Should I Get A Radiofrequency Ablation?
Navigating Chronic Low Back Pain
Chronic low back pain is a widespread issue, affecting millions and significantly impacting quality of life. If you're one of those individuals, you know that finding effective, long-term solutions can be a frustrating journey. While interventional procedures like injections are often considered, it's crucial to understand the bigger picture and the significant role lifestyle factors play in managing your pain.
The Current Landscape of Interventional Procedures
Interventional procedures such as epidural injections, nerve blocks, and radiofrequency ablation have become increasingly common for chronic spine pain. The goal is usually to reduce inflammation, numb nerves, or destroy the nerves transmitting pain signals.
However, a recent clinical practice guideline has issued strong recommendations against many of these procedures for both axial (localized) and radicular (radiating) chronic spine pain. This guideline considered a comprehensive review of evidence and included the perspectives of patients living with chronic spine pain.
Why the shift? The evidence supporting the long-term effectiveness of these injections is uncertain. Furthermore, there's considerable inconsistency in clinical practice guidelines, with some organizations recommending injections while others advise against them. This highlights the need for a more holistic approach to managing chronic low back pain.
Chronic spine pain is defined as pain >3 months in duration. For those with pain in the spine, or pain the refers into the lower extremities, some fail traditional conservative management strategies such as physical therapy or chiropractic. Once they no longer see any benefit to these modalities, they are left with a very uncertain future. Do I do "pain management" and receive injections to my spine, or near my spinal cord? Do I do an ablation procedure which will effectively "burn" my nerves into not hurting (hopefully)? Do I have back surgery?
The interventional pain management route is becoming more and more common, and I see people daily who have either had face joint injections, epidural injections, radiofrequency ablations, or intramuscular injections. In my opinion, I felt that people with these procedures at large weren't doing that well. That leaves me with the question: is it me who is not getting people better? Or are most people with these procedures getting better, and only the ones who aren't doing well are coming to physical therapy?
This review was published in the British Medical Journal (BMJ) in February 2025. It was looking at people with both axial (midline) spine pain, and radicular spine pain (into the legs).
They were looking specifically at:
epidural injections (steroids, anesthetics, etc)
joint-targeted injections (steroids, anesthetics, etc)
intramuscular injections (steroids, anesthetics, etc)
dorsal root ganglion radiofrequency (with or without injections)
radiofrequency nerve ablations (with or without injections)
Here are their recommendations:
For axial spine pain (pain in low back):
strong recommendations against
epidural injection of local anesthetic, steroids, or combination
joint radiofrequency ablation with or without injection
joint-targeted injection of anesthetic, steroid, or combination
intramuscular injections
For chronic radicular spine pain:
strong recommendations against
dorsal root ganglion radiofrequency with or without injections
epidural injection of anesthetic, steroid, or combination
Now I'll be the first to admit, these are pretty shocking given how commonly these procedures are being done. In the article, they go on to discuss the fact not only are they largely not helpful when compared with placebo, they pose many potential adverse events, such as:
small risk of moderate to serious harms such as deep infection and temporary altered consciousness
very small risk of catastrophic harms such as paralysis and death
The Power of Lifestyle: Your Foundation for Pain Management
While injections pr ablations might seem like a quick fix, they often don't address the underlying issues contributing to chronic pain. That's where lifestyle interventions come in. These strategies empower you to take control of your health and manage your pain naturally.
Here's how key lifestyle factors can make a difference:
Diet: An anti-inflammatory diet can help reduce pain. Focus on whole foods like fruits, vegetables, lean protein, and healthy fats. Managing calories can be important if you need to lose weight. Most importantly, those with chronic pain need to steer away from highly processed foods and go for natural foods like meat, vegetables, and fruits.
Exercise: Regular physical activity is crucial for strengthening back muscles, improving flexibility, and reducing pain. A combination of cardiovascular exercise, strength training, and stretching is often most effective. This is, of course, a challenge if you have chronic back pain. Getting guidance on how to exercise with pain may be most beneficial.
Stress Management: Chronic stress can exacerbate pain. After all, the nervous system becomes senstivitve to physical stressors or emotional stressors. We only have one nervous system, so any kind of stressor will affect our pain levels. Practices like meditation, deep breathing exercises, yoga, and mindfulness can help you manage stress levels and reduce pain.
Sleep Hygiene: Poor sleep can worsen pain and increase inflammation. Sleep is the time when all of our natural healing processes take place. Prioritize getting 7-9 hours of quality sleep each night by establishing a regular sleep schedule, creating a relaxing bedtime routine, and optimizing your sleep environment.
A Holistic Approach to Chronic Low Back Pain
Managing chronic low back pain effectively requires a comprehensive strategy that considers all aspects of your health. Instead of relying solely on interventional procedures, focus on building a foundation of healthy lifestyle habits.
Here's a possible roadmap:
Consult with your doctor: Discuss your pain management options and get a thorough evaluation to rule out any underlying conditions.
Prioritize lifestyle changes: Implement the dietary, exercise, stress management, and sleep hygiene strategies.
Consider alternative therapies: Explore options such as physical therapy, chiropractic care, acupuncture, and massage therapy, which can complement your lifestyle efforts.
The Bottom Line
Chronic low back pain can be challenging, but it doesn't have to rule your life. By prioritizing lifestyle factors and adopting a holistic approach, you can take control of your pain and improve your overall well-being.
As always, I will leave you with this.
If you feel like you might need some help navigating the healthcare system, then I've created some content just for you. These programs are meant to teach you about orthopedic conditions and allow you to implement changes in your own body in as little as 4 weeks!
www.resilientbodyinstitute.com/programlist
If you need any help with any of the information I've given or the questions I've asked, please email me at [email protected]
*This is not intended to be medical advice. If you are experiencing pain, always consult with a physician.
If you believe this to be an emergency, please call 911 and seek medical attention.
References:
Wang X, Martin G, Sadeghirad B, Chang Y, Florez ID, Couban RJ, Mehrabi F, Crandon HN, Esfahani MA, Sivananthan L, Sengupta N, Kum E, Rathod P, Yao L, Morsi RZ, Genevay S, Buckley N, Guyatt GH, Rampersaud YR, Standaert CJ, Agoritsas T, Busse JW. Common interventional procedures for chronic non-cancer spine pain: a systematic review and network meta-analysis of randomised trials. BMJ. 2025 Feb 19;388:e079971. doi: 10.1136/bmj-2024-079971. PMID: 39971346.
