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Gautam Das asked:




Different radio frequency lesioning procedures are proving invaluable in pain management day by day. It is the best form of treatment for trigeminal neuralgia, different cancer pain and different kinds of spinal pain including low back pain and neck pain.

Radio Frequency (RF) lesioning involves passage of a very high frequency current through a 27 G thermocouple probe. This probe is passed through a 20/22G cannula (a kind of needle), which is insulated except at its tip. When a high frequency alternating current is passed (at 300 kHz) through the RF thermocouple probe the charged ions in the human tissue around the exposed tip of RF cannula moves to & fro. This produces electro-mechanical friction heat is generated. The thermocouple probe is not heated itself, it actually dissipates the heat generated at the surrounded tissue. Thus the heat is totally controlled by the operator. The lesion generated is shaped like a matchstick head with a diameter of 2-4mm. Beyond this distance; electrical field is weaker as it is dispersed, so no lesion is produced.

The temperature & therefore the heat lesion is maximum around the shaft and minimum at its tip. On the other hand the electrical field generated is maximum at its tip and minimum around the shaft. In the conventional RF rhizotomy type we are producing heat lesion. In the pulsed RF electrical field is producing the lesion. In pulsed RF temperature is not raised beyond 42-degree C. Electrical field produces some punch in the capacitor of small diameter nociceptive (pain transmitting) fibers. Thereby signal transmission through this fibre is stopped.

In the conventional type the nerves are regenerated in future & average pain-free period varies for type of nerve. In a properly performed lesion pain free period is 3-4 years. In the pulsed RF the average pain free period is 4-24 months.

The conventional RF rhizotomy is done at sympathetic ganglions, and at purely/ predominantly sensory nerves. It is always avoided in mixed or predominantly motor nerves. Before doing actual lesioning radiological and electrical tests are done to keep the probe away from these nerves in conventional RF lesioning. The commonly performed conventional RF rhizotomy procedures are at following nerves.

1. Trigeminal (Gasserian) ganglion and its divisions i.e. mandibular nerve & maxillary nerve.

2. Stellate ganglion

3. Cervical facet joint medial branch

4. Thoracic facet joint medial branch

5. Splanchnic nerves

6. Lumber sympathetic plexus

7. Superior Hypogastric plexus

8. Lumber facet joint medial branch

9. Sacro-Iliac joint supplying nerves

In Pulsed RF as there is no heat lesioning it is safe to perform it in most kinds of nerves. It is mostly effective in nerve ganglions but also effective trunks. It may be performed in all the above procedures except trigeminal ganglion. It is mainly indicated in Dorsal root ganglionostomy. It is also done in mixed peripheral nerves like suprascapular nerve.

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Dr Todd Sullivan asked:




Low back pain Chiropractic Care can be the result of over-straining, an accident injury or a whole host of other causes such as not lifting a heavy weight properly, or a sports injury. Being older and overweight can contribute to low back pain and Chiropractic Care.

Often with a bit a rest and self care, low back pain resolves itself in time, but sometimes the pain just doesn’t subside and the limited range of motion and pain begin to keep the person from being able to enjoy their life. That is when it is time to consider Chiropractic Care to relieve your low back pain.

Chiropractors take a natural approach to health care
While most people have probably heard of Chiropractors, not everyone is familiar with their approach to health care. This can lead some people to be a bit leery of considering Chiropractic care. A Chiropractor is a doctor who takes a holistic approach to health care. They focus on the spine, and the central nervous system, which are at the center of the musculoskeletal system of the body. They take the approach that everything within the body is interconnected, and their role is to remove whatever might impede the body’s own natural healing process.

Spinal manipulations help relieve pain and restore alignment
Chiropractors take a natural, non-surgical and drug-free approach to caring for bodies. They use spinal manipulations to treat physical disorders that have their origins in the nervous system and the musculoskeletal system. The goal of these spinal manipulations is to relieve pain and restore range of motion and mobility to the joint. When a Chiropractor does a spinal manipulation, they use their hands to apply a calculated and precise forceful motion pushing the restricted joint past its range of motion. This movement may cause a crack or a popping sound.

Other approaches that Chiropractors might take in treating low back pain might include ultrasound, electrical muscle stimulation or massage to warm, stretch and relax tight muscles.

Prevention of low back injury
Because low back pain is often the result of strain or over use, there are things that you can do to strengthen the back to prevent such injuries. A regular, consistent exercise routine that include stretching and weight training will help to build both strength and flexibility in the muscles and ligaments that support the spine. A strong, flexible back is far less prone to injury than a sedentary one.

Observing proper lifting techniques such as not attempting to lift a weight that is too heavy, remembering to lift from bent knees and not from the waist are good ways to protect the back.

Good posture can also prevent low back pain. If you work at a job that requires you to sit for long periods of time, make sure that your chair has proper back support, and try to stand up and stretch occasionally.

Low back pain and Chiropractic care might be the issue that brings you in to the Chiropractor’s office, but you may find that you will keep returning in order to keep you body in proper alignment to prevent future health complications.

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Back pain is in general a common problem that every one faces. It is a vulnerable problem that a person of any age experiences. Children, Adults, Pregnant woman, or a person of old age can also face the back pain problem. There may be several factors behind your back pain problem as it is not restricted only to one particular reason. And so people needs to face loads of trouble during back pain to cure it. Your prime duty is to know the causes and take some preventive measures so that you need not feel the pain during backache.

There can be varied causes for back pain:

Lumbar Muscle Strain: Straining of muscles is the most common cause of low back pain. Chances are bright in this case that a patient may completely feel relieve from muscle strain.

Spondylolisthesis: In this case the adjacent vertebra becomes unbalanced and begins to ‘slip’ which causes back pain and if it still prolongs then back pain can turn to be a serious problem.

Osteoporosis: A patient needs to face this problem because of compression fracture of the vertebra. You may face orthopedic problem and much of uneasiness too. It also leads to feeble bones.

Ruptured Disc: It is also called as Herniated Disc which causes back pain. The treatment of herniated disc depends and differs on an individual’s condition and circumstances. It is incorrectly being called in general as “Slipped Disc”, affecting the spine, in which a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion to bulge out. Herniated Discs are found in ? of adults older than 20.

Spinal Stenosis: This is a medical condition in which the spinal canal narrows and compresses the spinal cord and nerve. In the aging population, when the spinal canal becomes too stiff then it can result into back pain. A patient suffering under this situation may even feel minor trauma causing irritation and nerve root impingement which indirectly results into back ache.

There are many of causes of back ache that can put you into serious health trouble. For acute back pain the underlying cause is meniscoid occlusion. You may get startled to know that the lower back pain causes also differ as per the person’s age. Some of the common causes of back pain for adults under age 50 include spinal disc, herniation and degenerative disc disease or isthmic spondylolisthesis. And for adults over age 50 include osteoarthritis (degenerative joint disease) and spinal stenosis, trauma, cancer, infection, fractures, and inflammatory disease.

Thus, to cure your back pain you need to practice exercises regularly. Collect information to know back pain causes and if the situation worsens then it is highly recommended to consult doctor for the betterment of your health.



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