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Ablation May Offer Relief from Chronic Back Pain

NEW YORK (May 1, 2012)

Neel Mehta, M.D. and Michael L. Weinberger, M.D.
Neel Mehta, M.D., and Michael L. Weinberger,
M.D., are pain medicine specialists at NYP.

People with back pain and other chronic pain conditions who do not experience relief from medications, physical therapy, or chiropractic care may feel like there is no hope. However, a procedure called nerve ablation may offer another option. Ablation is a technique that quiets the nerves responsible for transmitting pain messages from the affected area to the brain, where they are processed and become palpable.

Doctors use ablation most often for two types of back pain: pain originating from the facet joints (the joints that connect the spine's vertebrae) and pain originating from the sacroiliac joint (the joint that connects the spine to the hip). There are other cases where doctors may utilize ablation as well such as pelvic pain, nerves affected by trauma or surgery, or pain caused by cancer and cancer-related treatment.

How Ablation Works:

Most ablation procedures are done using radiofrequency ablation. After numbing the skin, doctors use fluoroscopy (a technique that provides real-time x-ray images) to guide a probe to the nerve(s) where the pain is suspected of originating. Next, they perform a nerve stimulation test to ensure they've located the correct nerve(s) and that dampening it/them won't affect other bodily functions, explained Neel Mehta, M.D., the Director of Outpatient Medicine at the Pain Medicine Center at NewYork-Presbyterian/Weill Cornell Medical Center. When switched "on," the probe emits radiofrequencies that create a small pinpoint of intense heat. With this heat, doctors carefully dampen the nerve's ability to transmit pain signals.

However, as with medication, the pain relief is not, unfortunately, permanent. "Pain relief from this ablation typically lasts from three or four months to up to 12 months, said Michael L. Weinberger, M.D., an Associate Attending Anesthesiologist in the Department of Anesthesiology at NewYork-Presbyterian/Columbia University Medical Center. "Nerves can regenerate after a year," said Dr. Mehta, explaining the reason why the effects of nerve ablation wear off, "but the procedure can be repeated."

Other types of ablation utilize cold (cyroablation), alcohol, or phenol to disrupt nerve transmission. The latter two techniques are reserved for patients with more life threatening conditions, such as late-stage cancer. In general, "the aggressiveness of the technique varies based on disease and what other treatments are available," Dr. Weinberger said.

Talk With Your Doctor First

It is important to talk with your physician to determine if this procedure is right for you. Typically, ablation is used after other more conservative treatments are tried. The procedure is not recommended for people with active infections or bleeding problems or for pregnant women. Dr. Weinberger noted that ablation is typically not suggested for patients with postherpetic neuralgia – pain caused by shingles.

For those who choose ablation: it is an outpatient procedure that typically takes about an hour. It is not painful and most people only experience a minor discomfort at the site of the procedure for up to three weeks during the healing process.

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