Radio Frequency Ablation - That was painful!

What’s new?

It’s over, I finally had the radio frequency ablation for my neck. What started on Thanksgiving night 2022, finally was completed on Tuesday, March 7th. All I can say right now is ugh, that was a new adventure in pain and exhaustion!

At the moment I’m not ready to call the procedure a success. For some reason if I lift anything heavier than one of my Fruit Punch Zero Sugar Powerade’s (hey Powerade how about a sponsorship) I get pain around the C2 area of my neck, sometimes it is significant pain. In addition, I’m starting to think I have a possible new mechanical issue with my neck. Something just doesn’t feel right in there right now, the worst part is I do not have the articulation skills in order to describe the feeling. All I know is it just doesn’t feel right at the moment.

That said, I’m not ready to call the procedure a failure either. There has been a reduction of the pain I’ve been having since Thanksgiving. I’m now having periods of time where I do not feel anything in the C2, C3, and C4 area of my neck, that is new for me. If I do have some pain in that area, I don’t seem to be living in fear of it escalating. The pain seems to be staying constant which I’m considering a victory for now.

What is a Radio Frequency Ablation?

For those of you that don’t know, during a radio frequency ablation a tiny electrode is placed inside a hollow needle. A radio frequency current is directed to the medial branch nerve of the joint capsule for 60 to 90 seconds.This radio frequency wave makes heat.The goal is to damage or burn the nerve which prevents or stops the pain signal from reaching my brain which will hopefully result in pain relief.

During this procedure I was under the influence of some ketamine/anesthesia combination. I have had an ablation without the aid of anesthesia in the past, I do not recommend this option. There was some hope that the ketamine/anesthesia combination would cause me to forget the procedure, this did not happen. Here is the reason why I’m guessing.

This time I had the radio frequency ablation done on both sides of my spine. The pain is probably worse on my left side but its a close competition. Since this is a fight fire with fire type procedure, performing the procedure on both sides made sense in my head. While burning the nerves on the left side, something happened. The heat went from a “burning sensation” to a “my neck is on fire” sensation. To put it another way, I went well beyond the burning sensation on the pain scale. We are talking pain that hurt both the physically and mentally. I asked the doctor why this happened, he mentioned something about not being able to do his usual technique. All I know is I don’t want to live through that again!

Will it help?

Evidence suggests that I will have some pain relief from this procedure, the amount will vary by cause of the pain and the location. It could be 10 days to a full 3 weeks before I will know the final results of this procedure. I can expect any pain relief I might get to last from 6 to 12 months. Some people are lucky and the relief can last for a few years, others may only have limited pain relief

Here is the bad news considering how painful the procedure was. The treated nerve can and most likely will regrow. From what I understand, the nerve can regrow at a rate of a half inch per year. This means there is a good chance I will have to go through this procedure and pain again.

What is my earth shattering conclusion?

Ready for a profound and life changing conclusion. Yeah me too! Sorry to disappoint but I don’t have one. All I have is a recommendation that pain management doctors and probably rheumatologists examine the language they use to describe the symptom of pain. In particular, the terms acute and chronic should be based on the patients point of view regardless where in the healthcare system they are not their doctors or the payers.

What specifically do I mean you ask? This current pain started on Thanksgiving and was most likely brought under control the first of March. According to my public school math skills, that is just over 3 months time. Or to put it another way, this most recent pain can be classified as acute. Yes, by the most common definition of acute this correct. However, it is not correct if you look at the pain in terms of my life.

Lets look at my life from the prism of medically. Statistics suggest that there is a real possibility that this debilitating (debilitating meaning both personally, professionally, and mentally) pain could return in as little as 6 months. That means by Halloween I could be right back to where I was this past December/January/February. Also, a radio frequency ablation is designed to prevent my brain from receiving a pain signal from my nerve. The procedure does not medically address the underlying conditions that are causing my pain, the degenerative disk disease, chronic pain, and moderate to severe facet joint syndrome. These conditions are still getting worse, if the ablation is successful I will be getting break from knowing exactly how fast I’m getting worse. Pain is a measure of the severity of my conditions.

Lets look at my life from the prism of mentally. I’ve spent the last 3 plus months concerned that I’m about ready to lose the ability to drive. If I can’t turn my head in order to make a right turn on red, for example, I probably shouldn’t be behind the wheel of a car anymore. At the very least, being scared to turn my head due to the possibility of severe pain will probably cause some sort of accident where I’m at fault. Both of these examples weigh heavy on me, especially since I’m no were close to retirement or have the resources necessary to hire a driver. If I’m already concerned about driving, imagine trying to work through that same stress. The chances of a brain fog error or not having the mental energy to complete tasks in a reasonable amount of time has also become a concern. There is not a lot of demand for a chronic pain patient with 2 plates/8 screws in their neck who can no longer drive due to severe chronic pain issues.

I’ve also gotten to the point where I take a pain pill before I go hiking, even on easy or moderate trails. Carrying a backpack of water, an emergency Powerade, and something to snack on now causes enough pain I need help or else it would affect my hike. Due to this, I’m almost scared to think what pain skiing would cause (skiing being probably the sport I’m technically best at). Unless it is some epic powder day where the snow is lighter than air, my skiing days are probably numbered. That hurts mentally to both type and think about.

How might we change medical language for the better? First, we need to think of patients as either acute or chronic. For example, if you were to admit to a hospital for a broken arm or even COVID, you would be considered a acute patient since there are no underlying conditions. All ones symptoms (for the sake of simplicity and my lack of articulation, I’m considering Long COVID as chronic in this example) would be considered acute. Whether its a cough suppressant or pain management for the broken arm, it would be assumed that both the condition and symptoms can be mitigated in 3 months or so. Now, if patients like me with rheumatoid arthritis and AFib are admitted, they would be considered chronic patients even if they are admitted for a broken arm or even COVID. Treatment would be looked at from a long-term perspective, even if we know a broken arm can completely heal in 6 weeks.

Why you ask? Many, if not all chronic conditions like rheumatoid arthritis, are selfish bastards. They want to be the constant center of attention. Although a broken arm is a relatively easy medical encounter to diagnosis and heal from, it still causes trauma to the body. This trauma can cause the rheumatoid arthritis to flare for months at a time (my rheumatoid arthritis flared for 3 solid months after my right hip replacement surgery). Due to this, and in a perfect world, the treating physician for the broken arm should be in contact with the patients rheumatologist and pain management doctor for the next few months. In this example, a few days of oxycodone then switching to Advil for the acute patient might be the standard protocol but for the chronic patient, the protocol is probably going to be much different. The chronic patient will require more help because they have underlying condition(s).

Second reason for my recommendation. This change will help with medical literacy which in tern will help reduce stigma for chronic patients. We all know that with social media platforms like Twitter there will always be trolls and bullies. That’s the cost of doing business online. However, there are to many people that don’t understand the difference between acute and chronic. They think pain is pain, or a cough is a cough. These people don’t understand that pain can mean something is in the process of healing or being shredded apart because my immune system thinks joints are something evil. Maybe this is naive, but I have a strong feeling that if we could better delineate the differences in treatment this would help raise medical literacy while reducing stigma. I’m not taking opioids daily because I’m addicted to the high, I take them daily because my immune system is currently shredding the joints in my hands daily and its a workaholic which means it doesn’t take holiday’s off.

The final reason for my recommendation. I admit, its based on pure selfishness. This language change will give more glory to patients like me. For example you ask. First, I was born with bilateral hip dysplasia. I was in my early 30s before I could not take the pain in my left hip anymore. Since I was still considered young, my surgeon recommended I have my left hip resurfaced instead of replaced. The surgery was considered acute since I was only in the hospital for the better part of 2 days. However, I would argue that I had spent 30 years on a bad hip which more than qualifies for an chronic label. We should celebrate the 30 years of living a life in pain vs the 2 days it took the surgeon to correct I think.

My neck pain follows the same logic. Yes, this current round of pain started on Thanksgiving. However, I had my first neck surgery in 2005 and second in 2019. To put it another way, I’ve been dealing with elevated neck pain for 18 plus years now. Outside of my family and close personal friends, I think most would be shocked at that 18 year figure. The 18 years helps them put into perspective just how bad my degenerative disk disease and chronic pain truly is.

How should I end this post?

All I can say right now is ugh, that was a new adventure in pain and exhaustion!