“I’ll be a suck-egg-mule” is about what I was ready to cry out during one of the injections I had for my neck pain. My doctor, “Dr. B.,” took good care of me. She used imaging to guide the needle from my upper back, and I remember the push through the tissue and the moment it went through the joint capsule. She kept using lidocaine, yet I still nearly cried.
I really did like Dr. B. She had an amazing sense of humor, which really helped me through those procedures. When she said, “Okay, here’s a little pinch.” I replied, “Pffft! Little Pinch?! You’re violating my skin with using a javelin-sized needle!”
She replied, “Well then, here’s a sharp poke!”
“Much better!”
I’ve never learned my lesson; always be a wiseacre AFTER a medical procedure is completed.
I’ve had 11 radiofrequency ablations in my neck. The pain eased quite a bit for a while, and I was grateful for the break. Then it came back.
When somebody asks whether the treatment worked, I have to give them both halves of the answer. If you’re deciding whether to go through a procedure, how much it helps and how long it helps are two different things. You want to hear about both before you get on the table.
Radiofrequency ablation (RFA) uses heat to disrupt pain signals carried by small nerves that serve the facet joints, which help the spine move. A doctor can also inject anesthetic near a nerve to see whether temporarily blocking it eases the pain, while an injection into the joint itself is a separate procedure.
From the National Library of Medicine:
Over the past two decades, lumbar facet blocks and RFAs have gained wide acceptance for the treatment of low back pain (LBP). The accumulation of evidence from ongoing studies continues to put the indications, effectiveness, and overall clinical role of these interventions into sharper focus.
In an effort to circumvent this problem, the American Society of Regional Anesthesia and Pain Medicine initiated a guideline development process among a number of pain societies and U.S. Department of Veterans Affairs and Department of Defense members. A steering committee set and strengthened 17 key questions using a modified Delphi process, aiming for expert consensus.
The questions covered topics such as the application of physical examination and imaging for selection of patients, conservative regimens before blocks, whether to use MBB or IA injections for diagnosis and prognosis, and optimal procedural technique with sedation, amount of injectate, and placement of electrodes.
The result was complete consensus between committee members on all questions except for one of the participating societies, which had two differences (number of blocks and the cut-off before a positive block before RFA), but still supported the overall guideline
Researchers at the University of Washington are asking whether they can better predict who will benefit from ablation. A $4.64 million grant from the National Institutes of Health will support a four-year study of persistent low back pain that may come from the facet joints.
The researchers plan to recruit 750 adults scheduled for lumbar ablation and follow their outcomes. They’ll use data from the ongoing ASTRAL trial to check their predictions. ASTRAL compares different ablation techniques.
They’re studying the lower back. My procedures were in my neck, and the grant announcement gives us a research plan, with answers still ahead. What caught my attention was the question the researchers are taking seriously. Two people can go in for the same procedure and come out with different amounts of relief. If researchers can figure out which differences they can spot ahead of time, a doctor could give the next patient a better answer than an average from a group of strangers.
If I were sitting in the exam room weighing another one, I’d want to start with what happened last time. How much did I improve? How long did it last? What makes the doctor think the same joint or nerve is involved now?
I’d also want to talk about how much the injections hurt and what we could do about that. It’s easier to have that conversation in an exam room than when you’re already on the table trying to decide whether you’re about to holler something about a mule.
I don’t begrudge a single day my neck hurt less. When you live with pain, temporary relief can be worth a lot. I can remember how much the injection hurt and still be glad I got some relief. Both belong in the conversation if I’m asked to do it again.
The next patient should hear what the doctor knows about the likely benefit, how long it might last, and where the best answer is still a guess. Then the patient can decide what that stretch of relief would be worth.