I’ve been a little quiet, and the reason is that I am recovering from my second cervical facet radiofrequency ablation (RFA). The procedure is one that I first had at the Michigan Headache and Neurological Institute (MHNI) after doctors there discovered that I have early degeneration in my neck related to my Ehlers-Danlos Syndrome that is causing pain that refers to my head (frequently called cervicogenic headache) and contributes to my migraines. After my first RFA (C2-C5) I had a reduction in my pain lasted about 7 months. This time frame is pretty typical for the sort of relief an RFA is expected to provide as eventually the nerves regenerate. Since I’ve now had two (very different) experiences with RFA, I thought I would share some about the procedure it’s self and my experiences with it.
RFA is the process of using a heated needle to burn away affected nerves (in this case in the neck) under the guidance of flouroscopy (live XRAY). During my first RFA, the procedure was done under light anesthesia and in a hospital setting. As such I don’t remember much of the actual procedure. My second and most recent RFA was done in the office of my pain doctor with only local anesthesia (lidocaine). I won’t lie I was a little nervous about going without the general anesthesia, but in the end it went really well.
In both cases, the use of a local was the first step, and as usual, it stings and is somewhat uncomfortable while spreading but does not cause significant pain (at least for me). I (and many others with EDS) find that I need more local than most people, but I am lucky that once I started communicating that to my doctors, locals began to work better for me. After the local has time to set in, the doctor uses XRAY guidance to position the radiofrequency needle, which without the general anesthesia is painful, but for me was not intolerable. My pain doctor simply explained that it just has to be positioned too deeply for local anesthetic to help with that part. Next, the doctor tests the position of the needle by passing an electrical current through it and watching for the patient’s response. The patient usually experiences a reproduction of their typical pain, and may experience muscles “jumping” in their neck or back. My doctor wanted to make sure that my arm muscles were not affected. This part actually made me laugh – its a bit like having a muscle spasm that your doctor planned (and resolves just as quickly). The pain that was created was the kind I am used to dealing with, so again it wasn’t intolerable. Once he was sure he was in the right area, the doctor warmed the needle, and while I could feel the heat it did not burn me.
I have to wonder if having me awake and responsive increased the accuracy of the procedure, because after my first RFA I experienced terrible burning nerve pain for a few weeks (hence my hesitancy to write about it). Once the torture ended though, I did get some relief, as I mentioned above (which should be obvious since I was willing to try it again). This time around, I am about a week and a half out from my cervical facet RFA with my local pain Dr. I would have to say that he did an excellent job because while I experienced normal soreness expected after having a surgical procedure in a tender area, I did not experience the burning nerve pain that I had after my first RFA. I am hoping that as I continue to heal I will begin to see a similar benefit as I experienced the last time and will have some months with dampened pain levels. Lower pain means more living, and for that I am always grateful.