What is a Radiofrequency Ablation?

Sounds super scary right? And you don’t even know what it is yet. I am inspired to write this after explaining to a lot of people the procedure I had done recently. So why not get some word out on what this is, and how it can help with chronic pain conditions that stem from neurological disorders.

So what is it first of all? A Radiofrequency Ablation (or Radiofrequency Nerve Lesioning) is basically where they take a wire, and insert it down a needle into a part of you (generally along the spine if you are treating pain, other places for other issues) which is then heated up and tissue is ablated. Ablated means they’re removed, cauterized, or destroyed – think of it like one of those chemical peels, the top layer of skin is being ablated. Which sounds horrible and possibly painful just reading that but I swear it isn’t! Usually for pain management it is done to nerves coming from certain points on the spine, and the medial nerves (which sends the pain signal up to the brain) are targeted.

This is a picture of where they are and what things look like in the Cervical section of the spine.

It doesn’t feel really any different than any other injection procedure you might have, though sometimes you may get a muscle twitch when they pass current down the needle to make sure they are hitting the right spot. Once they know they are in the right spot using the current to stimulate and a fluoroscope, they pass a current down the wire that generates radio waves (which also produce heat) to cauterize, or ablate, the nerve. It is actually a pretty easy procedure, and I seem to recover faster than from other types of procedures. Plus I find it helps me a lot more with my pain than a cortisone injection these days.

Since it is easier to be a visual learner most of the time, here is a great video to watch with some animation so you won’t feel too squeamish if blood makes you woozy.

So as you can see it is waaaaay less scary than sticking a needle in you and burning off parts of your nerves sounds. Plus the nerves grow back in a few months and if you are lucky don’t have to repeat the process. If you are like me and do, it has a lot less negative side effects than getting cortisone over long periods of time, and you get to be free of some pain!

Remember all of our bodies are different and yours may react differently than mine, talk to your doctor, or a few doctors (which is best) and make sure you do your own research to make sure this is the right procedure for you and your pain condition. WebMD is a great resource as always for things like this, and definitely ask a professional!

How Do You Do It?

Sometimes I dread being asked this question, more than the small talk question of “how are you.” Unlike the inquiry of your state of being, that you may have to give the white lie of “I am OK” and be done with it, this question can’t be brushed off. Also I feel I don’t have a good, answer to this question. By that I mean I think – “I don’t know, I just do,” followed by a shrug, a pretty lame answer. “I just do” can even seem a rude, but in all reality, I don’t know any other way to be. People have told me I am unique, and that I am “strong.” I don’t know about all that, I personally think I am just a normal human. Anyone can do what I do, I really do think everyone is capable of living a happy and positive life even with chronic pain. So I will attempt to describe how I do what “I just do.”

Something I know for sure is I am stubborn, I have always been as stubborn as a mule. While this hasn’t always been a boon to me in all situations, I guess it could be a large motivation in my need to keep going. I have an almost blind determination to just make it through today, because tomorrow could bring something new. New information, new techniques, and new experiences. Possibly even a reduction in pain, but you don’t know unless you make it to tomorrow. I absolutely know that I have to see tomorrow, and no matter how bad I feel now tomorrow will eventually come. This fierce determination springs from somewhere deep in me, bubbling up from a source that is, to be completely honest, hidden even to me. It could be my stubbornness, but a lot of days I am not really sure why I drag myself out of bed, and force myself to go through the motions of a normal day. There are a lot of days where just the act of getting out of bed is excruciating, but I do it. Sometimes its very, very slowly, but I still do it. I have to, something in me makes me feel I must. My stubborn mind tells me that staying in bed is not an option, so get up! There is stuff to do! I am even starting to wonder if I may actually be physically unable to stop completely. To just give up and wallow in a puddle of self pity and immobility seems to be something that is beyond me. I also think, just going through the motions makes you feel better, even if your pain levels don’t improve. More often than not it usually does improve my pain levels. Just like getting up, having a shower and getting dressed can make you feel better when you are feeling sick.

Another thing that helps me not start to slip into the quitter sort of thinking, is making sure I feel like I accomplished something. That feeling of despite everything stuff still got done, makes me feel like the day wasn’t completely surrendered to The Pain. You can say to yourself, “Hey Self! Even though you couldn’t do everything you wanted to today, you still did something. Good job!” And you really do feel good about it. Even if that something seems simple like just sitting up for an hour, reading, or walking to the mailbox. Because sometimes, even though you may not want to admit it, that is all you are truly able to do. I have struggled with it, but I feel I have gotten to a point where I have accepted my new limitations. I set daily goals I can meet, and adjust them according to my pain. Like I said it can be a struggle, especially if you are a person that was very active and forced to halt. Speaking as just such a person, it is hard, but not impossible. Before my accident I was working a full time job, a commuter cyclist, and avid student of two styles of martial arts when I wasn’t cooking, sewing, reading, drawing, etc, etc, etc. Then my life came to a screeching halt. But like the saying goes, when one door closes, others open. You have to embrace the fact that a simple task such as mopping the floor, cooking dinner, or even just walking the dog, could require hours, or even days, to recover from. Tasks you did effortlessly before some have now become difficult, maybe even impossible. This wears on the psyche, and for me creates thoughts like…

“I am not who I was before…I am broken…I am useless…”

Thinking like this can really throw you into what I call a “well of despair.” That dark pit of soul crushing sadness, that sort of depression that makes everything seem not worthwhile. If one thinks only negative thoughts, it will only continue the descent into negativity, and inevitably giving up. It is a deep pit, one you have to claw and fight your way out of once you are init. Not many chronic pain sufferers escape alive once they allow themselves to fall in. One thing you always hear is suicide rates and that they are extremely high for chronic pain. Negative thinking is a slippery slope into that pit. It starts small, and seems innocent at the start, but it grows quickly. This then breeds depression, anxiety and stress. Pain is already isolating, it cancels plans, it doesn’t stop for birthdays or holidays, and it can make you want to withdraw from people and the world. Feeding it negative thoughts only increases its power, so why give pain more power than it already has?

Pain, especially chronic pain can be very hard. The worst thing when discussing it with people is, it is invisible. If you have a broken arm, people can see the cast. But being in pain doesn’t always show on the surface, or it is intentionally hidden, and this can sometimes lead to further isolation. People don’t understand that sometimes you have to cancel plans. That you can attempt to plan in advance but things are always “pending how I feel.” Friends can think you are avoiding them because you were able to do something one day, but then not at another. To top it all off, it is frustrating for you since you aren’t able to do what you want. The invisibility of pain can destroy relationships if you allow it, and sometimes even if you try not to. Pain separates you from your loved ones, your support, and makes it far easier to slip into the “well of despair.”

Sometimes its bigger than a well, sometimes its the size of the inside of a Tardis.

Also falling into that kind of thinking is a hard fight to get out of, harder still when you are fighting your own physical pain. So the best way to combat that is to not slip and fall into that trap, or, even better, be so far from the edge that it isn’t even a worry. Positive thinking, it is so so important, find that silver lining in all situations. This has kept me from the edge so far, and it really is an easy habit to keep once you get started.

Another way I have found works to fight falling in, is to keep my mind (or hands) busy. Up wandering the house at night because you can’t sleep? Time to fold that laundry. Time to do some research. Time to work on my stretching exercises, or other exercise routines. Time to do some baking/cooking. Time to work on creating something. Time to do anything that will take your full focus, anything that takes your full focus means that you can not be also thinking about anything else that might be going on. This includes how much pain you are in. Being able to focus your mind so intently on something diverts it from the task of reminding you that something is hurting. It can give you a much needed emotional break at the worst of times, and it can feed into that feeling of accomplishment I mentioned earlier.

Everyone is different, and everyone’s perceptions shape them, but I think everyone is capable of living happily. You just have to chose to be so, no one, and no thing, will ever make you happy for you. You have to do it for yourself, and chronic pain sufferers can be happy, I am living proof! Every day is full of potential, seize it! As long as you never give up, and never surrender. Just do it and tomorrow will be right around the corner.

Massage, It Isn’t Just Some Fluff ‘n Buff Thing

The simple act of human touch is far more important than most realize, and proving to be a larger part of the healing process than thought of in modern medicine. Humans are extremely social animals, and while we are much more domesticated primates now, we still have that primal need for touch. With touch being so healing, it is no surprise massage is so healing as well. The current term massage, comes from French and translates to “friction of kneading,” in Arabic massa means “to touch, feel or handle” and the ancient Latin term for massage was frictio which is obviously close to friction. No matter what the term used for it though, it is a natural reaction to pain. When you injure something, or something just hurts, the natural human reaction is to rub the area. And it is this that has developed through human history into present day massage therapy and medical massage.

Massage is non-invasive as a treatment, and helps to heal damaged muscles, stimulate circulation, stimulate the immune/lymphatic system, reduce pain, relieve spasms & tension, and alleviate stress. Since massage generally puts one into an extremely relaxed state, the body will naturally release more endorphins, which we already know are the body’s natural pain medication. Massage will also reduce levels of hormones that rise during stress, which can be damaging to the body over extended periods of time. I am a firm believer in massage as a large part in chronic pain management, and starting a regular massage routine caused a huge change in my quality of life. My pain was reduced, and range of motion not only increased, but was able to be maintained. I was not always a believer though, after my accident, and even after my surgeries, many of my friends and family told me I should get a massage.

“You should get one, it would really help,” they would say.

I would say “No, that is some silly luxury for Spas, and Cruise ship denizens, I don’t need that.”

But 1,000’s of years of human history can’t be wrong…can it?

Definitely not. In fact they, my family, and friends, were all so very, very right.

Depiction of massage in the “Physician’s Tomb” dated to around 2330 BCE, further proof that everyone enjoys a foot rub.

Massage is a fantastic way to help relieve stress, pain, and generally maintain the health of mind, body, and spirit. Almost every known historical, and modern, cultures have some type of massage for medical or therapeutic use. Most generally use massage to relieve stress, prevent or heal injuries, and assist with pain. Massage is included in the most ancient medical texts and presently has tons of different styles and methods. But even with this variety, almost all of them have the same goal, overall body and mind wellness, and massage has long been considered an integral part of the healing arts. So much so that Hippocrates said –

“The physician must be experienced in many things, but assuredly in rubbing; for things that have the same name have not always the same effects. For rubbing can bind a joint that is too loose and loosen a joint that is too rigid… Hard rubbing binds; soft rubbing loosens; much rubbing causes parts to [loosen]; moderate rubbing makes them grow.'”

And he should know, considering he was the student of Herodicus, who could be considered one of the historical founders of modern sport medicine (though that title has many claimants, and all are highly debatable). Ayurveda and Traditional Chinese medicine have some of the oldest documented writings on massage, and is widely used in their treatments past, and present. The infamous Avicenna of Persia, spoke of analgesics used with massage, and massage’s pain relieving effects when used just on its own. He also mentions that massage should be performed prior to exercise, which only became well known in recent years due to televising during the ’84 Olympic games.

Massage use was well documented in Ancient Greece, athletes were often given massages. Since Rome loves to copy Greece, Roman athletes and Gladiators were treated with massage as well. Julius Caesar was known to regularly receive massage to assist with neuralgia and possibly treat his epileptic seizures. Galen, well known for his own work with Gladiators, and as a Physician, was a supporter of massage, and its ability to treat many ailments. He believed, a good diet, exercise, rest and massage were key to a healthy body. He was also a very strong spokesman against people who would lower the opinion of massage.

You heard me, no happy endings!

Which is a frequent problem even now, most of the time when massage is mentioned you inevitably get the “happy ending” jokes. Not all massage is of a sexual nature, though there were some blurring of lines during the 19th century. Where massage was used to treat hysteria, and while it was considered medical, its definitely crossing some lines. This early association in America could be a reason for most modern association of massage with sexual acts. Probably not helped by advertisements…

“I promise it won’t get weird”

And hilarious machines…

Your 19th century lady’s secret in the bottom drawer. So discreet!

Just as Galen was frustrated with these associations in his time, we fair no better in our modern times. Massage is inevitably linked with seedy parlors that offer the infamous “happy ending,” more than a valid medical treatment. Despite all of this though, massage is highly esteemed in some medical circles and is rapidly gaining supporters in the medical community. So hopefully in the future the more healing features of massage will be lauded, rather than the carnal.

It is that effectiveness in treating people that has kept massage alive for centuries, and now modern science is starting to revive the medical community’s interest in it. Some clinical studies have been done, but not enough for modern science to state that yes, it is 100% effective, and they fully understanding of how it all works. Luckily it is a field that is rapidly gaining attention, and research is speeding up on it, so we may be hearing changes of opinion in the medical community in the next decade. In the clinical studies that have been done so far, some as recently as 2008, it has been shown that massage is the best relief for chronic back pain. Much more so than other treatments including acupuncture, medications, and other conventional medical treatments. Some studies have found that anxiety, pain, depression, and stress can all be reduced through massage therapy. Its also been found to help with neck pain, which I can personally vouch for, and thought to alleviate some pain for cancer patients. The American Pain Society and the American College of Physicians recommend that patients with chronic pain should include massage in their pain management regimen. So while modern science is not fully sure why massage works, the evidence is starting pile up, and clearly point to it working. It is just the “whys and the hows” that aren’t completely understood, current theories are that it helps to either block pain signals sent to the brain, or it could be that it causes the release of serotonin, endorphins, or other chemicals the body produces that help deal with pain. It could even be it triggers some other beneficial change in the body that we aren’t even familiar with yet, there is still so much about the body we do not know.

What I can say is from personal experience is that massage can do wonders for neurological pain, back pain, neck pain, shoulder pain, tension headaches, muscle pain and spasms. So many times the expert hands of my masseuse have found an area that needed work, that I was in too much pain to pin point, and alleviated more pain than I thought possible. Seeing my masseuse can turn some level 10 pain days right around, changing a horrible day to a great one. Even migraines from spasms can be relieved with massage, and a good neck and shoulder massage has been the reason I have gotten through some horrible migraines. Times when injections or other medications are not option. Massage is, unlike lots of treatments, something you can add to your regimen that is considered mostly safe with little danger in using it frequently. Of course you do want to consult with your doctor if you have special needs, or conditions, but most ailments can benefit from massage.

A massage will generally consist of the manipulation of the skin, muscles and other tissues, done with a body part (hand, feet, elbow, etc) or with tools. Some stretching may be involved, as well as the application of heat, vibration, or other methods. Some massage, like deep tissue, can be mildly painful, but you should never feel you can’t stand the pain. It is important to give feedback to the masseuse, to make sure they are using the right level of pressure for you. Don’t be afraid to ask for more pressure if you need it, or ask them to back off a bit if it hurts too much. It is important you work together, so your body doesn’t take more than it is able to handle. Remember it should “hurt so good,” but never just hurt. As you build your relationship with your masseuse, you will find they know the amount of pressure you like and can take, and they will eventually get to know your body’s needs almost as well as you do.

There is a bit of a lingo that comes with massage, so below are a few basic movements you will hear mentioned. They are:

• Effleurage – gliding or stroking
• Friction – rubbing or pressing
• Petrissage – squeezing or kneading
• Tapotement – striking, beating or percussion
• Vibration – oscillations on the skin

These can again be done with a part of the body, or with a tool as said earlier. Sometimes besides heat and vibration, essential oils can be used in combination with massage to assist with pain reduction, ease stress, or aide the release of muscles. I highly recommend locating a masseuse who uses therapeutic grade oils in their massage, as they add a whole new treatment dimension to the massage process. The style of massage practiced doesn’t really matter in general, as long as they are certified in some sort of therapeutic massage techniques. The masseuse you choose should sit and talk with you prior to each session to find out what areas will need focus, if any, and a general idea of your existing issues. This is important as it help’s them, and you, to create a sort of “game plan” for that treatment session.

Aromatherapy, while it still mostly falls into the realms of what most people consider too “out there,” or too “woo woo” as I call it, but there has been studies in smell and the body’s reaction to it. And there is enough evidence for me to consider that they just might be on to something. Certain smells diffused in the air during a massage session can assist with the body and mind’s relaxation, and can even assist with pain relief, since relaxation will make those endorphins release. So aromatherapy, combined with massage and oils, is the best, and possibly most effective way, to treat pain and stress in my humble, non-medical, opinion.

Again, you should do your own research, look into a few styles and find out what will work best for you. Interview a masseuse before going, and make sure you read up on the style they use for treatment to make sure it is right for you. It is always a good idea to talk it over with your doctor before embarking on any new pain treatments, and this way they can inform you of any issues you would need to be mindful about – such as with cancer patients, or pregnant women. Make sure the masseuse is certified, and if their certifications aren’t displayed, make sure you ask to see them. And if you are ever in doubt about anything, always ask a professional.

If you are in the Austin area, I highly recommend AZ Massage.