People With Success W/New Pulsed Low Radiofrequency Ablation

[saint]

PN after compression fracture of L1 L2, 2008. Years of burning pain. Recent help with RF Ablation - covered by insurance. Florida. - ONLY 25% of the pain I had prior to ablation I had presently. It was important to have 3 treatments to knock the pain down

So yours were successful Vicky? Can I ask how you're doing now?

[saint]

JJ11,

"...but I experienced a flare up after a few months following each."

RU saying that the relief only lasted a month?

I had this performed on me at Stanford... gosh, must be 10 years ago now.
It did absolutely nothing for me.
I was very disappointed it didn't help me at all. I mean zilch. Nada.

But I have to wonder if they really hit my pudendal nerve. The doctor told me, 'let me know when you feel it in your testicle' (this is my major point of pain).
I never felt it in my testicle as it was moved around.
And I think they became a little nervous because the room was probably booked and we had to get out of there.
So, my belief is that he just turned the thing on even though it probably wasn't exactly where it should have been (if it's so important to feel it in my testicle).

But my PCP has another patient with PN who has found relief from this, so she is encouraging me to try it again.
But if it only lasts a month, I can't see much point.
I have a solution which is working for me. Out on disability and the pain pump.
But I would love to get off of the pain meds.
Simply getting good sleep (because I don't have to get up and go to work) makes a big difference.
I glanced at results from a double blind trial with melatonin (10 mg nightly), and they found that those who received the melatonin had nearly 40% reduction in pain (along with more sleep).
They seemed to suggest (I didn't read the whole thing just the abstract) that it was the melatonin.
But I wonder if it wasn't just the sleep.

Skip

Does the pain pump work? My pain is not well controlled. Melatonin helps pain?

[egley]

Hi All,

I will add my recent experience.

I had RFA done to my pudendal nerve on October 31st.
This time, as opposed to the previous time, they found the pudendal nerve.
I know, because I felt it BIG TIME in my right testicle, which is where the majority of the pain resides.
But it made no difference whatsoever.

I also had RFA done many years ago... around 2009... by the same doctor at the same clinic (Pain Clinic at Stanford).
I noticed no difference that time either. However, since I never felt anything in my testicle I thought that may have been the reason it didn't help. I gave on the Pain Clinic but am back because they are as good as anyone else it seems and they are in network... I can't afford to keep throwing money at doctors or PTs not in network anymore.

I am now of the opinion that there is something mechanically wrong with my pelvis.
Just a theory at this point, but it is now the direction we (the Pain Clinic) are heading...
I have my reasons for suspecting this... Too much for me to go into here...

All the Best to Everyone out there! Keep searching!
Skip

[Violet M]

So what are you going to try now, Skip? Can't remember if you already tried the mindbody approach...

Violet

[egley]

Dr Coleman of the Pain clinic sent me for an MRI of my pelvic region to see if there may be something awry.
Just had it done a few days ago - have yet to see Dr Coleman for a follow up.
I'm not sure, but I think I convinced him last visit that it just may be a mechanical issue with my pelvis.
At least he ordered the MRI, so we shall see.

I've never been a big believer in the mind/body thing.
When I sit it hurts, when I don't it's fine. Been that way since this whole thing started mucho years ago.
Plus the fact that my pain level went down considerably after my fusion... I'm thinking I messed up my pelvic region and my spine 4 decades ago and it came back to haunt me in my older age, one of the symptoms being PN. I have a few vertebrae with issues but the spondy is fixed, thank God.
I still have a bad gait which I am trying to straighten out. Making some progress...

I don't know if I will ever be able to be rid of it entirely... it's going to be long and arduous.

Skip

[Violet M]

Sorry, I think I misread your previous post to mean that you did not think you had a mechanical issue but now when I re-read it I see that you say you think it is. And I think your reasons for thinking that make a lot of sense. A mechanical problem was the case for me which is why I think the mindbody approach/theory did not work for me. Getting all of those mechanical issues worked out can be a real challenge. I wish you success, Skip.

Violet

[Dr. Jason G. Attaman]

Saint,

There was a reply from Dr Attaman about this (not sure I am spelling his name right) at the bottom of page 1 of this post.
He is saying that the term 'ablation' is not appropriate. He uses 'Treatment' instead.
It doesn't zap the nerve out of existence.
It is 'pulsed' in such a way as to not generate a lot of heat which would damage the nerve.
I believe when they use the term 'ablation' it is meant they are deliberately destroying the nerve.
Not sure why this misleading 'ablation' term got stuck onto this procedure. it's unfortunate.

But I spoke with Dr Weiss (the urologist, not the other one), and he is not convinced it doesn't damage the nerve.
It was a long time ago (around 2008). I'm not sure he still holds to that opinion today.

All the best to you!
Skip

Hello Skip,

Your summary is correct. The pulsing term comes from the following; the radiofrequency energy is turned on and off in pulses, preventing the tissues from reaching 43C or higher. So, if the tissue starts to reach 43C, the pulse intervals increase allowing the tissues to cool down. Hence pulsed radiofrequency treatment. There was one study suggesting a one cell layer region of injury with pulsed RF, however this may be due to tissue trauma and is not considered significant.

Tissue damage occurs at 45C. Pulsed radiofrequency treatment limits its temp to 42C. Therefore no damage occurs. It has been in use for a very long time at this point for nerves all over the body, including very critical motor nerves (median nerve aka the carpal tunnel nerve which controls function of the thumb, nerve roots which control function of the limbs) and there is no report that I am aware of of these nerves being injured by the 42C max temps.

Cryoablation works differently by freezing the nerve with an ice ball. That creates swelling around the myelin sheath and the blood vessels that surround the nerve. This swelling results in the death of the axon inside the myeling sheath tube. However, the myelin sheath remains completely normal, and as a result the axon fully regenerates normally inside the myeling sheath over time.

I hope this helps, Dr. Attaman

[Dr. Jason G. Attaman]

I wrote a blog about pulsed radiofrequency treatment and compiled some of the literature here:

https://jasonattaman.com/pulsed-radiofr ... neuralgia/