Can Radiofrequency Rhizotomy Reduce Neck and Back Pain?

Question: I've had chronic back and neck pain for some time. I've been diagnosed with degenerative disc disease, a bulging disc, and bone spurs in my neck. I've had epidural steroid injections, physical therapy, and massage. My doctor now wants to try a nerve block for my lower back. He explained to me that it will narrow the problem down, and then he can burn the nerves using radiofrequency rhizotomy. Is this temporary? Do the nerves grow back?
—San Jose, CA

Older man trying to get up with a cane, having a very painful expressionAnswer: Chronic neck and back pain are extremely common, but how you treat chronic pain can vary greatly. Nerve blocks and radiofrequency rhizotomy are just 2 treatment options on the neck and back pain treatment spectrum.

Numerous factors play a role in your symptoms: Degenerative disc disease, bulging discs, and bone spurs (called osteophytes) can certainly all cause pain. It sounds like the majority of your symptoms are neck-related. And although you can also have spinal stenosis and pinching of the nerves in your neck, I don't think this is what's happening in your case.

Most patients with your symptoms find pain relief with physical therapy, massage, epidural steroid injections, and medications. However, that doesn't mean that they work for everyone. Also remember, we all experience pain a little differently, which means that you—as with many other people with chronic neck and back pain—may need something more than these treatment options.

As you mentioned, you've already tried less invasive treatments, such as physical therapy. But because those treatments didn't work for you, your doctor recommended a nerve block and radiofrequency rhizotomy as the next step.

Many patients find pain relief with nerve blocks and radiofrequency rhizotomy, but as with other interventional pain management treatments, they don't work for everyone.

Nerve blocks are medication injections onto or near the nerves. Common medications that get injected are local anesthetics and steroids.

Below are some of the most common reasons nerve blocks are used.

  • Provide diagnostic information to help identify the source of your pain and other symptoms—this is what your doctor is trying to do with the nerve block he wants to try. He wants to figure out exactly which nerve it is that's causing the problem.
  • Control acute pain
  • Provide periods of pain relief by making nerve paths less sensitive

If your doctor finds that a trial nerve block injection helps reduce your pain temporarily, then he or she may use radiofrequency rhizotomy (also called radiofrequency ablation), which is a technique that involves deadening small nerves (called the medial branch) that give sensation to the joint.

If these small nerves are being compressed (pinched) by the facet joints, then they will send pain signals to the brain. By deadening them, the pain signals can't be sent.

Facet joints can also cause pain due to other spine conditions, such as arthritis. This procedure can help decrease those painful sensations.

Here's how radiofrequency rhizotomy works: During the procedure, a cannula (a small tube) and a needle are inserted into the area of the facet joints in the neck or low back, depending on the location of your pain. A small current of electricity produced by a radio wave is used to heat the nerve tissue. This kills the small nerves that provide sensation to the joint, decreasing pain signals from that area.

With radiofrequency rhizotomy, there is a possibility that the nerves will grow back. If that happens, it can occur within 6 to 12 months of the procedure. But for most patients, radiofrequency rhizotomy lasts longer than a medication injection or a nerve block.

Although it can be tricky to treat chronic neck and back pain, you may find pain relief with a nerve block and radiofrequency rhizotomy. These treatment options can help you manage your pain and allow you to increase your daily activities.