Pain Medicine Expert Opines On Standard Of Care For Radiofrequency Ablation Treatment

Case Overview

The case involves a young man who underwent radiofrequency ablation to address his refractory chronic pain. During the procedure, the patient suffered a bowel perforation from thermal injury which resulted in the placement of a colostomy bag. The patient was told that he would be able to have the colostomy bag reversed, but his bowel function still has yet to be restored. An expert in pain medicine, familiar with radiofrequency ablation, was sought to review the matter and comment on any potential lapses in the standard of care.

Questions to the Pain Management expert and their responses

How often do you perform radiofrequency ablation for chronic pain?

I perform approximately 4-5 radiofrequency ablation (RFA) procedures per week. Most of these RFA procedures are for chronic spine pain related to facet joint mediated pain, although I also perform RFA procedures for chronic neuropathic pain unrelated to the spine (e.g. ilioinguinal neuralgia, meralgia paresthetica, intercostal neuralgia).

What is the standard of care to prevent thermal injury in a patient during the ablation?

The standard of care to prevent any injury, including thermal injury, during interventional procedures such as RFA, involves multiple factors. Appropriate training is mandatory, typically accomplished through an ACGME-accredited Pain Medicine fellowship, or equivalent. For the procedure itself, appropriate imaging guidance is mandated. Depending on the anatomical region and the skill level of the proceduralist, this may be ultrasound, fluoroscopy, CT guidance, etc. Imaging guidance allows the performing physician to clearly identify needle placement at all times, to ensure that surrounding anatomical structures are not injured. For fluoroscopically guided procedures multiplanar fluoroscopy, utilizing images captured in multiple views (i.e. AP, Lateral, Oblique, etc.) to clearly identify appropriate anatomy and needle placement with respect to target structures and surrounding (non-targeted) structures. Typically nerve stimulation is also utilized to ensure proper needle placement prior to initiating thermal ablation. If sedation is utilized, sedation should be provided only to the level necessary to safely perform the procedure, as appropriate sedation will often allow a patient to report unanticipated procedural pain that may warn the performing physician of inadvertent aberrant needle placement.

About the expert

This highly-qualified expert is double-board certified in Anesthesiology and Pain Medicine. He completed his BA at Michigan State University Honors College and his DO at the University of New England College of Medicine. He completed his internship in General Surgery at the Naval Medical Center and his residency in Anesthesiology at the University of Michigan where he served as Chief Resident. He also completed a fellowship in Interventional Pain Medicine at the University of Michigan. He is a member of numerous professional societies including the American Osteopathic Association and the American Society of Anesthesiologists. He is currently the Director of Pain Management at a major hospital in MA.

E-024812

Specialties:

Pain Management

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