Ablation for lower back pain L4-5 S1

I totally agree! My back issues started in 2011 & the injections helped until they didn’t in 2019. Traditional surgery’s not an option b/c I have CP & a curvature in my spine. Had the SCS in 2021, additional lead added, several adjustments & finally had the entire thing removed Feb 2024 b/c it never helped. The spine is a tremendously complex area to work on - I feel for our doctors who try their best, but also feel for us who need relief!

I'm 10 days out from the RFA and I'm starting to feel the old pain coming back. To say the least I'm upset. I' having the right side done in 4 days. I'm trying to be optimistic. If this does not work I'm not doing anything else for a while. I'll consult with other doctors. I have sever spinal stenosis.
There are other issues, pretty much my back is a mess. Anyone having a RFA and it didn't work what was your recourse.? I'm not doing this more than once.

I had RFA in my lower spinal facets last November 2023. It lasted until about 3 weeks ago. Then had steroid injection in the facets last week and they didn’t work.
I have another appointment on Thursday July 25th but I don’t want steroid injections again.
I also have a consultation with a pain surgeon scheduled for Wednesday July 24 for my right sacral ileum (sacroiliac??) joint because steroid injections do not last a week anymore and I desperately want some relief from the pain. Right now I’m surviving the pain on Percocet oxycodone 7.5 Acetaminophen 325 mg one and a half tablets three times a day.

@marsha3121 - Sorry for all your difficulties. It sounds like you have a very reasonable medical strategy laid-out and I trust you will be much more knowledgeable after your July 24th and 25th appointments. The "pain surgeon" (do you mean physiatrist? I've not heard the term pain surgeon before and I would like to learn more about the type of doctor you're going to see) should be especially helpful.

Spinal issues are notoriously difficult to diagnose. The injections you've already received provide useful feedback to the medical professionals as they work through all the possible causes of your discomfort. But I know the process can seem extremely slow to you as you seek relief.

Please share the results of your two upcoming appointments. It's always useful to know "the rest of the story". Thanks.

Marsha, I think they only like to perform RFA every ten months. It might be that the steroid injection was intended to get you through to ten months. I don't know why the injection didn't help, but I do know that they sometimes miss the nerve.
The pain surgeon may be thinking of fusion.
I have trouble with the SI joint and would feel remiss without saying that I get complete relief with chiropractics. It doesn't last, but it's easy and easy to repeat. Some physical therapists are certified to perform the class five thrust adjustment, but I have found a PT that does it effectively, because they do them so seldom.
The SI is a long, slender ragged joint. If y ou over rotate the ileum this joint which barely moves anyway gets stuck and pinches nerves. You might be helped by a sacro-iliac belt. I'm no fan of those.
I've never been able to release my own SI joint, but since you are in pain you might try

I have been through this all. There isn’t anything you guys have mentioned that I haven’t been through so I hope I can offer some thing insightful. There are two kinds of RFA one is called heat and one is called pulse. The pulse never worked for me if you had the pulse you must try the heat, my first RFA in 2000 and 2001 lasted 15 years. I had spinal stenosis and every other disc vertebrae scoliosis thing you can imagine eventually I needed surgery. In the meantime I had judicious, epidural nerve blocks corticosteroids emergency trips to the emergency room, shots of Toradol in my butt sciatic and other things in 2018 orthopedic surgeons, I met the orthopedic surgeon of my dreams and let him do surgery immediately. It was a simple x-ray that he took to show me that my vertebrae had grown together. I was wondering why the pain had stopped. This is bad because when the vertebrae grow together, they squeeze the nerve route. Root. LOL
Here’s the first step diagnose where the pain is coming from. A good pain management doctor or a good orthopedic surgeon is going to isolate where the pain is coming from by doing various procedures. The second step is to see what your options are to get rid of the pain, I don’t like a lot of medication because I’m very sensitive to medication and because they’re always side effects. When I get the corticosteroids or the epidural injections, I get 25 to 50% normal dose because I always get fat around my belly and facial flushing and insomnia, you have to work closely with your doctor and you have to find a good doctor that you can develop a relationship with Before I had my surgery in 2018, I had various small things which help relieve pain. For example, one MRI showed that I had a fluid filled sack that could easily be drained by a competent pain management doctor that help put off surgery for two years. You really have to learn about your body and ask a lot of questions , finally I want to say that my facial tissue release work is amazing and unfortunately it is not covered by any medical insurance company. After having many surgeries, my SI joints caused me a lot of grief and pain. I was close to having surgery again when my orthopedic surgeon said to try deep myofascial work , but that was for my neck area. When I went to the massage therapist and told him I was having pain in my SI joint he did some work and miracle of miracle. I now have 10% of the pain in my sacral joints. I was so close to surgery. I can’t even explain it , but I probably should’ve paid along time ago for myofascial tissue release work. I was always told that massage is a luxury and I couldn’t afford it. Deep myofascial tissue release is very painful. It’s not your enjoyable massage and you have to go back regularly. I go twice a month , but I can’t tell you how much it’s improved my life without medication and without surgeries. The first two months of doing it I would feel drunk when I was finished. There was so much toxins that were being released now I’m feeling better on my third month of it and I will probably never stop because it’s taking me 67 years to get here , never give up and never stop. Also, I forgot to mention that for 25 years I’ve taken low doses of Percocet even if I have no pain I don’t take it. Addiction was not a problem for me pain as a problem and to continue working, I had to be on low-dose Percocet , that is a combination of the oxycodone and the acetaminophen. That is worked very very well for me over the years. I am sorry people miss use it abuse it it’s been stolen out of my medicine cabinet by the pet sitter and a lot of aggravation and humiliation to continually get it over the years things being what they are, but I don’t think I would have been here without it And lived a productive life so I always share that I use it. Use whatever tools you need to to get by and stay healthy.!

@loriesco Welcome to Connect! I'm glad to hear about your myofascial release tissue work. I am also a fan of MFR, and have done it for years with my physical therapist. Typically, it isn't painful or aggressive unless there is a reason for that. The way that MFR works is to create a shearing pressure against the barrier of tight tissue, and then just wait for the body to unwind the fascia so it can move and glide again. By working through the layers, you get deeper into the body with repeated sessions. In doing this, it releases everything it needs for healing, and lets body fluids circulate in tissue that was previously dehydrated. I recommend MFR a lot and I do a lot of it on my own at home to maintain my condition. We have a discussion about MFR that you may enjoy. Thanks for sharing your experience!

Neuropathy -"Myofascial Release Therapy (MFR) for treating compression and pain"
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/

thank you! I would appreciate that! I see you left a link. In my case - it IS super painful (probably because there is so much history of overuse, tension and body misalignment!) I don't sit in a drunken for two days. Like I did the first two times. but my body seems to hold on to that tension and go right back to it. I'm sure it will take a very long time to repair the lifetime of damage I've done - and came with the body model I was sold! 😉 Thank you for the link.

Yes, hold off on surgery until you have no other choice