SI Joint Radio Frequency Nerve Ablation

Man, that's a complicated title.

Radio Frequency Ablation in the nerve endings around my SI joint and lower spine....

Essentially, the nerve endings are burned... killed... lesioned... in hopes that it will give me some temporary relief by preventing those nerves from sending pain signals; so that my nerves and brain don't quite register the pain of the crumbling joints. 

The whole process of RFA is a difficult one. First they did two rounds of injecting numbing agents to the nerve endings they plan to burn. I won't lie - these procedures are brutally painful and the freezing only lasts a few hours. They are, however, necessary. It is to ensure that I was a candidate for the ablation. 

As with all procedures, the ablation comes with risks - and some are frightening. They have to make sure they have the right position, the right nerve endings, and that the body doesn't respond poorly. So the numbing injections have to be done... twice... before they can attempt the ablation itself. 

I am not going to tell you that the block freezing feels 'like a pinch'. It doesn't. It hurts a lot more than a pinch. If you have had Cortisone injections into your SI Joints, then that is probably the closest comparison I can make, except slightly worse because it is more than one location where they inject a needle. For me, it was four spots on either side. Eight brutal injections - some worse than others. To be very frank, I nearly vomited from the pain alone at each and every stage

. 

BUT - that sharp, nauseating, deep pain from the needle and the freezing entering the joint only lasts seconds. After a few excruciating seconds, it settles to an ache. Then, after the first round - after I had done it once and knew I could get through it - the subsequent injections were easier to handle mentally. Time did not seem to go as slowly during the second round of block freezing injections. 

Then came the actual Radio Frequency Ablation. 

This procedure is an extension of the freezing procedures. They still have to do the freezing injections before they burn the nerves - so I cannot say it is less painful. 

BUT - the amount of freezing given is quite a bit more (my back remained numb for over a week after my first ablation procedure). So when they insert the large gauge needle and thread in the electrode, it very truly does feel like pressure on the back, as opposed to pain. Obviously freezing does not permeate every spot perfectly every time, so there were moments when I felt pain, but they were few and far between. 

Then came the actual burning. Again, if I felt some pain from the burn (which did not happen every time), it was manageable. The burning 'machine' has a rhythmic beeping to it that lasts 2 minutes. 120 seconds. So the day before my first ablation procedure, I prepared several songs that are around 2 minutes long*. That way, when the doctor said the burning would start, I would begin humming or singing one of those songs in my head (or out loud) until the beeping stopped.  

It was a very important distraction and worked beautifully the first round. 

The second round (yesterday) was more painful. It seemed more complicated in that it took longer to find the correct needle placement. This meant stopping and starting, some extra freezing (which hurts the most in these procedures - for me, anyways), and testing the nerve. Essentially, testing it feels like a small electrocution that sends pain signals into the si joint, hip, and down the legs. It isn't pleasant. (It's even worse when the doctor says to 'turn up the voltage'). But it is all necessary to ensure positive results. By the last burn, I was feeling nearly desperate for it to be over. When the last burn started, I could feel quite a bit of pain, though not entirely unbearable. I had a choice whether to stop, add more freezing, then start again, OR grit my teeth and bear it for 120 seconds. I did the latter. I could not hum my songs during this, it was too painful, so I focused on rhythmically breathing in and out slowly and trying to relax as many muscles as I could. 

The most fascinating part for me was during the first burn in my left side. It was the first ablation procedure. I could not feel any pain, just some pressure in my back from the needle, but my body responded to the pain I wasn't feeling. This wasn't fun, but it was super interesting. It felt as if someone had placed a heating pad on my stomach from the inside, which resulted in some sweating and nausea, along with a 'pit in my stomach'. I felt like I might vomit, but it subsided within about 30 seconds. 

All of this is in an effort to give me a bit of pain relief from the damage my Ankylosing Spondylitis is doing to my spine and joints. It will hopefully allow me to move a bit better, walk a bit better, and feel a little less pain every day, hopefully for a year. They say it can last 6 months or longer - so I'm crossing my fingers that I will experience more of the long-term relief. Then I get to do the ablation procedures over again: IF it works. I will have to wait 3 weeks or more before the results of this procedure are even noticeable. Until then, my joints will remain achy and inflamed from the procedure itself. 

I'll update in a month whether I feel these procedures were worth it - but I remain optimistic!! 

If anyone has any questions about my experience please feel free to message me at any time. ❤❤

**

The songs I chose that seemed to fit the best with the timing of the burn included:

Sentimental Journey

Tea for Two

Bushel and a Peck

Side by Side

Chapel of Love

Glory of Love

Moon River 

Nerve Freezing

Last week I had my first appointment of having my nerves frozen in my SI joints in preparation for nerve ablation. 

The preparation for the ablation is brutally painful, but necessary. In order to ensure that my body will tolerate severing the nerves, they need to test my body's response to freezing. 

Essentially, if I have some relief without a great deal of complications, then we can go forward with ablation.  

Here is how the appointment went: 

Mask on, I was prepared for a procedure similar to cortisone injections into the SI joints. I was unaware, however, that they would be injecting both sides AND injecting freezing into multiple locations. Luckily, I found this out before the procedure began. 

I had to be face-down on the table as the doctor and technician prepared my back. I wore a dress for easy access (and so that I wouldn't have to try to put pants on over the injection sites afterwards). The technician and the doctor were both very calming and as gentle as possible. Unfortunately, shoving a needle into an inflamed joint to freeze an irritated and inflamed nerve is, very obviously, going to be painful. 

I don't want to deter anyone from getting this procedure done, but I also want to be completely honest. The procedure was brutal. After the first couple of injections, I became extremely nauseated, sweaty, and felt as though I may vomit from the pain (thinking in my mind that I was about to vomit into a mask), but I was able to push through. I know that I could have asked the doctor to take a second, but I also wanted the procedure over with. 

He was extremely efficient and was very adept at trying to get me thinking about other things. 

At one point, the needle grazed the nerve, and I felt a 'funny bone' type of zing down my right leg. It was not as painful as some of the other sensations, so it acted as a kind of odd distraction. It was fascinating, so I was actually happy for that particular moment. 

All in all, the needling itself lasted no more than 15 minutes (times vary for each patient of course). So I kept focusing on my breathing - trying to breathe out heavily during each entrance of the needle - and tried my best not to flinch or tighten my buttocks too much. (I find it amazing how, if properly prepared, we can stay relatively still as someone is inflicting pain). 

Unfortunately, these freezing tests, when done without the use of Cortisone, only provide relief for approximately six hours. So it doesn't quite feel worth it. It is a means to an end, though. The relief from actual nerve ablation could last 6 months or more! 

I have one more set of freezing tests and then the nerve ablation will be scheduled. I'll let you all know if I have found it worth it once the relief from the ablation is evident (likely a few weeks after the procedure itself). 

Summary: 

Nerve freezing feels similar to Cortisone injections, with a bit more of an intense pain during the procedure and more locations. So it is a bit more painful, a longer procedure, and multiple injection sites. BUT it is also a quick procedure. Now that I have been through it once, I am more confident going into the second appointment. It will be rough, but it doesn't take long.