Five Things You Didn't Know About Nerve Burning For Back Pain

A relatively recent method of treating pain, nerve burning (also called rhizotomy or nerve ablation), works by impairing the nerves that carry pain signals to the brain. It is a minimally invasive procedure that provides lasting relief for those living with chronic pain.  

As a reliable method of pain relief that can be employed when all else fails, nerve burning naturally raises many questions in the minds of anxious patients. Here are five things you didn't know about nerve burning, courtesy of Atlas Pain Specialists, whose mission is to provide high-quality pain management to individuals who need it.   

1. Patients feel pain relief from nerve burning differently 

Nerve burning can be done in different ways, for example, using heat, cold, or chemicals. What the procedure is called depends on how it is done, for example, it may be called radiofrequency ablation, cryoablation, neurotomy, or rhizotomy. 

Patients respond differently to these procedures and may have long-term or short-term pain relief. Pain relief can be immediate in some people, occurring within 10 days in other people, or may take up to three weeks in others.  

The patients also get pain relief for varying amounts (6 months or more than 2 years). The nerve may regrow through the burned lesion that was created by radiofrequency ablation. If the nerve regrows, it is usually 6-12 months after the procedure. 

Though nerve burning is 70-80% effective in people with successful nerve blocks, it may not be effective for everyone. At Atlas Pain Specialists, we will first identify the cause of pain before deciding the best long-term treatment plan for you.      

Because it is likely that you will still have some lingering pain during your recovery, you may be given instructions to apply ice or heat to the area to relieve the pain. You may also receive a prescription for a pain reliever or be given medication directions for over-the-counter painkillers. 

It's very common for patients suffering from chronic pain to become deconditioned since they find it difficult to remain active with their pain. If you lack strength, your doctor may prescribe physical therapy sessions to help them gain strength again. 

Over time, the treated nerves will grow back, but you may not experience the pain again. If the pain does reoccur with nerve growth, your pain management specialist may recommend a second procedure to relieve your pain.   

2. The Nerve Burning procedure only takes 20 minutes to an hour or longer 

There are several types of rhizotomy, all of which involve destroying the fibers within a nerve that carry pain signals. Depending on the location of the nerve and type of nerve burning the length of the procedure takes between 20 minutes to an hour.    

Glycerin/Glycerol Rhizotomy 

With this type of rhizotomy, a surgeon uses a needle to deliver a small amount of a chemical (glycerin or glycerol) to the root of the affected nerve. The chemical destroys the pain fibers in the nerve over the course of 45 to 60 minutes.  

Radiofrequency Rhizotomy 

Radiofrequency rhizotomy (also known as radiofrequency ablation) is similar to the glycerin rhizotomy, but instead of using a chemical to destroy the nerve fibers, a radiofrequency current is used to burn the fibers. It is often used for patients who do not get complete relief from glycerin or those who have recurrent pain and may need assistance to get through scar tissue.  

Endoscopic Rhizotomy 

With endoscopic rhizotomy, a surgeon uses a camera device called an endoscope to locate the affected nerve and sever its fibers. The endoscope is inserted through a small incision via a series of tubes called a tubular retractor system.

This allows the surgeon to get to the nerve while bypassing healthy organs and tissues. This procedure is also called direct visualized rhizotomy and takes 30-45 minutes on average  

Radiofrequency neurotomy is an outpatient procedure, so you'll go home later that same day. 

You'll wear a hospital gown and lie on your stomach on an X-ray table. An intravenous (IV) line will be placed in your arm or hand to deliver medication that will keep you comfortable during the procedure. 

Numbing medication will be injected into your skin before the radiofrequency needles are inserted. The provider will the use a special X-ray machine (fluoroscope) to guide the radiofrequency needles to the precise area — so only the targeted nerve tissue will be treated.  

Most patients can walk around immediately after the procedure. After being monitored for a short time, you can usually leave the office or suite though someone must drive you home. 

Patients may experience pain from the procedure for up to 14 days, but this is generally due to the residual effects of the nerve ablation or muscle spasm. Patients are often up and around and back to work 24 to 72 hours after the procedure. Pain relief is typically experienced within 10 days, although relief may be immediate for some patients and take up to three weeks for others. 

Patients should schedule a follow-up appointment with the referring or treating physician after the procedure to document the efficacy and address any concerns the patient may have for future treatments and expectations.  

3. Nerve Ablation is not as painful as you might think 

Since nerves are involved in transmitting pain signals, the concept of "nerve burning" may create an emotionally distressing picture. However, while everyone has a unique reaction, the truth is that it is a lot less painful than you may imagine. 

There are cautionary steps taken to ensure that the procedure is as painless as can be: After all, the goal here is to reduce the pain caused by the damaged nerve. Some of these steps include: 

• Taking note of any allergies and current medication 

It is standard practice to have patients sign consent forms, detail their medications, and disclose any drug allergies at the time of the surgery. Even if you're not allergic to any medications that might be used during the surgery, it's still vital to know what you're taking right now because some medications interact badly with others. 

• Numbing the injection site 

You may be worried about the thought of the doctor poking under your skin to find the damaged nerve. The injection site will be sterilized and numbed so that neither the injection nor the pain will be felt. 

The injection site is numbed with minimum discomfort as the patient lies on an x-ray table. They are awake and able to provide input to the doctor throughout the process.  

• Administration of a low-dose sedative 

Usually, the sole medicine used for this procedure is a low-dose sedative like Valium or Versed (Midazolam). A sedative or tranquillizer is a drug used to calm an anxious or agitated person. 

They have a depressive effect on the central nervous system and slow down mental processes, and are effective in alleviating anxiety and stress. You may feel tingling all over your body, especially in your limbs.  

• Imaging guidance to the target nerve is used. 

Diagnostic blocks are performed to determine the origin of a patient's pain. A similar technique is used when burning the associated nerve.  

A fluoroscope (a type of x-ray) helps the doctor guide a thin hollow needle to the source of the pain. With fluoroscopy, the doctor can see the needle in real-time on the monitor, ensuring that it is inserted precisely where it needs to be. 

Numbing medicine is given to the patient after the needle has been inserted. Patients may experience some pain; however, it is often experienced more as pressure than actual pain. 

Injection of contrast material can verify that the needle is in the right spot. Depending on the type of nerve burning, the pain-transmitting nerve fibers are burned, and the pain signal is disrupted.  

One nerve can be burned in about 90 seconds, and many can be burned simultaneously. 

• Post-procedural precautions 

Common adverse effects of injections include temporary pain or burning comparable to what you experienced before the surgery. You will likely have to wait in the clinic for 30 to 45 minutes or more to ensure that there are no complications. 

It is important to manage potential complications like internal bleeding or site bleeding to prevent further discomfort. Depending on how well you tolerate the anaesthesia, you could return to work as soon as one or two days after surgery. 

4. Burning Nerves for pain can also be used for neck and knee pain 

Typically, nerve burning is used to treat pain in the back, hips shoulders, and buttocks (sacroiliac joint). Nerve burning can also alleviate chronic pain in the knees and neck. 

Here at Atlas Pain Specialists, our focus is on free pain living, including treatment and preventative measures. We may try a number of different therapies for your knee injury, and if it doesn't improve, we may resort to genicular nerve burning if necessary, but this depends on the root cause of your pain. 

The knee is prone to wear, strain, and blunt force damage from accidents or degenerative diseases. The pain alleviation by genicular nerve burning can last for up to 18 months, and if it wears off after that, you can have the procedure done again in 6-12 months. 

Nerve burning can also be used to treat neck pain. Multiple nerves can be treated at once during this procedure, typically requiring around 2 weeks of recovery time. 

Doctors inject a topical anesthetic into the painful neck area, then introduce a needle and probe into the afflicted nerves. Doctors may utilize a live X-ray of your spine to put the probe accurately.  

5. It's non-invasive and contains very few risks 

One of the benefits of radiofrequency nerve ablation is a short recovery time. Patients can get back to their daily routines between 1-3 days after the procedure.  

It's not uncommon to feel some discomfort, superficial burning pain, or hypersensitivity in the area of the procedure. Some patients describe the feeling as similar to a sunburn. 

Nerve burning is a relatively safe procedure with minimal risk of complications. The risks associated with nerve burning depend on the type of procedure and which nerves it's performed on.  

Glycerin/glycerol rhizotomy risks include bleeding, infection, nausea, vomiting, a small chance of sensory change (feeling of numbness), and anesthesia complications. Radiofrequency rhizotomy has a higher likelihood of causing sensory change (feelings of numbness) than the chemical method. 

The advantages of nerve burning include:   

• Pain relief. 

• No surgery. 
• Return to regular activities after a day or two of rest. 
• Little to no recovery time. 
• Decreased need for pain medications. 
• Improved function. 

When heat is used to damage the nerves, various precautionary methods are taken so that nearby nerves aren't damaged. Nerve burning is done using fluoroscopic (x-ray) guidance and should NOT be performed on people who have an infection, are pregnant, or have bleeding problems.   

The complications reported include a temporary increase in nerve pain, neuritis, neuroma, localized numbness, infection, allergic reaction to medications used during the procedure, and/or lack of pain relief (in less than 30% of patients).    

The risk of complications from RFA is very low. On occasion, permanent nerve damage or pain can occur. In some people, their original pain may get worse. Other complications, including infection and bleeding at the needle insertion site, are uncommon.   

These symptoms are typically not severe; however, the pain may sometimes be troublesome and may last several weeks. While these symptoms are less common in the mid and low back, they may be more common at higher levels of the neck. These side effects may be due to increased irritation of a nerve that was only partially damaged and may still possess some function.  

The medial branch nerves control some small muscles in the neck and mid or low back, but the loss of these nerves usually does not cause any significant loss of motor function. The lateral branch nerves do not control any muscles or sensations in the arms or legs, so a heat lesion poses less danger of negatively affecting those areas. 

There may be a concern that without the ability to feel sensation through the treated nerves, an injury to either the neck or back may be caused. There is, however, no scientific evidence to support this concern. In fact, in the many years that neurotomies have been performed, patients have not been found to be at an increased risk of injury.  

Radiofrequency ablation procedure-related risks. A few examples of risks associated with the RFA procedure are Hyperesthesia—an excessive, abnormal sensitivity over the skin of the injection site. 

• Damage to surrounding blood vessels and nerves during needle insertion resulting in excessive bleeding and/or irreversible neurologic damage causing long-term numbness and tingling 
• Heat damage to structures adjacent to the target nerve 
• Superficial skin infections over the injection site 

• Allergic reaction to the anesthetic used to numb the skin 
• Apart from these risks, muscular tissue damage and itching at the injection site may occur in some cases.  

Sedation-related risks. Although the use of sedation is rare, mild to moderate sedation or general anesthesia may be used during the RFA procedure in some cases. In rare cases, allergic reactions and respiratory depression (breathing difficulty) may result from the sedation process. 

As with any injection procedure, treating a facet or sacroiliac joint with radiofrequency ablation must consider benefits versus risks carefully. Discussing and understanding the potential risks of radiofrequency ablation with a doctor is advisable before opting for this treatment method.  

Frequently Asked Questions 

Is nerve burning considered surgery? 

Nerve burning is not considered a surgery. It's considered a minimally invasive procedure. This means the procedure is performed using methods that access your body with the least amount of damage or disruption to your skin and tissues. In general, minimally invasive treatment methods lower the risk of infection and other complications, reduce the length of hospital stay, lessen the amount of pain experienced and shorten recovery time.  

Radiofrequency ablation (RFA) uses heat to destroy tissue. When used for pain management, heat is used to target specific nerves that cause you pain. Heating the nerve stops or reduces pain signals from reaching your brain. RFA is considered for long-time pain conditions involving your spine after other methods, such as pain medication and physical therapy, have not been successful. RFA is helpful for many people who decide to have the procedure. Talk with your provider to see if RFA is right for you.  

What if nerve burning doesn't work? 

Nerve burning is a treatment option for patients who have experienced successful pain relief after a diagnostic nerve/pain receptor block injection. Like the mentioned procedure, rhizotomy doesn't offer a 100% success rate for 100% of patients who undergo it. 

A small percentage of people may feel no significant pain relief after rhizotomy. And those who do get the desired pain relief may experience the pain gradually returning after several years as the nerve regrows. 

It's best to consult with your doctor to determine whether a second rhizotomy, another type of rhizotomy or another treatment will offer the most pain relief if the pain comes back. Depending on the origin of your pain, other treatment options could include decompression surgery to remove or move aside tissues pressing on the nerve.