Our programs

Radiofrequency Facet Joint Denervation

Radiofrequency facet joint denervation is a safe and effective day case procedure for the treatment of back or neck pain arising from the lumbar, thoracic or cervical facet joints. It is also known as radiofrequency ablation, neurotomy, lesioning or rhizolysis.

Facet joints connect the bones of the spine. These small joints at the back of the spine provide stability and flexibility to the spine and can become painful with age, wear and tear or with injury. The facet joints are the source of pain in up to 40% of older patients with back pain and over 50% of patients with neck pain after whiplash injuries. Medial branch nerves, located near the facet joints, transmit the pain signals from the facet joints to your brain.

If the lumbar or cervical facet joints have been confirmed as the source of your pain, usually by diagnostic medial branch blocks (see cervical and lumbar medial branch blocks), then it is likely that radiofrequency facet joint denervation will be an effective treatment for your back or neck pain. Radiofrequency energy is used to disrupt the function of a medial branch nerve, so that it can no longer transmit pain signals from a facet joint.

Radiofrequency facet joint denervation is performed as a day procedure at StimMed Private Hospital in a specialised x-ray facility. All patients are given intravenous sedation to ensure they are as comfortable as possible throughout the procedure. The doctor performing the procedure will use local anaesthetic to numb your skin before accurately inserting a needle using x-ray guidance next to the medial branch nerve to the facet joint. The doctor will then check that the needle is properly positioned by stimulating the nerve. This may cause muscle twitching and provoke some of your pain. Once the needle is in the correct position, the area will be numbed and radiofrequency energy used to disrupt the medial branch nerve. Several nerves may need to be treated to obtain optimal pain relief. You will be monitored for 1-2 hours following the procedure prior to discharge.

Radiofrequency facet joint denervation is a minimally invasive procedure and serious side effects are rare. You may experience local bruising and discomfort and may feel sore for up to one or two weeks. This is normal, and is usually due to muscle and nerve irritation. Full pain relief from the procedure may take several weeks. Most patients are able to return to work within two days following the procedure.

Nerves regenerate after radiofrequency facet joint denervation. This usually takes between six months and two years. Your pain may or may not return when the nerve regenerates. If it does, the procedure can be repeated on multiple occasions as required.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner. StiMed clinic can facilitate you obtaining a second opinion. Please discuss this with us.

Pulsed Radiofrequency Treatments

In the mid 1990’s, applying a pulsed electrical stimulation to nerves was developed as a novel approach to relieving pain. The effect of the stimulation is to change the function of the nerve tissue and alter the transmission of pain signals along the pain-sensing pathway to reduce pain (ie. neuromodulation). This can be especially helpful for pain conditions that are the result of nerve damage or irritation.

The treatment is performed in a day surgery using specialised equipment and x-ray guidance. A light sedation is administered by an anaesthetist to optimise your comfort. Depending on your response to the treatment, your Pain Specialist may use pulsed radiofrequency singly or in a series of sessions to optimise its effect.

Many studies have shown PRF to be safe and effective, and complications are rare with precise needle positioning techniques and x-ray guidance. Complications include (but are not limited to) infection, bleeding or bruising, damage to nearby structures, allergic or other drug reactions. While the procedure itself is not very painful, you may experience a post-procedural flare of your pain before the full benefit develops over 2-3 days. You should consult your Pain Specialist to discuss the specific benefits and risks of any procedure you intend to undertake.

Pulsed Radiofrequency Treatment can be helpful in the treatment of:

  • Back and leg pain, Radicular leg pain or “Sciatica” (Dorsal Root Ganglion PRF);
  • Back/Buttock Pain or Cluneal Neuropathy (Cluneal Nerve);
  • Occipital Neurlagia (Occipital Nerve);
  • Shoulder Pain (Suprascapular Nerve);
  • Inguinal or Groin Pain;
  • Other peripheral nerve pain.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner. StiMed clinic can facilitate you obtaining a second opinion. Please discuss this with us.

Spinal Cord Stimulation

Spinal Cord Stimulation (SCS) is an exciting and relatively new development in the field of Pain Medicine. It provides a way to alter the experience of pain by modulating cell-to- cell communication of pain signals within the spinal cord. The overall effect is to reduce the experience of pain.

This treatment involves the insertion of small electrodes near the spinal cord that transmit electrical impulses. A small battery powered impulse pulse generator (IPG) that is secured beneath the skin provides energy to the electrodes. Various patterns or programmes of stimulation with electrical current are now available to optimise the pain relief each patient experiences. Each patient will work closely with their Pain Specialist to individually tailor their most effective programme.

Spinal Cord Stimulation is most commonly used to treat back, leg (‘sciatica’) or arm pain that has not responded to spinal surgery. Spinal Cord Stimulation can also be effective in treating Complex Regional Pain Syndrome (CRPS) and persistent pain following injury or surgery. Research has also shown that it can be effective in treating and other neuropathic pain conditions.

If your doctor decides that this treatment is appropriate for your condition, a comprehensive trial is performed. This involves inserting temporary electrode leads through a needle into the epidural space. These leads are connected to a temporary, external pulse generator (hand held battery device). This is performed as a day procedure in hospital. The stimulation trial will continue for approximately 7 days. During the trial period, we will monitor changes in the level of pain and functional capacity (activity you can do). If you experience significant reduction in symptoms and improvement in function, implantation of a permanent system will be considered.

Stimulation of peripheral nerves can also be effective in the treatment of conditions such as headache and shoulder pain (see Suboccipital Stimulation and Suprascapular Nerve Stimulation).

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner. StimMed clinic can facilitate you obtaining a second opinion. Please discuss this with us.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner. StimMed clinic can facilitate you obtaining a second opinion. Please discuss this with us.

Clinical Psychology

Sometimes when a person is referred to a clinical psychologist for help with a pain problem, the person’s initial reaction is: “Psychologists deal with mental problems. My pain is a real physical problem. How can a psychologist help me? Does this mean the doctor thinks it’s all in my mind?” The following section explains how coping skills training can be an important component of pain management, and why a problem like chronic pain can be improved by using psychological techniques.

What is a Clinical Psychologist?

A clinical psychologist has an undergraduate degree in psychology, and then a post graduate degree specialising in the assessment and treatment of a range of physical and emotional difficulties. The clinical psychologist might also have a PhD in clinical psychology, but clinical psychologists are not medical doctors. They do not prescribe medication or carry out physical examinations.

What does psychology have to do with pain?

When we experience pain after an injury, illness or disease, we expect the pain to stop once the body has healed. Unfortunately the pain does not always stop, and it can continue long after the body’s tissues appear to have healed. Medical treatments to relieve the pain are not always successful, and over time the experience of persistent pain can affect all parts of a person’s life. Chronic pain can be emotionally distressing, it can affect your ability to work or to participate in your hobbies and leisure activities, and because of those changes there can be negative effects on family, friends and co-workers. Clinical research has shown that our experience of pain generally gets worse. Sometimes we can push ourselves to complete a task or finish a job, only to find that the pain flares up and we feel even worse.

Knowing how best to live with a health problem that you never expected to persist is a real challenge, which is why getting some help with it can be valuable.

Pain Coping Skills Training

Medical researchers have been testing behavioural methods of helping people with chronic pain to improve their quality of life for over 40 years. Pain coping skills training refers to scientifically validated strategies and techniques that are taught to chronic pain sufferers to assist them living with pain, and can include the following:

  • Relaxation training;
  • Activity pacing techniques;
  • Attention diversion exercises;
  • Mood management techniques (cognitive therapy techniques);
  • Medication reduction plans under medical supervision;
  • Communication skills training and couples coping skills training;
  • Assistance with vocational rehabilitation and integrating pain management into the workplace.

It should be noted that these techniques don’t cure pain, and they aren’t intended to. What they can do is help you to become more active, less reliant on others and to feel more in control of your pain – in other words, to suffer less. They also take time to learn (between 4 and 12 sessions is the typical number of sessions), and there is usually “homework” to be done outside of the consultations so that you can practise the strategies being discussed.