How long to wait for RFA to "kick in"

[pharmer]

In fellowship we told our patients to expect pain improvement status post conventional RFA for facet pain to be noticed between 2-6 weeks after the procedure. In my practice we like to provide a phone call follow up to see how patient's are doing and we have targeted 4 weeks post procedure to check in. What have you guys been doing in your practices regarding RFA follow up time period and what time frame have you been giving your patients regarding when they should expect improvement vs considering therapeutic failure?

---

Members don't see this ad.

 

[Dr. Ice]

In fellowship we told our patients to expect pain improvement status post conventional RFA for facet pain to be noticed between 2-6 weeks after the procedure. In my practice we like to provide a phone call follow up to see how patient's are doing and we have targeted 4 weeks post procedure to check in. What have you guys been doing in your practices regarding RFA follow up time period and what time frame have you been giving your patients regarding when they should expect improvement vs considering therapeutic failure?

Do something similar. I have found that at the 4 week mark, if they are not better, they aint gonna get better...

 

[PinchandBurn]

I too look do 4 weeks. I tell them that it may tk up to 4-6 weeks to work.

If they still have pain, we re-evaluate them.

 

[mdvol]

4 weeks here

 

[bedrock]

4 weeks for standard cervical/lumbar RF.

6 weeks for TON or SIJ RF. Both of those often take longer to heal.

 

[oreosandsake]

I have seen patients been told to wait about 2 weeks for the effects to kick in, but have had patients tell me that they felt better by that evening or the next day. Is this expected or just a strong placebo effect?
Also, many euphemisms are used to describe RFA. when we "burn" a nerve, it does destroy both the axon and myelin, correct?

 

[Ligament]

1-5 weeks of post RFA neuritis, and wait 8 weeks to see full effects. Thats what we tell the patients.

8 weeks is probably overkill but it covers 98% of all patients and expected results.

I tell them all this up front.

 

[SSdoc33]

I have seen patients been told to wait about 2 weeks for the effects to kick in, but have had patients tell me that they felt better by that evening or the next day. Is this expected or just a strong placebo effect?
Also, many euphemisms are used to describe RFA. when we "burn" a nerve, it does destroy both the axon and myelin, correct?

axon and myelin are burned.

immediate effect is from the local or the fact that the nerves are no longer transmitting the pain signal.

 

[ampaphb]

Used to tell them 2-4 weeks. Then I did it on my mom. Took her 6 weeks to get better, but she got 3 years of good relief.

 

[el guapo]

I generally say 2 weeks, up to 6 weeks to the patient. I recently had one that took about 8 weeks to kick in, disappeared from my practice then came back 18 months later when his pain increased from 0/10 to 1/10 to get a repeat.

 

[clubdeac]

On a side note, I've had several patients return 6 weeks later stating the lumbar RF didn't work. When I ask them to show me where their pain is they point directly to their sacral sulcus. Their axial lbp is no longer problematic. I then inject the SIJ and voila, much improved. Not sure why this occurs but I've seen a number of these lately...

 

[Ligament]

On a side note, I've had several patients return 6 weeks later stating the lumbar RF didn't work. When I ask them to show me where their pain is they point directly to their sacral sulcus. Their axial lbp is no longer problematic. I then inject the SIJ and voila, much improved. Not sure why this occurs but I've seen a number of these lately...

Yes i see this every week! My theory is since lumbar facet pain is gone, they move more than they have in years, and this flares up the SIJ. It is most common in the elderly. Alternately, could bd the SIJ was only a secondary pain generator until uncovered by the lumbar RF. but ive seen hundreds of these cases.

 

[SSdoc33]

Yes i see this every week! My theory is since lumbar facet pain is gone, they move more than they have in years, and this flares up the SIJ. It is most common in the elderly. Alternately, could bd the SIJ was only a secondary pain generator until uncovered by the lumbar RF. but ive seen hundreds of these cases.

agreed. see it all the time.