Radio Frequency Techniques In Pain administration

Radio Frequency Techniques In Pain administration

Different radio frequency lesioning procedures are proving invaluable in pain administration day by day. It is the best form of rehabilitation for trigeminal neuralgia, different cancer pain and different kinds of spinal pain including low back pain and neck pain.

Radio Frequency (Rf) lesioning involves duct of a very high frequency current straight through a 27 G thermocouple probe. This probe is passed straight through a 20/22G cannula (a kind of needle), which is insulated except at its tip. When a high frequency alternating current is passed (at 300 kHz) straight through the Rf thermocouple probe the charged ions in the human tissue around the exposed tip of Rf cannula moves to & fro. This produces electro-mechanical friction heat is generated. The thermocouple probe is not heated itself, it in effect dissipates the heat generated at the surrounded tissue. Thus the heat is totally controlled by the operator. The lesion generated is shaped like a matchstick head with a diameter of 2-4mm. Beyond this distance; electrical field is weaker as it is dispersed, so no lesion is produced.

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The temperature & therefore the heat lesion is maximum around the shaft and minimum at its tip. On the other hand the electrical field generated is maximum at its tip and minimum around the shaft. In the approved Rf rhizotomy type we are producing heat lesion. In the pulsed Rf electrical field is producing the lesion. In pulsed Rf temperature is not raised beyond 42-degree C. Electrical field produces some punch in the capacitor of small diameter nociceptive (pain transmitting) fibers. Thereby signal transmission straight through this fibre is stopped.

In the approved type the nerves are regenerated in time to come & mean pain-free period varies for type of nerve. In a properly performed lesion pain free period is 3-4 years. In the pulsed Rf the mean pain free period is 4-24 months.

The approved Rf rhizotomy is done at sympathetic ganglions, and at purely/ predominantly sensory nerves. It is all the time avoided in mixed or predominantly motor nerves. Before doing actual lesioning radiological and electrical tests are done to keep the probe away from these nerves in approved Rf lesioning. The commonly performed approved Rf rhizotomy procedures are at following nerves.

1. Trigeminal (Gasserian) ganglion and its divisions i.e. Mandibular nerve & maxillary nerve.

2. Stellate ganglion

3. Cervical facet joint medial branch

4. Thoracic facet joint medial branch

5. Splanchnic nerves

6. Lumber sympathetic plexus

7. Superior Hypogastric plexus

8. Lumber facet joint medial branch

9. Sacro-Iliac joint supplying nerves

In Pulsed Rf as there is no heat lesioning it is safe to perform it in most kinds of nerves. It is mostly effective in nerve ganglions but also effective trunks. It may be performed in all the above procedures except trigeminal ganglion. It is in general indicated in Dorsal root ganglionostomy. It is also done in mixed peripheral nerves like suprascapular nerve.

Radio Frequency Techniques In Pain administration

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