Finding Freedom from Chronic Back Pain

How Thoracic Facet Radiofrequency Neurotomy Offers Lasting Relief at APSI Wellness

For those living with persistent mid-back pain—the kind that thwarts a deep breath, makes turning in bed an ordeal, and casts a shadow over daily life—the search for a solution can feel endless. You may have navigated a frustrating gauntlet of treatments: medications that fog the mind but don’t fix the pain, physical therapy that provides only temporary relief, or injections that wear off after a few months, leaving you right back where you started. If this cycle sounds familiar, it’s time to understand a precise, advanced procedure that breaks it: Thoracic Facet Radiofrequency Neurotomy (TRFN).

At APSI Wellness, with accessible clinics in Cincinnati, OH; Maysville, KY; and Naples, FL, we specialize in turning the page on chronic pain. We move beyond merely managing symptoms to providing targeted, lasting solutions. Thoracic Facet Radiofrequency Neurotomy is a cornerstone of this approach—a minimally invasive, evidence-based procedure designed to silence the specific nerves responsible for facet joint pain in your mid-back, offering relief that can last for years, not just months.

 

To appreciate the solution, we must first identify the true problem. Your spine is an intricate stack of bones (vertebrae), and at the back of each vertebra are small, paired joints called facet joints or zygapophysial joints. These joints are the guiding rails of your spine, allowing for smooth bending and twisting while preventing excessive motion.

In the thoracic spine (your mid-back, T1-T12), these joints are particularly vital for rotational stability and posture. Like any joint, they are lined with cartilage and encapsulated by a membrane rich with tiny nerve fibers—the medial branch nerves. These nerves are the pain messengers for the joint.

How Facet Joint Pain Develops

Facet joint pain, or facet syndrome, is not a single event but often the result of cumulative stress. Common causes include:

• Degenerative Osteoarthritis: The wear-and-tear of aging, where protective cartilage breaks down.

• Repetitive Stress or Poor Posture: Common in occupations or activities requiring prolonged sitting, twisting, or heavy lifting.

• Acute Trauma: Whiplash from an accident, a fall, or a sports injury.

• Secondary Compensation: Due to problems in other spinal regions (like lumbar or cervical issues), forcing the thoracic spine to work harder.

When a facet joint is injured or degenerates, it becomes inflamed. Every movement stresses the joint, sending pain signals via the medial branch nerves to your brain. This pain is typically felt:

• As a deep, aching, or stiff sensation directly along the spine in the mid-back.

• With potential referral patterns to the chest wall, ribs, or shoulder blade (scapula) region.

• Worse with extension (leaning backward), rotation (twisting), or prolonged standing/sitting.

• Often mistaken for muscular pain or even cardiac or organ-related issues.

The Limits of Conventional Approaches & The Diagnostic Pathway

Traditional treatments often fall short because they fail to address the specific nerve-mediated pain generator.

• Medications (NSAIDs, Muscle Relaxants): Mask inflammation and pain temporarily but do not heal the joint and carry risks with long-term use.

• Physical Therapy: Essential for strengthening and mechanics but often cannot calm the severe, persistent pain cycle enough to allow for effective rehab.

• Steroid (Cortisone) Injections: These can provide significant anti-inflammatory relief, but it is typically temporary (lasting weeks to a few months), as they do not interrupt the nerve’s ability to transmit pain.

At APSI Wellness, we follow a rigorous diagnostic protocol to ensure that Thoracic Facet Radiofrequency Neurotomy is the right solution for you. We believe precision is paramount.

Step 1: Comprehensive Clinical Evaluation
Our board-certified pain specialists begin with a thorough history and physical exam, mapping your pain and identifying hallmark signs of facet-mediated pain.

Step 2: Diagnostic Medial Branch Blocks (MBBs) – The Essential Test
This is the critical step that separates our approach. A medial branch block is a minimally invasive procedure where a small amount of local anesthetic is precisely injected to numb the specific medial branch nerves suspected of carrying your pain.

• The Procedure: Using real-time X-ray guidance (fluoroscopy), your physician guides a fine needle to the target nerve. The injection is quick, and you go home the same day.

• The Interpretation: After the injection, you will log your pain levels. The key question is: Did you experience significant pain relief (usually 70-80% or more) during the period when the anesthetic was active?

• The Meaning: A positive response is a diagnostic confirmation. It proves that these specific nerves are the primary conduits of your pain. If diagnostic blocks do not provide relief, it tells us your pain likely originates from another source, sparing you an unnecessary neurotomy. This diagnostic rigor is a standard of care we strictly adhere to.

Thoracic Facet Radiofrequency Neurotomy: The Procedure That Offers Lasting Relief

If you experience significant, reproducible relief from two diagnostic medial branch blocks, you are an excellent candidate for the neurotomy—the long-term solution.

Radiofrequency Neurotomy (RFN), also called radiofrequency ablation (RFA), is a precise technique that uses thermal energy to create a controlled, localized lesion on the medial branch nerve. This lesion interrupts the nerve’s ability to transmit pain signals from the diseased facet joint to your brain.

What to Expect During Your Procedure at APSI Wellness

1. Preparation: The procedure is performed in our state-of-the-art ambulatory procedure suites. You will have an IV placed for relaxation medication. You are awake but comfortable, which is important for communication.

2. Precision Guidance: You will lie face down on the procedure table. Using fluoroscopic guidance, your physician will meticulously guide a small radiofrequency needle to the exact location of the target medial branch nerve. Multiple nerves are often treated in one session to address all painful joints.

3. Sensory and Motor Testing: Before any treatment, your doctor will perform low-voltage sensory and motor stimulation. This safety step ensures the needle is perfectly positioned on the sensory pain nerve and not on a motor nerve, preserving your muscle function.

4. Treatment: Once placement is confirmed, a local anesthetic is injected for comfort. Then, the radiofrequency generator is activated, heating the tip of the needle to a precise temperature for a controlled duration (typically 60-90 seconds per lesion). You may feel a mild warming or pressure sensation.

5. Completion: The needles are removed, a small bandage is applied, and you are moved to a recovery area. The entire process usually takes 30-60 minutes, and you will go home the same day with a companion to drive you.

The Science of Lasting Relief: Why It Works

The goal is not to destroy the nerve entirely but to create a precise thermal lesion that disrupts the pain-signaling fibers (C and A-delta fibers). The nerve’s structural sheath often remains intact, allowing for the possibility of regeneration over a long period—typically 12 to 24 months, and often much longer. For many patients, the pain does not return to its original severity. If it does, the procedure can be safely repeated.

Recovery and What to Expect After the Procedure

Immediate Post-Procedure (First 72 Hours):
You may feel some procedural soreness at the needle sites, similar to a muscle bruise. This is normal and resolves quickly with ice and over-the-counter pain relievers. The therapeutic pain relief from the neurotomy itself typically begins within 1-2 weeks, as the initial inflammation from the procedure subsides and the nerve signals are fully interrupted.

The First 2-4 Weeks:
This is a crucial period. You will be given specific activity guidelines. While you may feel significantly better, it is essential to avoid strenuous lifting or aggressive twisting to allow the treated area to settle. Gentle walking is encouraged.

Long-Term: Reclaiming Your Life
This is the goal. As the full relief sets in, patients report being able to:

• Sleep through the night without pain.

• Return to hobbies like golf, gardening, or playing with grandchildren.

• Sit through a workday or a long car ride comfortably.

• Engage meaningfully in physical therapy or core strengthening programs without the previous pain barrier.

Important Note: RFN treats the nerve pain from the arthritic joint. It does not “cure” the underlying arthritis. Therefore, a commitment to spine health through posture, core strength, and healthy movement remains vital for long-term success. Our team at APSI Wellness integrates this holistic philosophy into every treatment plan.

Why Choose APSI Wellness for Your Thoracic Radiofrequency Neurotomy?

Seeking an advanced interventional procedure requires trust, expertise, and comprehensive care. APSI Wellness is built on these pillars across our three locations.

1. Expertise You Can Trust: Our physicians are fellowship-trained, board-certified in pain medicine, and possess deep, subspecialized expertise in advanced spinal procedures. They perform hundreds of these procedures annually, ensuring the highest level of skill and precision.

2. A Commitment to Correct Diagnosis: We never skip steps. Our strict adherence to the two-step diagnostic block protocol exemplifies our commitment to treating the right patient with the right procedure. Your safety and outcomes are our priority.

3. State-of-the-Art Facilities: Each of our clinics—from Cincinnati to Naples—is equipped with advanced fluoroscopic imaging technology, ensuring needle placement is millimeter-perfect for maximum efficacy and safety.

4. A Holistic, Patient-Centered Philosophy: At APSI Wellness, we see you as a whole person, not just a painful spine. Our integrated approach may include collaborations with physical therapists, guidance on nutrition for inflammation, and stress management techniques to support your overall healing journey.

5. Accessible, Compassionate Care: With clinics in Ohio, Kentucky, and Florida, we are committed to serving our communities. From your first consultation to your post-procedure follow-up, our team is dedicated to providing clear communication, empathy, and unwavering support.

Is Thoracic Facet Radiofrequency Neurotomy Right For You?

If you suffer from chronic mid-back pain that has not responded adequately to conservative care like physical therapy or medication, and particularly if you experienced good but temporary relief from facet joint injections, this procedure may be your pathway to lasting freedom.

The journey begins with a conversation. Contact APSI Wellness today to schedule a comprehensive evaluation at the location most convenient for you. Let us help you determine if your pain is facet-mediated and if you are a candidate for a treatment designed not just to manage your pain, but to dramatically reduce it for the long term.

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Take the First Step Toward a Life with Less Pain.

APSI Wellness – Advanced Pain & Spine Interventions

• Cincinnati (Milford) Location:
  5405 DuPont Circle, Suite A, Milford, OH 45150

• Maysville Location:
  1907 Old Main Street, Suite 1, Maysville, KY 41056

• Naples Location:
  9975 Tamiami Trail North, Suite 1, Naples, FL 34108

Visit our website to learn more or schedule your consultation: www.apsiwellness.com

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Thoracic Facet Radiofrequency Neurotomy is a medical procedure that requires a formal consultation and diagnostic workup with a qualified pain medicine physician to determine individual candidacy, benefits, and risks.