Pain medicine, pain management, fibromyalgia, Arizona pain, back pain, pain treatment, discography, back pain, neck pain, migraine., headaches, sciatica, muscle pain, Arizona pain center, acupuncture, arthritis, Arizona, Scottsdale,
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Neuropeptides (chemicals) released from the periphery of your nerves are nociceptive (pain sensing) inflammatory
mediators as well as pain generators. The nerves connect to the spinal cord which eventually sends the signal to the
brain to sense pain.  When the nerves are identified that are causing pain, successful pain relief has been obtained when
they are denervated (Koscharskyy 2007).



Anatomy

The anatomy and physiological function of the spine is important in evaluating a person with pain. The bony spine is
positioned so that individual vertebrae (bones of the spine) provide a flexible support structure while also protecting the
spinal cord.  The facet joint of the spine is a moveable connection that connects one vertebra to another.  They are highly
innervated with nerves which provide sensation and often pain.

Separating each individual vertebrae are discs that act as cushions to minimize the impact that the spinal column
receives.  The discs are designed to be soft and provide support,  but have a tendency to herniate backwards causing
irritation to the adjacent nerves. Disc disease is one of the most common causes of chronic neck or back pain and
accounts for approximately 10% of all lower back pain complaints.  Disc disease may be acute, herniation resulting from
trauma, or more commonly chronic caused by degenerative disc disease.  Degenerative disc disease is a process which
is due to a thinning and degeneration of the discs over time and can lead to a disrupted spinal function, nerve
impingement, or peripheral nerve irritation.

Disc denervation is considered for patients who have disabling chronic pain, especially when due to a discogenic
pathology and when conservative treatments have failed.  Neck and back pain are the most common complaints that are
treated with disc denervation.



Procedure

In disc denervation, your pain physician uses a device to generate heat in order to dull the nerve that is causing the pain.  
Using a small thin needle, your physician will administer a local anesthetic to numb your skin and subcutaneous tissue.  A
radiofrequency needle is advanced under fluoroscopy or real-time x-ray to the desired location.  Electrical stimulation is
initiated through the needle and your disc pain is duplicated.  When the correct nerves have been identified, the nerve
supply to the disc is denervated with radiofrequency.  This technique can destroy pain causing nerves and minimizes the
effects on the surrounding structures..

A band-aid is placed over the needle entry location after the procedure.  The procedure typically takes less than an hour
and you are able to go home shortly after.



Benefits

Disc denervation has several advantages for the treatment of back and neck pain.  It is a minimally invasive procedure
which may provide significant relief.  No hospitalization is required and the procedure is performed with local anesthesia
and sedation.  Typically there is little post-procedure discomfort and you are able to quickly resume your normal activities.
 Another advantage to disc denervation is that denervated can be controlled, minimizing the risk of damaging adjacent
nerves.   Also, if the pain recurs, this minimally invasive treatment may be repeated.



Risks

Complications associated with disc denervation are rare.  This treatment option is associated with an overall 1.0%
incidence rate of minor complications per patient (Kornick 2004).  As with all surgeries and procedures there is a risk of
bleeding, infection, or nerve damage.  The most common complaint is pain at the procedure site after the local anesthetic
has worn off.  



Outcomes

Radiofrequency denervation procedures have been used as pain management for over two decades.  In a large clinical
study performed in 2007, 68.4% of the patients treated with radiofrequency denervation had good to excellent pain relief
lasting from 6 to 24 months. This large, prospective clinical study indicated that radiofrequency denervation of the lumbar
zygapophysial joints provides long-term back pain relief in a routine clinical setting (Gofeld 2007).  

Radiofrequency denervation results in significant alleviation of pain and allows for an increase in daily functioning and
movement.  These results were seen in many patients with chronic low back pain, both on a short-term and a long-term
basis (can Kleef 1999).  With various research studies underway, denervation procedures may be considered as a viable
treatment option in patients who are suffering from back pain (Oh 2007).

If you are suffering from chronic back or neck pain that has been refractory to other treatments contact Arizona Pain
Specialists today to see if you can benefit from this innovative treatment.  We are happy to provide the cutting edge of
pain medicine to the Phoenix area.



Journal Articles

Principles and Uses of Radiofrequency Nerve Lesioning in Chronic Pain Control
Ahmet H. Ozturk, MD CHH Pain Management Clinic

Complications of lumbar facet radiofrequency denervation. Kornick C; Kramarich SS; Lamer TJ; Todd Sitzman B
Department of Anesthesiology, Division of Pain Management, Mayo Clinic, Jacksonville, Florida, USA. Spine. 2004;
29(12):1352-4 (ISSN: 1528-1159)

Lumbar discogenic pain. Disk degeneration and minimally invasive interventional therapies Kosharskyy B, Rozen D.
Anasthesiol Intensivmed Notfallmed Schmerzther. 2007 Apr;42(4):262-7

Radiofrequency denervation of the lumbar zygapophysial joints: 10-year prospective clinical audit.
Gofeld M, Jitendra J, Faclier G. Pain Physician. 2007 Mar;10(2):291-300

A randomized controlled trial of radiofrequency denervation of the ramus communicans nerve for chronic discogenic low
back pain. Oh WS, Shim JC. Clin J Pain. 2004 Jan-Feb;20(1):55-60

Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain.
van Kleef M, Barendse GA, Kessels A, Voets HM, Weber WE, de Lange S. Spine. 1999 Sep 15;24(18):1937-42
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Pain medicine, pain management, fibromyalgia, Arizona pain, back pain, pain treatment, discography, back pain, neck pain, migraine., headaches, sciatica, muscle pain, Arizona pain center, acupuncture, arthritis, Arizona, Scottsdale,
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Pain medicine, pain management, fibromyalgia, Arizona pain, back pain, pain treatment, discography, back pain, neck pain, migraine., headaches, sciatica, muscle pain, Arizona pain center, acupuncture, arthritis, Arizona, Scottsdale,
Disc Denervation
by Nicole Berardoni M.D, Paul Lynch M.D, and Tory McJunkin M.D

Disc Denervation is a pain procedure used to treat chronic disc
related or discogenic pain.  Affected pain causing nerves are
heated and destroyed with radiofrequency.  The heat generated
from the radiofrequency modifies certain nerve fibers and blocks
the perception of pain that is received by the brain.  
Radiofrequency denervation is a superior technique to other
treatments based on the thermocoagulation of selected nerves
using an electrode capable of accurate temperature generation
(Ahmet 2006).
Discogenic pain, discography, Pain medicine, pain management, fibromyalgia, Arizona pain, back pain, pain treatment, discography, back pain, neck pain, migraine., headaches, sciatica, muscle pain, Arizona pain center, acupuncture, arthritis, Arizona, Scottsdale,
At Arizona Pain Specialists we offer multiple
discogenic pain.  These include Disc
Denervation, IDET, Discography and more.
Book I  -  Pain Syndromes

Chapter 1     Low Back Pain
Chapter 2     Neck Pain
Chapter 3     Cancer Pain
Chapter 4     Headaches
Chapter 5     Spinal Stenosis
Chapter 6     Sciatica
Chapter 7     Arthritis
Chapter 8     Fibromyalgia
Chapter 9     Motor Vehicle Injuries
Chapter 10   Complex Regional Pain
Syndrome
Chapter 11   Vertebral Body
Fractures
Chapter 12   Hip and Leg Pain
Chapter 13   Diabetic Peripheral
Neuropathy

Book II  -  Interventional Procedures

Chapter 14   Epidural Steroid
Injection
Chapter 15   Facet Injections/Medial
Branch Blocks
Chapter 16   Radiofrequency Ablation
Chapter 17   Spinal Cord Stimulator
Implants
Chapter 18   IntraDiscal
Electrothermal Therapy (IDET)
Chapter 19   
Vertebroplasty/Kyphoplasty   
Chapter 20   Discography
Chapter 21   Percutaneous
Discectomy
Chapter 22   Occipital Nerve Block
Chapter 23   Sympathetic Block
Chapter 24   Stellate Ganglion Block
Chapter 25   Intrathecal Pump
Implants
Chapter 26   Caudal Steroid Injection
Chapter 27   Adhesiolysis
Chapter 28   Cervical Steroid
Injection
Chapter 29   Sacroiliac Joint
Injections
Chapter 30   Celiac Plexus Block
Chapter 31   Head and Neck
Procedures
Chapter 32   Joint Injections
Chapter 33   Continuous Catheter
Nerve Blocks
Chapter 34   Peripheral Nerve
Stimulation/Field Stimulation
Chapter 35   Disc Denervation

Book III   Other Treatments

Chapter 36   Medication Management
Chapter 37   Acupuncture
Chapter 38   Prolotherapy
Chapter 39   Botox
Chapter 40   Massage
Chapter 41   Alternative and
Complementary Medicines
Chapter 42   Exercise and Nutrition
Counseling
Chapter 43   Prayer
Chapter 44   Cognitive Behavioral
Therapy
Chapter 45   Group Therapy
Chapter 46   Biofeedback
Chapter 47   Chiropractic
Manipulations
Chapter 48   Vitamin Supplements
Chapter 49   Customized
Pharmaceutical Formulations
Chapter 50   Hormone Therapy

Frequently Asked Questions