Facet RFA (Radiofrequency Ablation) in Castle Rock

What is an RFA (Radiofrequency Ablation)?

Radiofrequency Ablation (RFA), also known as facet joint nerve ablation, radiofrequency neurotomy, or rhizotomy, is a minimally invasive procedure used to treat chronic neck, back, or knee pain. This procedure uses heat generated by radiofrequency energy to temporarily disable nerve signals, reducing pain and improving mobility.

How Does an RFA (Radiofrequency Ablation) Work?

During the procedure, a specialized needle with an electrode tip is inserted near small branches of nerves that provide pain sensation to joints. In the case of the spine, this most commonly involves medial branch nerves that supply the affected facet joints. Radiofrequency energy is then delivered to the targeted nerves, generating heat that interrupts their ability to transmit pain signals. By blocking these signals, RFA can provide long-lasting relief for patients with persistent neck or back pain.

What Conditions are Treated with an RFA (Radiofrequency Ablation)?

RFA is commonly used to treat chronic pain associated with facet joint arthritis of the neck and back, whiplash-related injuries, knee osteoarthritis, and persistent knee pain following knee replacement surgery.

How Should I Prepare for an RFA (Radiofrequency Ablation)?

Before your procedure, inform Dr. Carrera’s team about any medications you are taking, especially blood thinners and anti-inflammatory drugs, as you may need to stop them temporarily. If you are receiving IV sedation, avoid eating or drinking for several hours before the procedure.

It is advisable to arrange for someone to drive you home after the procedure, as mild soreness or temporary numbness in the treated area may occur. Dizziness is also common after neck procedures. Wear comfortable clothing to allow easy access to the treatment site.

Prior to the actual ablation procedure, Dr. Carrera will usually perform test injections on two separate days. These test injections involve administering a small amount of lidocaine (numbing agent) into the suspected pain source. These injections take only a few minutes and are typically done in-office. Pain from the test injections is usually rated between a 4 to 5 out of 10. These injections confirm that the correct area is being targeted and are required by insurance providers before proceeding with RFA.

What Happens During an RFA (Radiofrequency Ablation)?

The procedure is performed while the patient lies on a treatment table. The treatment area is cleaned with an antiseptic solution, and a local anesthetic is applied to numb the skin. Using fluoroscopic (X-ray) guidance, Dr. Carrera will insert a thin needle near the medial branch nerves. A small amount of electrical stimulation may be applied to confirm proper placement by assessing your motor responses.

Once correct positioning is verified, radiofrequency energy is delivered to the targeted nerves, generating controlled heat that disrupts their function. The entire procedure typically takes about 20 minutes.

How Painful is an RFA (Radiofrequency Ablation)?

Most patients report mild to moderate discomfort during the procedure. A local anesthetic is used to numb the area before the ablation process begins. Patients typically rate the pain from the procedure between a 4 to 6 out of 10, with brief moments that may reach a 7 out of 10. Dr. Carrera performs this procedure under IV awake sedation, which creates a relaxed, drowsy state. Patients often compare it to feeling like they have had a couple of margaritas. There is about a 50% chance that patients remember the procedure. Post-procedure soreness is common but usually resolves within a few days.

What Should I do After an RFA (Radiofrequency Ablation)?

Following the procedure, patients should avoid strenuous activities for at least 24 hours. Soreness at the treatment site is normal and can be managed with over-the-counter pain relievers and ice packs. Patients should gradually resume normal activities based on their level of comfort. Full pain relief may take up to two weeks.

When Will I Experience Pain Relief After an RFA (Radiofrequency Ablation)?

Pain relief can take one to two weeks, though in rare cases, it may take up to six weeks. It is normal to experience temporary discomfort for several days before significant relief occurs.

How Long Does an RFA (Radiofrequency Ablation) Provide Pain Relief?

The duration of pain relief varies among patients. Most experience benefits lasting between six months and two years. The procedure is successful in approximately 75% of cases, with success defined as at least six months of at least 50% pain relief. On average, pain relief lasts about eight months. Because the treated nerves typically regenerate over time, patients usually require repeat procedures for sustained relief. RFA can be repeated as often as every six months if needed.

What are the Risks of an RFA (Radiofrequency Ablation)?

While generally safe, RFA may have some side effects.

Common side effects include temporary discomfort or soreness at the injection site, mild swelling, and bruising. These effects usually resolve within a few days but can take up to two weeks to improve.

Unique common side effects for neck ablations include a mild sunburn sensation lasting a few days and a numb patch where you previously had neck pain, which can last several weeks.

Rare but serious risks include infection, nerve damage, and prolonged pain at the treatment site. There have been rare reports of weakness following ablations in the upper part of the neck. This is not a concern in lower back procedures.

How Often can I Get an RFA (Radiofrequency Ablation)?

Since the medial branch nerves can regenerate over time, most patients require repeat treatments. You can usually repeat an RFA as often as every six months. Most insurance providers require at least six months of at least 50% pain relief before approving another ablation, while some require at least three months of relief.

Does Insurance Cover an RFA (Radiofrequency Ablation)?

Most insurance plans, including Medicare, Medicaid, and most commercial insurers, cover RFA for neck or back pain if the patient meets certain medical criteria. These criteria typically include experiencing pain for at least three months and failing conservative treatments such as activity modification, physical therapy, and medications like Tylenol or NSAIDs. An MRI is often required before the procedure.

Insurance companies require that patients first undergo diagnostic test injections to confirm the targeted nerves are the source of pain. Additionally, insurers may require proof that other conservative treatments, such as physical therapy or medications, have been attempted before approving the procedure. Coverage policies vary, so it is important to check with your insurance provider to determine specific eligibility requirements and potential out-of-pocket costs.

Who can Perform an RFA (Radiofrequency Ablation) Procedure?

Radiofrequency ablation procedures are typically performed by interventional pain specialists or physical medicine and rehabilitation (PM&R) doctors. Dr. Carrera is double-board certified in both specialties, ensuring the highest level of expertise in performing RFA.

Dr. Carrera performs test injections in-office using very small needles, which significantly reduces costs for patients compared to having these injections done in a hospital or surgery center. Additionally, he performs the actual ablation procedure with IV awake sedation, ensuring a more comfortable experience for patients. Many patients report little to no memory of the procedure.

Dr. Carrera also uses Stryker Venom needles, specialized needles designed to better capture small nerves, significantly increasing the likelihood of dramatic pain relief. Most other doctors use cheaper needles. Utilizing these specialized needles comes at no additional cost to you. These high-quality tools improve accuracy and effectiveness, maximizing the success of the procedure.

Should I get an RFA (Radiofrequency Ablation)?

If you are experiencing chronic neck or back pain and are wondering if radiofrequency ablation is the right treatment for you, a consultation with Dr. Carrera and his team can help determine your eligibility. Patients in Castle Rock, Lone Tree, Highlands Ranch, Parker, Denver, and surrounding areas are encouraged to call the office at 720-455-3775 to schedule a visit and learn more.