Pulsed radiofrequency ablation

General General TN & GPN (Old Site)
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Hi everyone,

I have been silently lurking around this site and I have decided you all are amazing, knowledgable, and patient individuals. You all have so much strength that I can’t understand because I feel very weak.

I have been dealing with facial pain for 4 months now (my suspicion is ATN, but no doctor wants to give me a diagnosis). I made one post a while back about my story, but reader’s digest version: I have bilateral pain in all branches which is constant, aching, crushing, and rarely shooting. This happened after getting 3 dental fillings on two bottom molars and one upper. I have tried a whole slew of drugs, but am currently on 25 mg Nortriptyline and 1800 mg Gralise (gabapentin) and I’m usually around a 4-5/10 pain with occasional days of the I-want-to-die pain.

My pain mgmt doc was persistant about trying a stellate nerve block, which did not do anything. He is adamant that the next step is pulsed radiofrequency ablation to the trigeminal nerve. This makes me nervous because I’ve read over and over on this site that if the cause of your neuralgia is damage to your nerve/ATN then a nerve damaging procedure is a huge no-no.

What I’ve read is that if the ablation is PULSED then it does not damage/burn the nerve. Is there anyone that has had any success with this procedure? I’m very hesitant about this and, honestly, I think you all have more expertise on the matter than any of my docs do. They say I “may recover from this in 6 months to a year.” No one will give me a diagnosis and it’s all very frustrating. I appreciate you guys.

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I’m so sorry you’re experiencing such constant pain, Faith-Full. I, to, have considered this procedure, but I’ve shied away from it for fear of developing anesthesia delorosa. I wish you luck in your decision, and I hope others respond.
Beth

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Thank you for your response, Beth. My doc made the distinction of saying that because it is "pulsed" radiofrequency ablation and not just "radio frequency ablation" that this would not damage the nerve but just "stun" the nerve. Is this what you understand? What I've read seems to be congruent with this, but I have become very distrustful of doctors lately because none of them seem to have any definitive answers in regards to TN/ATN.

Beth said:

I'm so sorry you're experiencing such constant pain, Faith-Full. I, to, have considered this procedure, but I've shied away from it for fear of developing anesthesia delorosa. I wish you luck in your decision, and I hope others respond.
Beth
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I hear you about not trusting doctors. I live in Maine, and there isn't a large population up here, so the doctors have limited contact with folks with TN. Unfortunately, while my neurologist used to work in NYC and saw a lot of TN patients, I feel like he's not up on the latest research and therapies.

As for pulsed radio frequency ablation, I honestly don't know. Is there a lot of research on it? I'll have to do some investigating myself. It makes sense that it wouldn't cause the damage that regular radio frequency ablation would.

To be honest with you, I'm so terrified that if I do anything radical, I'll have greater and lasting pain, so I'm a bit paralyzed. I'm without insurance right now, so I'm limited as to what I can do anyway. I'm in the process of applying for disability, so if I get it, perhaps I'll consider a more drastic or radical approach. For now, I have to content myself with minor meds and ice packs.

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By the way, Faith-Full, please don't feel any weaker than the rest of us. I have developed a level of fear about life that I never experienced before I came down with TN. I spend most days 1) changing ice packs in my head wrap, 2) figuring out which meds I can take, depending on what I have going on, 3) sleeping because of the meds or the pain, or 4) analyzing every pain, for fear that I'm working up to the I-want-to-die pain you mentioned. Oh, and whenever I go anywhere, I always have to pack ice packs or hot packs to put in my head wraps.

I hate it. It completely controls my life. Sometimes I feel sad that I don't have my old life anymore. But then I get philosophical and think, "it is what it is." Or, as we say in Maine, "Well, whaddaya gonna do?"

Sigh ...

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Hi Faith-full! I have not had ablation etc. and the meds that I took either were ineffective or gave me side effects. What did help me a lot was Homeopathy! I have had ATN x 23 yrs from a dental injury which included torn cartilage. It has been horrible but I am much better now. I take Swanson Migraine Relief,Swanson Nerve Pain Relief,Swanson Earache Relief every dayalthough sometimes I skip a day. I keep Hylands Miraine on hand for pulsing,bursting pain and Boiron Sinusalia which includes Spigelia which is specific to theTN. If you have sinus problems it can worsen pain and if you have allergies there is Hylands Seasonal Allergies or Swanson s Hayfever-we keep one on hand. Thankfully these items are very affordable on a tight budget like I have! I hope that you get some relief soon!!

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I am hoping to get some more insight from you all before I go through with the procedure. I spoke more with my pain management doc recently and he seems really “with it” unlike other specialists I have seen. He told me, “do not let anyone do nerve damaging procedures on you. And don’t let anyone open up your skull.” - In reference to him telling me my pain is “atypical facial pain” or “trigeminal neuropathic pain”. He is positive this pulsed radiofrequency ablation procedure will help me stating that this procedure “changes the protein structure of the nerve” and will provide on average 18 months of relief. He says all of his patients’ pain is resolved at least by the 5 year mark. I did a search on this site for “pulsed radiofrequency” but did not come up with much information. I am hoping this is something that will help me as well as others here. At least something to explore further.

1 Like
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Hi, Liz.

The following abstracts from the US National Library of Medicine may cast a bit of light on the reasoning behind pulsed RF ablation. Please note that the first is a limited case report, not a trial.
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Pain Physician. 2015 May-Jun;18(3):E433-5.
Management of refractory trigeminal neuralgia using extended duration pulsed radiofrequency application.
Thapa D, Ahuja V1, Dass C, Verma P.

Abstract

Trigeminal neuralgia (TN) produces incapacitating facial pain that reduces quality of life in patients. Thermal radiofrequency (RF) ablation of gasserian ganglion (GG) is associated with masseter weakness and unpleasant sensations along the distribution of the ablated nerve. Pulsed radiofrequency (PRF) of GG has minimal side effects but literature is inconclusive regarding its benefit in refractory TN. Increasing the duration of PRF application to 6 minutes in TN produced encouraging results. PRF application to the saphenous nerve for 8 minutes reported improved pain relief and patient satisfaction. We report successful management of two patients of classic TN, which were refractory to medical management and interventional nerve blocks. The lesion site were confirmed with motor and sensory stimulation through a 22 G, 10 cm RF needle with 5 mm active tip. Both the patients received four cycles of PRF at 42 °C with each cycle of 120 seconds (8 minutes). The visual analogue scale (VAS) in case 1 reduced from pre-block score of 80 to score 10 post-block, while in case 2 the VAS reduced from pre-block score of 85 to score 15 post-block. During follow up both the patients are now pain free with minimal dose of carbamazepine at 12 and 6 months respectively. We used PRF for longer duration (8 minutes) in these patients, which resulted in improved VAS and WHOQOL-BREF score in these patients. PRF of mandibular division of GG for extended duration provided long-term effective pain relief and quality of life in patients of refractory classic TN.

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And the following abstract appears to be stronger evidence and more directly related to your dental injury situation. the bottom line seems to be that in this limited trial, Pulsed RF ablation was somewhat less effective and involved more side effects after the procedure, than conventional RF ablation.

Pain Med. 2013 Mar;14(3):430-5. doi: 10.1111/pme.12046. Epub 2013 Feb 22.
Pulsed and conventional radiofrequency treatment: which is effective for dental procedure-related symptomatic trigeminal neuralgia?
Kim JH1, Yu HY, Park SY, Lee SC, Kim YC.

OBJECTIVES:

Many patients develop dental treatment-related symptomatic trigeminal neuralgia. However, the effectiveness of pulsed radiofrequency (PRF) treatment and conventional radiofrequency thermocoagulation (RFTC) for treatment of this disorder has not been determined. This retrospective study was conducted to compare the effectiveness and complications of PRF and RFTC in these patients.

METHODS:

Fifty-four patients who experienced the onset of symptomatic trigeminal neuralgia after a dental treatment were managed by PRF or RFTC. Data were collected by reviewing their medical records and conducting a questionnaire. Patients' characteristics, the dental procedures that caused the trigeminal neuralgia, the baseline and posttreatment pain intensities, duration of pain relief, complications, and satisfactions to the treatment were evaluated.

RESULTS:

Pain intensities were lower at 1 week (3.0/10 vs 6.4/10), at 1 month (2.5/10 vs 5.9/10), 3 months (2.6/10 vs 5.5/10), 6 months (3.1/10 vs 7.1/10) and 1 year (4.8/10 vs 7.2/10) in the RFTC group (28 patients) than in the PRF group (26 patients) (P < 0.05). The duration of pain relief without medication in the RFTC group (10.8 months) was longer than that in the PRF group (0 months). The incidence of complications in the RFTC group (46.4%) was higher than that in the PRF group (3.8%) (P < 0.05). The RFTC group reported higher satisfaction ratings (3.86/5) than the PRF group (2.19/5) (P < 0.05).

CONCLUSIONS:

Although the RFTC group had more complications than the PRF group, most were minor and transient, and the patient satisfaction rate with RFTC was very high. Therefore, RFTC is an effective tool for the treatment of dental procedure-induced trigeminal neuralgia.

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In both procedures, there are risks. That is true generally of all rhizotomy procedures in patients with ATN pain. But medical reality is that these procedures do offer some ATN patients significant relief for periods exceeding a year -- and in some patients exceeding three years.

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Thanks, Red, for your response. That was very informative. That is pretty much the conclusion I came to in looking at the research. I don’t know if I’m ready to take that leap or not yet, as I’m going to try some CAM tx next, but this is good info for further down the road perhaps. Thank you!

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Liz, have you had the procedure yet? I m scheduled for it t the end of September and I am really curious how it went. I have trigeminal neuropathy with permanent muscle damage as well so it is massive pain in my teeth and muscles every day all day. Ice packs are on my face 24-7, I have tried every med under the sun, nerve blocks (they missed my nerve bc my left side of my face is damaged). My pain has gotten consistently worse over the last five years and I am just so happy to find a doctor that is willing to try something. I am going to get the procedure done because something has to be done. Please let me know how it went.
Thanks and keep strong
Lisa

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Lisa,
I have not had the procedure yet, but I am still keeping it in mind for the future. I have been doing cold laser treatments which have helped me decrease my meds from 1800 mg gabapentin to 600 and 75 mg nortriptyline to 25 mg. So I am going to continue down the conservative route until I’m left with no other options.
From what I’ve read, the pulsed ablation does not have many risks or side effects so that’s the good news. I’ll be very interested to hear how it goes for you. I’m sure it will be a good thing!

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I will let you know how it goes. I am glad you are finding some relief with meds :slight_smile: Oops, ice pack needs changing LOL.

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Have had the procedure and it did absolutely nothing to help. Just cost a bunch. Made me cry a lot. And did not help. And I don't cry easily, I am a tough old bird at 67 and want help not monkey business. No more of this stuff- Get a MD Neurologist who specializes in TN or treats a lot of TN cases. Use the internet to find out what Neurologists are on staff at every Hospital in every big city around you. Call their office and ask questions. If they don't treat TN ask them who does. You deserve the best treatment, be your own advocate. Knowledge is power. Get all the info you can on every neuro guy until you find one with the special training to treat you.

.All the best to you- remember we are walking down the same road with you- you are not alone. You have the love and understanding of all us TN people to help you.

1 Like
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I had this procedure twice. Didn’t help me either. Went on to have a successful MVD

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Had pulsed ablation with no benifit, I ambilateral TN