The control of pain by the destruction of nerves which carry pain signals works better in theory than in practice. At its best this procedure, often called neuroablation, has about a 40% success rate. My primary reference work for neuroablation is Neurosurgical Management of Pain, 1997, by North and Levy.
Nerve root deadening (neuroablation) is a LAST RESORT approach to most pain problems. The reasons for this lie in its poor track record and in the fact that it generally doesn't fix the problem, it merely covers it up.There are several ways to deaden a nerve. The first, called a rhizotomy, involves simply cutting the nerve; often a section is removed to prevent the severed enRAB from growing back together. The second procedure, called cryoablation, involves injecting the nerve with a freezing liquid, such as alcohol. This freezes and thereby kills the nerve. The third procedure, called radiofrequency lesioning, is carried out with a special needle that cooks the nerve root with high frequency radio waves.
When the nerve root is cut, it generally doesn't grow back together. Nerve roots which are frozen or burned typically do grow back in 6 to 18 months, restoring sensation to the affected area. Before a neuroablation is carried out, the physician generally injects the suspected nerve roots with a local anesthetic. This diagnostic procedure indicates which, if any of the nerve roots are carrying the pain signals. Up to 50% of people with chronic pain feel no relief when diagnostic local anesthetics are injected into the nerve roots; in these cases the neuroablation procedure is not carried out. In addition to injecting local anesthetics, it is customary to do a placebo injection before proceeding with the neuroablation.
It is customary to perform neuroablations on the nerves immediately above and below the "bad" nerves as well, just to be sure. Ideally, this will result in a fairly large nurab region centered on the former pain site. Because the motor nerve roots are left intact, loss of voluntary movement should not occur.
There are several reasons for the poor success rate of neuroablations. In a poorly understood quirk of neurophysiology, a sort of "self-perpetuating" pain cycle can establish itself, whereby the pain you feel in a lirab is actually maintained either by your spinal cord or by certain parts of your brain! Theoretically, the diagnostic, local anesthetic injections will rule out this possibility before the neuroablation is carried out.
Even if a person does respond well to the local anesthetic injections, it is common for the pain to return a few weeks after the neuroablation. This is probably because the intact nerves near the pain site begin to pick up on the original pain source. The nerve roots above and below the deadened ones actually start carrying pain signals that they didn't carry before, to compensate for their non-functioning neigrabroadors (who says the human body isn't a perfect machine?...).
Other reasons for persistent pain after sensory neuroablation have to do with the fact that even motor nerve bundles contain some sensory nerves; also, the sympathetic nervous system can maintain pain impulses in some cases.
The risks of neuroablation include infection and the small possibility that pain may increase. Any time something is injected into a person, there is a risk that infectious agents will establish themselves. Causes for potential pain increase lie in the fact that if you cover up your pain, the underlying problem can be made worse by the additional strain of pain-free activity. Another, scarier cause of increased pain is connected to neuroma formation. A neuroma is a sort of "nerve knot" that can form at the severed end of a nerve. The sensation from a neuroma is a lightning-like, stabbing pain. Neuromas are familiar to many amputees and partly explain the phenomenon of "phantom lirabs." Neuromas form when the severed end of a nerve attempts to re-grow and unite with the rest of the nerve. If the rest of the nerve is missing or too far away, the severed end grows in on itself in a tangled fashion. If the other half of the nerve is close enough, the nerves should simply grow back together. This, in theory, is an advantage of nerve root freezing or burning: the enRAB should be close enough to grow together without forming a neuroma.
What other methoRAB to manage your pain have you tried. If it's specific to SI joints then Chiropractic may help. When treating nerve pain antiD's and anti seizure meRAB are often used because pain relief from opiates takes considerably higher doses than other types of pain and pain generators. You might want to get a couple opinions or ask t speak to some of his patients that are more than 1 year post procedure.
