Dorsal Root Ganglion Pulsed Radiofrequency Denervation Or Dorsal Nerve Root Pulsed Radiofrequency Neurotomy

The Persistent Pain Solutions clinic offers innovative methods for the long-term treatment of neuropathic or radicular back pain, such as dorsal root ganglion pulsed radiofrequency denervation and Nerve root pulsed radiofrequency denervation.

The dorsal root ganglion, located in your spine, plays a key role in transmitting pain signals to your spinal cord and brain. It receives its signals from the periphery (arms, legs, trunk) via the sensory branches of the spinal nerves. 

A dorsal root ganglion or nerve root pulsed radiofrequency denervation numbs or incapacitates these nerve structures,  ensuring those pain signals are targeted and disrupted. The procedure modulates nerve function via electrical stimulation and it can result in longer-term pain relief. This helps alleviate your chronic pain.

Dorsal root ganglion/ nerve root pulsed radiofrequency denervation treats neuropathic pain in the upper and lower limbs, hips, groin, and hands that is caused by various conditions such as chronic post-surgical discomfort following spine surgery or nerve compression due to herniated discs or spinal arthritis. 

Dorsal root ganglion/ nerve root pulsed neurotomy can also be used to treat radicular pain in the lower limbs commonly known as sciatica and brachialgia which is neuropathic pain in the upper limbs. Unlike heat radiofrequency neurotomy where the nerve is disrupted by creating a heated lesion at 85C, pulsed radiofrequency neurotomy uses electrical signals at low heat (42C) to disrupt pain signals without destroying the nerve. 

Patients who are considering this procedure first undergo Dorsal root ganglion/ nerve root blocks as a diagnostic procedure to ensure that the source of the pain is verified. If the patient experiences temporary pain relief from a block, then they are recommended a pulsed radiofrequency procedure as a therapeutic procedure to achieve longer lasting pain relief. 

Dr Meena Mittal uses dorsal root ganglion/ nerve root pulsed neurotomy and other types of nerve ablations or denervation techniques to alleviate focal pain or interrupt the transmission of pain signals to your brain. This method often results in a distinctive reduction in neuropathic or radicular pain, enabling you to live a more fulfilling life. 

What is a Dorsal Root Ganglion Pulsed Radiofrequency Neurotomy?

Dorsal root ganglion pulsed neurotomy (also referred to as dorsal root nerve ablation or denervation)  is a minimally invasive procedure to treat chronic pain by disrupting pain signals from a specific nerve cluster in the spine called the dorsal root ganglion. 

An electrode is inserted near the targeted ganglion, and radiofrequency waves are used to inhibit its ability to transmit pain signals. This can provide significant relief from conditions like chronic neuropathic pain affecting the lower limbs, upper limbs or truncal regions.

However, like any medical procedure, there are risks to getting a dorsal root ganglion neurotomy, and the effects may not be permanent, sometimes requiring repeat treatments.

How Does a Dorsal Root Ganglion Pulsed Neurotomy Alleviate Chronic Pain?

A dorsal root ganglion neurotomy alleviates chronic pain by disrupting the transmission of pain signals from the dorsal root ganglion to the brain. Here’s how the procedure works in a nutshell:

• Disruption of Pain Signals. The procedure involves using electrical signals at 42C to disrupt pain signals in the dorsal root ganglion. 
• Inhibition of Pain Transmission. By doing this, the DRG pulsed neurotomy effectively inhibits or reduces the nerve’s ability to send pain messages to the central nervous system.
• Pain Relief. With the disruption of these pain signals, patients often experience a significant reduction in chronic pain.
• Modulation of Pain Pathways. The procedure can modulate the neural pathways involved in transmitting and processing pain, thereby alleviating the sensation of pain in the affected area.

In essence, by targeting and disrupting the function of the dorsal root ganglion, a nerve ablation or neurotomy interrupts the pathway that allows chronic pain signals to reach the brain, providing relief. 

Why Would You Get a Dorsal Root Ganglion Pulsed Neurotomy for Chronic Pain?

Dorsal root ganglion pulsed neurotomy is commonly used to treat various types of chronic pain conditions, including postherpetic neuralgia (pain following shingles), peripheral neuropathies, radicular pain from sciatica or similar issues, and chronic leg and arm pain. It is considered in situations where patients experience a temporary benefit from dorsal root ganglion or nerve root blocks. It generally takes up to 6 weeks to take effect and the pain reduction can last anywhere from 6 months to 3 years. The expected benefit is anywhere between 50-80% reduction in pain. The procedure can be repeated if the pain returns.

The Risks of Dorsal Root Ganglion Pulsed Neurotomy

Dorsal root ganglion pulsed neurotomy is generally considered safe, but like any medical procedure, it carries some risks and potential complications. 

Here are the risks associated with this treatment:

• Infection. Any invasive procedure carries a risk of infection at the needle insertion site or around the treated area.
• Nerve Damage. There’s a possibility of damaging nearby nerves during the procedure, which can lead to sensory or motor deficits, numbness, or tingling.
• Incomplete Pain Relief. The procedure may not provide complete pain relief for all patients, and the pain may return over time.
• Pain Flare. There may be temporary increase in the pain for a few days after the procedure, this generally settles down quickly.
• Temporary Side Effects. You may experience temporary side effects such as swelling, bruising, or discomfort at the injection site.
• Rare Complications. It is rare, but serious complications can occur, including bleeding, allergic reactions to medications or contrast agents used during the procedure, or damage to surrounding structures like the spinal cord resulting in temporary or permanent damage causing weakness, numbness, bowel and bladder dysfunction. 
• Need for Repeat Procedures. The effects of a dorsal root ganglion neurotomy may not be permanent, and you may require repeat procedures for sustained pain relief.
• Failure. The procedure may not provide the required pain relief in which case other options may be discussed during the follow up appointment. 

It’s essential for patients to discuss these risks with your doctor and to weigh them against the potential benefits of the procedure. Careful patient selection, proper technique, and post-procedure monitoring can help minimise these risks. 

The Process of Getting a Dorsal Root Ganglion Pulsed Neurotomy

The process of getting a dorsal root ganglion pulsed neurotomy typically involves several steps, from initial consultation to post-procedure care. 

Here’s a general outline of the process from the initial consultation to the follow-up:

1. Initial Consultation.
   • Meet with your pain management specialist to discuss your chronic pain symptoms, medical history, and previous treatments.
   • The doctor will evaluate your condition and determine if dorsal root ganglion neurotomy is an appropriate treatment option for you.
2. Preparation.
   • If deemed suitable for the procedure, you may undergo some pre-procedure tests, such as imaging studies, to ensure you’re a good candidate.
   • Discuss any medications you’re currently taking with your doctor, as some may need to be adjusted or temporarily stopped before the procedure.
3. The Procedure.
   • You may be asked to fast for several hours before the procedure. (if performing under sedation anaesthesia)
   • The procedure is usually performed in an outpatient setting under local anaesthesia and CT guidance or in a hospital setting under sedation and X-ray guidance.
   • You’ll be positioned on an operating or CT table, and the skin over the treatment area will be cleaned and sterilised.
4. Procedure Steps.
   • Under fluoroscopic or CT guidance, a needle with an electrode is inserted near the target dorsal root ganglion.
   • The electrode’s position is verified through stimulation and sensory testing to ensure it’s targeting the correct nerve without affecting nearby nerves.
   • Once confirmed, radiofrequency waves are applied to the nerve, disrupting its ability to transmit pain signals.
5. Post-Procedure Care.
   • After the procedure, you’ll be monitored for a short period in a recovery area.
   • You may experience some soreness or discomfort at the needle insertion site.
   • Pain relief from the procedure can take up to six weeks to become noticeable.
   • You will be requested to complete a Pain chart such that Dr Mittal can assess for the response.
6. Follow-up.
   • Schedule a 6 week follow-up appointment with your doctor to evaluate the effectiveness of the procedure and monitor for any complications. You will be required to bring the completed Pain Chart to the follow up appointment. 
   • Discuss any ongoing pain relief, changes in symptoms, or the need for repeat procedures in the future.
   • If you have not had a complete response to the procedure, then further management like medications, psychology, physical therapy may be discussed. 
7. Recovery and Rehabilitation.
   • You may be advised to avoid strenuous activities or heavy lifting and attending a public pool for a few days after the procedure.
   • Physical therapy or other rehabilitation programs may be recommended to help maintain pain relief and improve function.

Throughout the process, it’s essential to communicate openly with your doctor about any concerns or questions you may have. They can provide guidance, support, and personalised care to help you manage your pain effectively.

Preparing for a Dorsal Root Ganglion Neurotomy

Getting a dorsal root ganglion neurotomy at the Persistent Pain Solutions clinic typically doesn’t require any special effort or activities on your end. Please disclose all medications you may be taking and note that you may have to discontinue some or all of them immediately prior to the procedure.

However, you will likely receive sedation for the procedure, which requires fasting for six to eight hours beforehand. Additionally, you will not be able to drive yourself home, so you must arrange transportation. 

Your doctor will provide specific guidance tailored to your situation, and be sure to follow your instructions carefully. If you have any concerns or queries, don’t hesitate to ask them.

After Getting a Dorsal Root Ganglion Neurotomy (Follow-Up) 

After your dorsal root ganglion neurotomy, you can return home the same day after a short period of observation. There are no specific restrictions on your day-to-day activities, but you should prioritise rest and stick to more gentle activities during the initial 24-48 hours after getting the denervation procedure. It is best to avoid attending public pools for 1 week to minimise the risk of infection.

You may experience some discomfort or bruising. Also be aware, that it’s typical for pain to slightly increase after the local anaesthetic wears off, but it should dissipate after that. 

Procedures such as dorsal root ganglion neurotomy or pulsed radiofrequency denervation are designed to provide long lasting pain relief. Please feel free to reach out to Dr Mittal and her team with any questions or concerns during your recovery period.

Finding a Doctor Who Performs Dorsal Root Ganglion Neurotomies Near You

If you are suffering from chronic neuropathic or radicular pain, then a pain specialist who can perform a dorsal root ganglion pulsed neurotomy or denervation may be able to help.

Get started by asking your general practitioner for a referral to a pain management physician who offers dorsal root ganglion pulsed neurotomy or similar procedures designed to alleviate chronic neuropathic or radicular pain. 

Also, check with family members, friends, or support groups (both online and in real life) for recommendations from those who have dealt with similar challenges and found paths to positive outcomes. Researching pain management clinics in your area is a good way to start your path towards relief as well. 

Dorsal Root Ganglion Neurotomy at Persistent Pain Solutions

Dr Mittal and her team at the Persistent Pain Solutions clinic provide dorsal root nerve ablations or neurotomies as well as dorsal root ganglion nerve blocks, procedures designed to alleviate  neuropathic and radicular pain stemming from issues like sciatica, post-surgical complications, arthritis, or similar conditions.

If the initial diagnostic dorsal root ganglion nerve block alleviates your back pain, then we utilise dorsal root ganglion nerve ablation or neurotomy, a technique where a small portion of nerve tissue is incapacitated, interrupting pain signals and  providing long-term relief from chronic leg and arm pain.

This procedure targets the dorsal root ganglion nerves at the posterior or base of the spine. Dorsal root ganglion neurotomy can alleviate some back and limb pain and enable you to effectively engage in rehabilitation and physical therapy or otherwise function better in your everyday life.