Musculoskeletal pain is one of the most common forms of chronic pain, whether it is due to injury or conditions such as arthritis. Various medical interventions can be used to replace prescription pain medication or used in conjunction with medications to give you relief for longer.
Radiofrequency ablation (RFA) is a treatment that uses radiofrequency to damage the nerves responsible for chronic pain. It is often used in conditions such as sacroiliac joint dysfunction in which there are many nerve endings around the site of inflammation or damage and that can contribute more widespread pain. Two forms of RFA exist. One uses heat to damage the nerve endings, whereas the other uses cold.
For RFA to be effective, you may need to go through testing to determine which nerve or groups of nerves are responsible for pain sensation and whether they can be successfully lesioned without adverse effects. In most cases, RFA is not a permanent fix. Since nerves have some regenerative capabilities, the ends of the nerves eventually heal from the damage and begin transmitting pain signals again. People who have RFA may gain a year or more of pain relief, at which time they may opt for another round of treatment or pursue surgical intervention if it is an option.
Much like epidurals are used as a form of regional anesthetic, nerve blocks are used to block pain signals on a smaller scale. Instead of destroying the nerve ends, in this treatment a small amount of anesthetic is used in a specific location to prevent pain signals from traveling along the nerve and reaching the brain. Nerve blocks are ideal for pain in peripheral regions, such as the arms and legs. Nerve blocks are not permanent; once the anesthetic wears off, pain will return.
The downside of nerve blocks is that the same nerve may transmit other signals, such as temperature or touch sensations. If the nerve responsible for your pain provides sensation to a larger area, you are more likely to experience loss of sensation in addition to pain relief. Nerve blocks may also be used a stepping stone to other treatment options. Since the nerve block can help surgeons pinpoint which nerve is responsible for your pain, the procedure can be used to ensure they have found the right nerves responsible for pain before they use other techniques, such as RFA.
Nerve stimulation can take various forms, such as electrodes worn on the skin or an implantable device. The idea behind nerve stimulation comes from the gate-control theory of pain. According to this theory, whichever signal reaches the brain first is what you feel. Therefore, a benign (non-painful) stimulus will close the gate on pain signals before they reach the brain. Most transcutaneous forms of nerve stimulation conduct a buzzing or pulsing sensation at the site where they are applied. Although the sensation may not eliminate pain completely, it can be effective in reducing chronic pain.
Implantable devices are often used to help reduce chronic back pain or pain related to nerve damage. The procedure may require several trials before the device can be implanted. This is to ensure the probes are in their ideal location and to adjust the electrical signal. Once the device is implanted, it is controlled by the patient. Typically, implantable devices are used when other treatment methods have failed. Since the probes make direct contact with the affected nerve, this is more effective than indirect methods of stimulating nerves and may be effective on a wider area.
Pain management is a multifaceted area of medicine that uses many techniques to help reduce pain and improve functionality. For people with chronic musculoskeletal pain, there are several approaches that can be used in addition to medication to achieve longer pain relief.