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Radiofrequency Ablation Procedure (Page 1)

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Hello, I am a new member. I hope to gain some advice on future treatment options and help others, where I can.

I have a history of fusion at L5/S1. I am taking pain meds and still have terrible pain and can't sit for more than 10 minutes. The doctors still haven't made a firm diagnosis, but the L5/S1 isn't in pain anymore - it is just below the belt line on both sides (possibly SI joint). I am going to try radiofrequency ablation on Oct. 15th. I am praying for some relief. Has anyone here had success or failure with this procedure? Also, I have heard about nerve stimulation that interrupts pain signals if anyone has experience with that. From what I read, it looks promising.

Honestly, I am barely hanging on to my job and my wife is fed up with my pain as she is putting in so much work around the house and caring for our 3 young children - I don't know how much longer she can take this either.
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First Helper littleonefb
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replied August 26th, 2008
Radiofrequency Ablation Procedure
Hello f251192,

I'm so sorry to hear of your predicament, as I can honestly understand the pain you must be going through. I too have lost my job due to pain, and my wife is financially supporting me through these difficult times.

Is your L5/S1 fusion the result of surgery or through some other means?

I just had an MRI and the physiatrist is suspicious of my disk at this place and also is recommending conservative treatment as a first step.

Let me just say that before you consider RFA (radiofrequency ablation), you may want to be certain that the SI joints are causing your pain. This can be diagnosed through a local anesthetic injection twice (double blind), as I will be having this procedure soon myself.

If your SI joints are the culprit for your pain, I would try prolotherapy, and manipulation for your joints before RFA. I've been told that RFA has a 60% success rate and the nerves will be back in 6-12 months with a 50% recurrence in pain. It is expensive and perhaps not worth the effort.

My prayers are with you though, and I hope you find the answers you are looking for.
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replied January 2nd, 2014
Hi. Have to advise about RF. Have had 5 in back and one in neck. First, immediately after and for up to a month the pain is terrible due to the nerves temporarily dying. You will need a heating pad, ice pack, tens unit and pain pills. Hopefully you will get relief for 6 mos to, some say a year. I got on average 6-8 mos relief, then the nerves rejuvenated and the full pain was back. The last time it didn't take and there was NO pain relief. Talked to a friend that had gone this route and more, he said this is expected, so now he exercises and doesn't use any pain pills. I also had trouble with the drop table form of chiropractic help. It caused more pain and was told by several doctors it would cause severe problems with my back. I hope this helps in your decision. Wishing you pain free days,,,,,
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replied August 26th, 2008
Active User, very eHealthy
Hello f251192,

Welcome to this forum.

I'm with Screaney, I'd cool it with the RFA until your docto has more information.

RichT
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replied August 29th, 2008
Extremely eHealthy
Oh my goodness, what I'm reading is not good at all here.

f251192, please do not do any kind of manipulation with and kind of chiropracter or an of this prolotherapy stuff either.

I'm sure that screaney meant well, but no way do you do those things after having any kind of fusion. and with unknown cause of pain, you don't go playing around with some kind of natural stuff that gets injected into areas of the body in, around or near the fusion site.

As for the RFA, Rich is correct, that is something that is just not done for the sake of being done.

You don't mention anything about having any tests done to see where the pain is coming from or how long ago your fusion was.

If you have not had any injection tests to determine if the pain is coming from the S1 joint, and a doctor just wants to do RFA to help the pain, run for your life from this doctor and find a new one.

For that matter, if your present doctor can not determine where your pain is coming from, I would suggest you seek a second opinion from another spine doctor before you have any attempts at RFA.

As for the RFA, the proper method is this. In an OR setting and under floroscopy, a PM doctor injects a small amount of lidocaine into the S1 joint area. Over the next 6-8 hours, you keep a very careful jounal about the pain you have or don't have. How much pain relief you get, how long it lasts and the type of pain you have as it returns. All this assuming the pain does decrease or is gone.

The other thing that this testing does is to cause quite a bit of painful muscle spasms which they usually give you pain meds and muscle relaxers for and it can last about 2 weeks.

After that subsides, you meet with the PM doctor and go over all the information you have kept on the pain relief you have gotten, if any and how long it lasted.

If you did receive pain relief and it lasted long enough, then you would be a candidate for the RFA. If you did not receive any pain relief or it was minimal or it didn't last long enough, you wouldn't met the criteria for the RFA.

If the PM doc says RFA, then the next step is to schedule the RFA to be done. That too is done in the OR setting and under floroscopy. You get a small dose of lidocaine for the needles to go in and the tube or tubes, then you must be awake and fully able to feel the pain as the doctor needs to be sure he has touched the correct nerve that causes the pain. Once he finds the correct nerve, it is severed with the radio frequency. How many times it is done depends on how many nerves are involvoed.

After the procedure you then again will have quite a bit of muscle spasm and pain and given meds for it. These can last up to 2 weeks.

Whether the RFA will work for you or not, no one can answer until after it is done, they can only tell you that you are a candidate for the procedure. It works well for some people, not so well for others, doesn't help some and makes the pain worse in others.

In any case, it is only a temporary fix as the nerves will grow back anywhere from 6 weeks to 18 months and sometimes the pain returns as less than before, sometimes it is the same and sometimes it is worse than before it was done. It can be repeated if the patient wants to have it repeated.

But a good doctor would never just do the RFA without determining where the pain is coming from. guessing that it is the S1 joint is one thing, checking with the lidocaine injections is another, but just doing an RFA without any checking first is not proper protocol for RFA and I would run, not walk from the doctor if that is what he/she is going to do.

As far as I know though, L5/S1 pain all is below the belt line on either side of the vertebrae. So it sounds like that there still might be some pain coming from the same area as you had fused.
You might want to ask your spine surgeon if he did a good and thorough decompression of the nerves when he did the fusion. Did he make sure the nerves where not being compressed in the lateral recess area of your vertebrae.
If he did not do that, then it is quite possible that the nerves are still compressed in that part of the vertebrae and until they are no longer compressed, you will have continued pain.

Not releasing the nerves from compression in the lateral recess area of the lumbar vertebrae is the most common reason for failed decompression surgery and continued pain post op after spinal fusion.

Fran
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replied August 30th, 2008
Active User, very eHealthy
Hello f251192,

You have received SUPERB words of advice and wisdom from Fran. Really "HEAR" what she is saying.

Take care.

RichT
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replied September 4th, 2008
RF Ablation
Thank you for the information. I will be more cautious and do much more research. The doctor did do a diagnostic test, where he injected an anesthetic, which helped for a couple of hours. I'm pretty desperate though, but I know I shouldn't jump at something that has the potential to help. I am just maxed-out on pain meds, the pain brings me to tears every few days, and I suffer from some mild hyperventilation nearly every day. I will definitely do some deep research before I get it done. Thanks.
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replied October 1st, 2011
RFA
I would say Fran is right on. I have had my pain for 10 years. I go in for cordisone injecttions on both sides. My problem is L4-L5 SI joints. It is bad.
I am in tears also and my life really has changed.
I have had RFA twice. First time it lasted a year. It was wonderful to be pain free. Then it came back I had it done again and it only lasted about 6 months. I had it done 3 weeks ago and my pain is 10 times worse than it has ever been. I am sapose to go get the other side done and now I don't know what to do. I think I will go back and have the cordisone shots. I am desperate. I can't live with this pain.
I will take pain free for any length of time.
It is worth trying the RFA even if it does not work.
Sunnyonesotrue
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replied November 29th, 2011
Hi, I was just wondering how you did on the test they give you to see if your a good candidate? They told me I have a 50/50 chance of it helping and I'm not sure it's worth it for me_ I am afraid it may cause more pain. Thanks for any info you can give me!
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replied September 4th, 2008
Active User, very eHealthy
Hello f251192,

I applaud you for your caution and taking the important time to do your research well.

AND please do seek the advice of several spinal surgeons. It DOES make a difference.

I wish you the very VERY best for you deserve the best.

HUGS

RichT
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replied September 27th, 2008
RF Ablation - Post-Procedure
I must report excellent news after I had this procedure. I work 3 hours a day in the morning, then come home and work laying down in bed. Often, I would come home (and even though I am a man), I would have to go to the bathroom and cry. It is just that the pain was so bad. I am so unable to concentrate (reading the same paragraph 10 times) to do my job and worried for my family, marriage and everything,, worrying about not being able to get disability, as I have heard they reject many people, even though they are disabled on technicalities. I had been considering ending it all, sadly.

I had the RF Ablation procedure on my right side of my lumbar. It still felt bad 2 weeks later, then by some miracle, I woke up and my pain had eased greatly. Now it's 5 days later and what a relief, it is like a new lease on life. I know it is still early, I will write back in a week or two to give an update, but I am praying this is a sustainable success.

God bless all of us pain sufferers. The general population can seem to be so cruel and just have no idea what life is like.

Talk to you soon and god bless you all.
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replied September 24th, 2011
I had my third RF Ablation done 3 weeks ago.
In between these procedures being done I have had steriod injections.
The first two RF Ablations done. They worked well for about a 6 months to a year.
I had the third one done 3 weeks ago. My pain is worse than when I had it done.
I am schedualed to have the left side done in three weeks.
I don't know what to do can someone give me some hopefull feedback. I have been in paind for 10 years!.
Thank you
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replied September 27th, 2008
Extremely eHealthy
That's fantastic news the RFB has helped you.
From what I have read and was told by my PM doctor, it can take about 2 weeks or so to start working and once it does, it will just improve for you.

I hope that you get long lasting relief for at least a year or more. But do remember that if the pain returns because of the regeneration of the nerves, the procedure can be repeated. And since it is already helping you now, you know that it will work again if you need it.

How true that the general population can be so cruel. They don't understand what chronic pain of any kind can be like. It's hard to explain to someone that doesn't suffer from it and most of us do not look like we are in the pain that we are in.

Maybe it's because we have become so good at hiding he pain on our face that people can't understand how we can "look so well" and be in so much pain.

Keep us posted on how you are doing. and again congratulations on success in reducing the pain that you have.

Fran
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replied January 6th, 2009
RFA info..to be continued and back pain...3 in one family!
For some reason i can't see the left half of this screen but see i am only missing a few letters. i can now tell you all can see it all .. so.. will continue..

i came here looking for info for my 72 year old mother who has vertebrae that area c3-c6 rubing.. and i assume pinching the nerve as well.. she is having a lot of neck pain..

she went to dr as her neck was hurting and she was having problems sleeping.. she took a fall ... and her neck hurt more... she went to 2 different ciropracters as she was traviling and felt relief.. these are not the ones that manipulate or pound on you they use a tool and it does relieve the pain.. (i have it done my self and am disabled with more than 1/2 of my spine having problems and in pain all the time.. the treatments work! more on this later!)
when my mother got home she went to her dr. they took x-ray's again and saw that the vertabra where now touching.. they sent her to a nerologyst. she is having the rfa done today jan 6, 2009.
she had to go to the dr. and he numbed the area he felt was causing her the problems and her pain did leave. that was the first visit. he also informed her of all his schooling and acredidations. and gave her info on this.

she went back today to have the rfa.
there are some side effects.
no one that has an infection or bleeds easy should have this done they state. there may be swelling, brusing, bleeding, soreness for up to two weeks. leggs may be numb .. some due to medication they give. it will wear off in hours.
the rfa may not help at all.or may decress the pain. her dr said it can last from 2-3-to 5 years..even.... and yes the nerve does grow back and so you may have to have it done again.
there is some discomfort vary's by person.... as one has to be awake but it is in the heating of the nerve. ice is sugessted for swelling and brusing at home.
not driving for 24 hours. no heavy lifting for 24 to 48. any problems call the dr. asap for answers.

i wanted to know if her medicare would cover this and they said it would .. she has other insurance as well and they told mom that it would be cover between the 2 what medicare didn't, the other would. of course there is deductables.. each year.. and this is a new year!

i wanted to know now that they worked on the pain part what can they do for the real problem of the vertabra.. as i feel fixing the pain is not solving the cause and the real problem.. just a band aid ... and am concerned that dr's. don't all look at the big picture of the patient just their pocket books some times.....
perhaps at her age the pain relief and not the wear and tear on the bone or vertabra.. is their idea that it is taken care of...i would think it would only cause other problems...down the line.. and want it taken care of.. in the best intrest of my mom's health and fullness of life.

being a disabled person.. with lots of nerve and spinal pain all over my body.. i understand all of what has been said on this site. don't loose hope..
i know it is not easy.. and every day is a new day.. every hour and min.. some times.. just try and remember other family is tired also and fustrated they can't help you more or help get you back the way you where either!!! you are loved... but you must learn how to love your self in pain and disabled condition.. (the hardest thing i have ever done! a work in progress!) keep trying new methouds.. for me it is drug free as possiable .. due to my own thoughts for care of me. i also have a low tolorace for normal doseage of all most all medications and am alergic to most that would help my condition.

i have turned to homopathic and herbs and infared lighting, and missage. i tried rolfing and it really did help me.. it is uncomfortable and there was brusing and discomfort but it was well worth it.. it is costly but i found someone so kind they did the rolfing and then if my insurance paid they would get the money.. for some reason the insurance didn't pay and they didn't charge me... i find this a mirical and don't believe most rolfer's would do this for someone as they need food on thier tables also.. but what i had done helped more than any thing else !! i did have some done at a rehab the insurance paid for and it was not as help full as the whole treatment.. you can look up rolfing .. and it will bring sites up... worth a try..

i purchased a light relief and it is my life line!!!!!!!!!!! now... yes as seen on tv.
well worth the $80.00 it cost more than any thing else other than the theraputic pilow for my neck i also use often that the insurance did purchased for me. i did get a light reief with a large paid as well and that was better than the light reief smaller area.. an softer to lay on. it also cost about $80.00 and well worth it.. geting them at the same time was smart.. the soft paid works with as in conected to the harder smaller light reief so you need both!

they are now coming out with some heathers that are infard heat and i am saving to purchase one and see if that kind of heat would help not only with heating my house but also the type of heat with more infard heat all around me! i have said for years i need a big tube to get into so it will be all around me!
there are a few other realy great things out there using infard lighting.. even for cancer and other ail ments..or relief of pain from: fybermyalga, , kemo treatments, myo-displacia, carpal tunnel, cp, ms, arthritus etc... these machines are bigger and more costly. i know people that have used them and they have worked for them... like a mirical! one is the ray or raye machine.. look it up..
try one of these... i will save for that after heater..lol!

i have shared my light relief with others and they felt reilef also... getting some one to try it is the hard part.. once they do they are hooked better than any heating pad.. oh yes you can use the light relief with the lights or also with lights and heat! i use the heat almost 100% of the time.

the other articals below helped me with my mother's situation and was helpful. i recomend talking to your dr. and or ciropractor. some don't like each tother.. lol! the type of ciropractor that uses a gun type device can't think of what it is called right now. is the best for me. i bruse easy and can't take snaping and manipulation i am in enough pain as it is.. i have had both kinds.. and all where mor caring about my condition and my mom's than most of the dr. i saw.. the nurologist where the worst of all!!!!!!!!!! compition and no evasive i guess.. i went to a pain clinic and was given a drug now off the market ...that i told them i was alergic to something in that medication.. sulfer! and they wanted to do bio feed back and never set up or returned my calls.. wanted to give out drugs..lots of patches and spinal blocks... that was almost the worst experiance.. all those people in the office togeather in pain.. gosh i couldn't hardly take it either.. so much pain and so much complaining.. and so many lifes changed...
i went to an other dr.. and got pt, with water therpy, palaties, balls and barrells and taping that also helped. they also tested my nerves & muscles and tendon's for damage and found out.. i was quite damaged! they stuck needles that where teflon in to my legs and arms and feet and sent electric curent through.. the nedles don't leave holes.. or bleed .. weard.. but that is the testeing what ever it is called they did.. i had no staroids...
my ciropractor has a table that moves to you and you step on it and it lay's down..no climbing up or on and off the table even! i am not able to go as often as i would like but if i could go more would have more relief i am sure. i have a missage chair and a good old hot shower helps also with a chair bench for back support.
i can use the light relief and get by with a generic tyonal or my homopathic formula's.
i like the homopathic that comes in "the blue tube" found at most health food stores. the one for pain and your symptoms... works best.. perhaps you also..
they also sell two types of "highland" brand homopathic meds for pain at wal-mart and cvs and other places. one is for back pain one is for leg craps. one seems to make me a bit grumpy ..telling me it is not working as well as the other.. as far as my pain..i don't take them togeather.. you will have to find what works for you..
the highland brand can be found close to the children's items as they also make other remidy's for teathing and ear pain, flu and cold these work great for me too!... just ask in the drug area and they should know...

you know a good old fashion cry helps now and then too. and laughter that is the best medicine of all with some love thrown in.. so keep smiling.. and enjoying being alive!!!!!!!!!!!!!!!!!!!!!!!! my nerve damage is painful but i also have lost feeling and so feeling a hug and touch is something i miss so much!
my husband had vertabra fused! an other story!
it did help him from head aches.. but the surgery went through the neck and left him with sleep apnia from weaking the neck muscles.. and that caused weight gain, lack of good sleep for both of us, high blood pressure ....etc.... him in hospital..over and over..and now on cpap and looking into surgery to remove flap from fused surgery.. in the future after he looses some wheigh.. life is so much fun!!!!!!!0Smile
will try and keep you up dated on my mom's rfa recovery and how it goes.. for her so you will have that info to go by.. she is fine with that.. and glad to help other's with info..
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replied February 18th, 2009
rfa procedure just done
For the past 7yrs have had lower back pain. Had some relief with chiropracter then physical theraphy, water theraphy, final a MRI which then sent to a neur doctor didn't recommend surgery but cortizone procedure in the lower back. Did the first session with a month/half of no pain waited the other month/half for the next shot and that one last even longer and then the last session this doctor recommended rfa procedure since i did so good with the cortizone procedure. I had the right side done on January 5th 2009 and then on February 2nd 2009 the left side was done. I'm just wondering when this will kick in like the cortizone procedure did. I was up and going 2 days after that procedure but not having the same result with this procedure it's now been close to 3 weeks. Any comments to this?
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replied February 18th, 2009
Extremely eHealthy
It can take as much as 3 weeks or even longer to obtain pain relief.

Not all patients that have nerve ablation, though, result in pain relief.

If you are concerned that you have not obtained pain relief, you should call you doctor and discus it with him/her.

Fran
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replied March 9th, 2009
Radial Frequency Ablation Coverage For Medicare
why is it that medicare covers more visits for frequency ablation in certain areas more than others? for example you get better coverage in Missouri than you do in Minnesota, never knew it made a difference in what area you lived, is medicare federal, whats the difference where you live, whats the difference in consideration....please reply for Phyllis
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replied March 31st, 2009
rf procedure
I am sorry for those of you experiencing debilitating back pain. I have had chronic pain for approx 20 years. I had to quit doing everything about 15 years ago (sports and fun-wise). I have gone through all the pain management techniques. I have had laser disk surgery. Currently have a couple docs who suggest fusion, but I'm trying to avoid that. I relate to f251192, about ending it all. Job loss was most upsetting to me as I feel a great sense of worth being able to work and provide service to public and home. Now I am totally dependant on my husband and family. My two children are grown, but I have never been there for them as I wish I could have been.

I am going, for a third time, for RF tomorrow. The first time I had it, the pain was even worse than when I went in, but as one of you mentioned, I woke one day and the pain was gone! But it only lasted about a year, then I bore the pain as usual for another year before I had another RF done. This second time, however, was horrible pain from which I received no relief. It didn’t work. That was in 2007. Then in Jan 2009, I was shopping and my back just “went out” and I had to have someone help me to my car. Long story short, I have new disk perforations in my back which are causing radiating pain down my right leg. The past was my left side. I am seeing a new doctor, but I again went through the steps leading up to the RF. The doc says he will do one side (the right since it hurts more) then in two weeks the other side, if I still have pain. I want ALL of it done at once, as I recall the pain of the procedure AND the pain afterward. I do not want to go back and do it again so soon. But I do have confidence that it will work because of the branch blocks relief last week.

I guess my point is, I empathize with back pain sufferers. I am sorry you have to feel that pain and still maintain the “I’m fine” face to the public. When clearly, we are not fine, but it gets SO old when all the people ask is “how’s your back” or “how you feeling today” when it’s pretty much always the same answer. I feel like doing the RF, even if as often as once a year, is worth it. Surgery was immediate relief, but therapy and healing was hard, and the cost was outrageous. I would have to go thru this RF procedure for 15 years to realize the cost of ONE surgery. So consider that as well. But it worked once out of twice, and I am hopeful for tomorrow’s procedure. The new doc I found has been absolutely nice and empathetic to the pain I must feel. And he has a sense of humor which I truly love. Laughter and positive attitude has been getting me through the pain the most.

Thank you for letting me “speak” and I wish all of you the best at whatever you try for pain. Laugh, breathe, find a happy place to visit in your mind. Mostly laugh—out loud!
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replied April 1st, 2009
Just had RFA 3 days ago...
I'm a nurse in orthopedic rehab...needless to say, 30% of my patients are back surgery..laminectomy/fusions/diskectomy/ro ds....and did my own personal reseach...most fail or have worse back pain (did you know there's a condition called FBSS...it fails so much there is a name....Failed Back Surgery Syndrome).
What started for me as siatica on my right side, turned into a blown out left knee, a limp, back pain, and tears and medication just to get through work. I have been going this for 2 years, and 4 doctors. Doctors say probably repetitive motion from lifting patients for years...after MRI/chiropractors/ steroid injections (epidural block), my doctor (athletic spine medicine) said "you need surgery...there's nothing else I can do for you."
That's when I asked my PCP if I could go to the pain clinic at Henry Ford Hospital in Detroit. Love the treatment and the doctors, but the wait for these procedures is crazy. I made my appt. in December, and after my 2 trials (MBB), it was a go because they were successful. (24 hours pain free....I did stairs and laundry and slept!!)
The day of the procedure, I couldn't turn without pain. When I sit, I usually don't have pain...only when I stand for 10+ minutes. (Real fun being a nurse.) Sitting/standing killed me, but I could lay down pain free...which I've done for the most of these past 48 hours. It feels like a rod is in my spine. BUT...the pain is all gone in my left leg, and I can stand up from our couch without help. I'm still on Neurontin/Motrin and Norflex for my spasms (post procedure which aren't severe, and the pain is present, but completely different. I can get up and down from the toilet without grabbing the sink...it's the little things for us pain suffers, isn't it? My doctor told me I could feel worse before better, as it takes 2 weeks for the nerve to "die". (I had the Pulsating RFA..think that's the right term vs. Cryo.) My right side is to be done May 26th, and I'm going through with it as of today. As my doctor stated, "surgery is the option for pain relief, and we still have some more things to try." He validated my thoughts after taking care of so many patients still in pain.
Obviously, this procedure is not without risks, but they are significantly less than surgery.
I hope to be able to post in the next 10 days with a great outcome.

Andrea
PS...Thanks Dr. Kim at HFH
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replied April 1st, 2009
It's ME again....
I also should have stated that I had L3-L4-L5-S1 levels done, and I'm 44 yrs. old. Since I have gained 50 pounds since this began (sitting and feeling sorry for myself)border on hypertension and have high cholesterol that didn't exsist before...before being very active....that when the pain decreses, I must strengthen my core (the only muscles that support the back). So, much of my recovery is up to me. God willing, I'll be able to be fit again.
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replied April 2nd, 2009
1st Day Back to Work after RFA
I ran around from 0730-1300...I can't believe it! Just a dull ache in my back...hope this is just the beginning....but I feel great again!
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replied May 9th, 2009
RFA 6 weeks out
Hi,
I had an RFA 6 weeks ago on L3,4,5,and S1. I too am waiting for teh "ache" to go away. The so called "neuritis" I can so relate to you. I had no idea it took the nerves
two weeks at least to die. I was beginning to think there was no hope for me at all!!
I am trying to remain positive!!
I am hoping I just wake up one of these days and boom no more pain.
That is my dream
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replied September 24th, 2009
I am scheduled for RFA but think I am going to opt out after reading much horrible stuff about it. Did your pain ever go away?
fc
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replied January 23rd, 2010
I had RFA Jan 21 2010 on L3/4 and L4/5. I had several epidural injections in the past yr and my opinion is that RFA was less painful. The day of the procedure I had an IV started and a sedative started right before the procedure. The sedative really helps and it felt like I was about 10% alert. At the end of the procedure I recall saying it only took about 5 minutes and the Dr said you were here for about 55min! They monitored me for about 30-45 min afterwords and was discharged. Drowsy for the rest of the day. The next day I was sore, but not much worse than before the procedure. Day 2 I feel really good and slightly better. I had tests to determine if I would be a candidate and I felt great for 1-2 days after the test (felt like I was a foot taller because I wasn't leaning over to compensate for the arthritic facet joints). If you had the tests to determine if you were an RFA candidate and they were successful, go for it. Some have said it was "brutal", but in my experience, it is not brutal. If you can tolerate and epidural injection, you can tolerate this...with the right Dr using a sedative. Also make sure the Dr. puts some steroid on the joint afterwards. Without a sedative and steroid on the joint after the procedure, I'm not sure how this would feel...guess...BRUTAL!
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