupt the sensory innervation of the joint, increasing the duration of the benefit obtained with the infiltrative treatment and avoiding the cumulative effect of repeated cortisone administrations.
It is a percutaneous technique that, under radio- or ultrasound-guidance and local anaesthesia, involves the introduction of a needle at the nerve branches that are subjected to stimulation with electrical impulses, not perceived by the patient, which aim to neuromodulate pain conduction. The procedure, performed in day surgery, is performed in the operating room, is free of adverse effects and can lead to lasting benefit with disappearance or reduction of pain symptoms for several months.
CASE STUDY PULSED GANGLIONIC RADIOFREQUENCY
Valentina, 35 years old, suffers from lumbar back pain with irradiation to the right lower limb; despite medication, she experiences difficulty walking due to severe pain that irradiates to the sciatic nerve, and is forced to use crutches. Valentina has already received other types of back infiltrations, without any benefit. So, after an online search, she decided to undergo an examination at Dr. Lo Bianco’s office in Palermo to investigate the cause of her problem and find out whether her lumbosciatica stems from a herniated disc. During the visit, the evaluation of diagnostic tests, radiological images (lumbosacral magnetic resonance imaging) and objective examination showed that the problem was caused by a herniated L4-5 and L5-S1 disc. Thanks to pulsed radiofrequency treatment of the right L4 and L5 ganglion, Valentina no longer suffers from back pain and has even resumed playing sports.
“I was afraid of surgery, Dr. Lo Bianco, with his professionalism and experience, managed to identify the source of my problem and solve it in a definitive and minimally invasive way. I was pleasantly impressed by the high-tech procedures used at Dr Lo Bianco’s practice, I don’t think I could have found a better way to solve my problem!” Valentina
CASE STUDY CONTINUOUS RADIO FREQUENCY
Antonio, 69, a former Greco-Roman wrestling champion, came to Dr. Lo Bianco’s office after years of severe lower back pain, exacerbated by flexion-extension movements of the spine. After viewing lumbosacral magnetic resonance images and a thorough clinical evaluation of the pain symptoms, Dr. Lo Bianco identified the cause of the pain as an arthrotic pathology of the interapophyseal joints of L3/4 and L4/5 called ‘facet joint syndrome’. Antonio underwent two infiltrations, for diagnostic purposes, to identify the target to be treated; then, continuous radiofrequency treatment was performed as a day-surgery. The technique, which is minimally invasive and percutaneous, through a thermal lesion with a change in pain signal conduction determines a reduction in chronic pain. The radiofrequency is performed with the patient awake, under local anaesthesia, with real-time X-ray guidance and does not produce any scarring.
“I had a really crippling back pain, Doctor Lo Bianco was the only doctor who was able to offer me a valid alternative that solved my problem. Thanks to him, I even started training again. I can’t thank him enough.” Antonio