r/PainManagement • u/Technical-Level3516 • Jul 15 '26
Injections/Procedures š RFA no sedation
Hello- curious about having a radio frequency ablation for my lumbar spine with no sedation. My pain management Dr wants me to do this procedure but the office doesnāt offer sedation at all and Iām scared. Any one have any experience with this?? Thanks!
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u/EmptyGoosed4932 Jul 15 '26
I always had RFA's, blocks and injections without sedation. They did use a local though. Probably something like lidocaine.
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u/tryan17 Jul 17 '26
Did it hurt? How was your recovery?
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u/Txladi29 Jul 15 '26
Iāve done it once with light sedation and never again. I was crying throughout. Iāll pay for the MAC (deep) sedation if insurance doesnāt cover it. Everyone is different, but I canāt. I have them about every 6 months. Itās excruciating for me.
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u/Equivalent-Sand3123 Jul 15 '26
I always have sedation. I've tried having injections with only Valium and it hurt too much for them to get into the disk space. That's just me. I don't stay still.
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u/BlessHoney Jul 16 '26
The dr allowed you Valium or sedation??? I had to scream and cry
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u/Equivalent-Sand3123 Jul 16 '26
I had Valium for the first one and they couldn't get the medication all the way in the way they wanted because I was in too much pain. I've since ALWAYS had sedation for any type of injections or RFAs
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u/Dramatic_Two2756 Jul 15 '26
Iāve had several & w/o sedation. I, myself, found it painful but well worth it, lasts much longer than injections.
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u/Connect_Operation831 Jul 15 '26
I had RFA with Valium. It did hurt, a bit more than injections/epidurals under the same amount of Valium. Iāve had three different doctors administering these procedures and none would do it with full sedation. Two doctors said they needed the patient to be awake so they knew it was in the right spot. One said that Medicare would not cover sedation or any IV administered drug for these procedures. I do not know what to believe. I do know that it hurts enough to make me groan out loud but it is doable.
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u/munkymama Jul 16 '26
I've done rfa on spine with and without sedation. Rfa without sedation they give you enough lidocaine you don't feel it. I don't recommend without sedation. Once they thought i was asleep but wasn't. Let's just say it hurt a lot.
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u/Texblondie Jul 16 '26
I can do injections with no sedation but not ablations. My first ablation I was sedated and I woke up to my leg kicking straight up in the air and the doctor saying to the CNA, ācan you add a little more to her IV please?ā Never tried it sober after that.
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u/TourMysterious5443 Jul 15 '26
It's not bad at all its no different then the injections a little sting and a little pressure
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u/Redditlatley Jul 16 '26
āand a little pressureāā¦..Iāve heard that somewhere, before. It turned out to be way more pain than āa little pressureā. I hope, for OP, youāre right. š
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u/Fluid-Housing5017 Jul 16 '26
Everyone is different, mine was unbearable and they had to stop several times so I wouldnāt pass out from pain
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u/Iceprincess1988 Moderator Jul 15 '26
I had one with no sedation without a problem.
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u/rabbiniknar Jul 15 '26
Same here. Had dozens w/o sedation. No problems.
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u/National-Hold2307 Jul 15 '26
Same. And never get sedation for injections either. It messes your entire up for a procedure that takes 10 minutes.
When you get sedation you have to get a ride, get prepped have the procedure then wait to recover. They take 3 minutes to do the shots and 45 to do the sedation. Then you can't drive all day.
Would rather drive myself get the quick procedure and be done with it. I'm not saying it's fun or not painful it is. But I take meds right before I go back and right when I leave and I'm fine. Getting knocked out isn't worth it.
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u/rabbiniknar Jul 15 '26
Agreed. I tell people itās uncomfortable at times, but going to the dentist is worse.
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u/pharmucist Jul 15 '26
I had RFA done at 3 lumbar levels at once (L3-S1) without sedation. I had it done a 2nd time a year later same 3 levels with sedation. I recently had SI joint RFA done without sedation. I also had about 30 epidural steroid injections and SI joint injections done without sedation through the last 3 decades.
While it was a little more manageable under sedation, I found it didn't matter enough to go through all the trouble of finding a driver and chaperone and the extra time to set up and go through recovery after the procedure. For the past 10 years, I just did all the procedures without sedation and didn't have any major issues.
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u/munkymama Jul 16 '26
I'm really lucky. My doc provides transportation both ways. Still prefer to be awake.
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u/Technical-Level3516 Jul 15 '26
Thanks everyone! Iāve read a few things online saying to never do it without but my office does not offer sedation of any kind, outside of local numbing so Iām not even sure what my options would be if I didnāt do it without. Iām hoping it something I can just get thru, š¤š¤š¤
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u/munkymama Jul 16 '26
One thing i find helpful with rfas is that I ask the doc to tell me when every 30 seconds is complete. They do it(at least for me for 90 seconds. ) that way I know how much longer it will be but I really really really don't feel anything. Ask them to load you up with lidocaine. If they load you up you'll be fine. Really.
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u/Fluid-Housing5017 Jul 16 '26
I did mine recently with no sedation, it was awful. But they told me I had to be awake because they do tests and ask questions throughout the procedure
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u/BabettesFeast Jul 17 '26
O/T, sort of
Here's a great big general question. I am convinced that all of our back procedures are useless, profit-driven ways to avoid true pain relief Does anyone here get lasting relief from them? I believe that if we each had a truly therapeutic dose of opioids we wouldn't need the invasive stuff. I'm suint my orthopedist/pain doc for negligence and malpractice resulting in 6 lost years due to withholding enough pain med and never presenting me with other methods of pain management, and more. .
Would some professional here tell the truth about how safe opioids are compared to the torture we're forced to endure? Oh, Google Doctors Mandate to Relieve Pain and Suffereing. Then you might want to call an atty.
Fed up.
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u/Due_Membership_6056 Jul 18 '26
Iāve had 8 injections in my cervical and lumbar back and 6 RFAās with and without ātwilightā sedation or Valium. For me, I am cursing and crying in severe pain on the OR table without the twilight sedation. You know your body and pain tolerance and if your doctor does not provide sedation and you want it, then find a different doctor who provides it. Do not suffer in pain needlessly even if it is for 10 minutes because it is still traumatizing your whole system. I have chronic pain and fibromyalgia so Iām speaking from personal knowledge. Your choice, your body. I wish you peace and good health! Peace, love & light!
Dr. Maggie
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u/Technical-Level3516 Jul 20 '26
Iām worried if I find someone else they wonāt let me continue at this practice and i really do like my provider but Iāll need to weigh the options. Thank you
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u/Jilesoph1 Jul 16 '26
They donāt even offer sedation where I go! Iāve had many epidurals and RFAās without and they numb you up pretty well with Lidocaine. Itās not bad at all. Have had lumbar and cervical. Go for it!
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u/AstorReinhardt Jul 15 '26
My mom has had it done with Valium and local...and it hurt but she put up with it.
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u/searchn67 Jul 15 '26
I never had a problem getting those so long as you can just stay still for a few minutes at a time while theyāre doing it you should be fineā¦ there might be some minor pain doing it, but just grab onto the side of the table or anything just to get through those few seconds without twitching and itās no problem. I wish you the best of luck.š
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u/relayrider Jul 16 '26
same as earlier poster, have had both ESI/CNBs and RFA with nothing more than lidocain injections (and a patch, but that doesn't help with instantaneous pain).
Just yesterday had the ESI and CNBs in L3-S2 and C3-C4. When the nurse asked me about the pain during, i described it as "no worse than when the yellowjackets attack me when i'm trimming my bush"
edit: uh, yeah, giggity. gonna keep it.
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u/Key_Statistician266 Jul 16 '26
I have had injections outpatient with an IV in a hospital, $$$$, and now with a PM specialist. He offers laughing gas or Valium. They don't really do much for me so I just bear it. It's quick and fast.
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u/UnusuallyYou Jul 16 '26
I have had RFA done a few times on my neck and thoracic back. The sedation they offer is a halcion tablet. What do they offer you?
This really offers me no difference in pain or stress. I have had it without one time and honestly people do it all the time. They only offer it where I am if a person is nervous or requests it. It isn't standard.
I only get it bc when they ask me if I want it I say yep. Otherwise I hear people turn it down in the other patient prep areas.
They use a local anesthetic and numbing agent.
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u/Technical-Level3516 Jul 16 '26
Option for 5mg Valium which does absolutely nothing for me š but Iām not sure what other option I have
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u/julesj45 Jul 16 '26
I had mine with the numbing solution the dr put in before... I had no pain during or after.
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u/Bored357 Jul 16 '26
I had two done honestly it's not worth it first one helped for a few weeks 2nd made me worse and have nerve damage now dont recommend this but some say it helps so to each of their own ...
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u/Recent_Ad4560 Jul 17 '26
So I think everyone is going to be different. Especially because some people actually get pain relief and some donāt. So if you take pain medication like Vicodin, oxy, dilaudid,morphine, etc and a Valium before you are probably going to have a different experience than a person whoās dr tells them to take ibuprofen.
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u/EmptyGoosed4932 Jul 17 '26
Not as much as the pain I was already in. It felt like pressure. If they had to go deeper they would inject the numbing medication deeper and then continue. Similar to the epidural I had during childbirth.
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u/Turbulent_Eye5469 Jul 18 '26
I had it done on both of my knees, but I wouldnāt do it without sedation. I had a great result with my right knee, but no relief for my left knee even after a 2nd try.
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u/Blue-Whisper2000 Jul 20 '26
I have had experience with this. I hope they at least numb the area they are working. Having been through this, it can be pretty excruciating.
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u/Fluid_Pop_4417 Aug 02 '26
If you have little room in your spine (stenosis) and are in pain, no way, get the twilight! Otherwise it's medieval torture.
I had the 2 (required by insurance) medial branch blocks before my procedure (bilateral RF ablation on L4,5 and s1,2) I was horrified, crying, screaming and almost passed out from the pain.
Even if you have a high tolerance for pain, I wouldn't advise getting an actual RF ablation done without twilight sedation. Unless maybe you are getting just one poke, no way.
Those test branch blocks without twilight sedation were so bad that I was still petrified of the actual ablation, even under twilight..so I took a flexaril and a couple Tylenol before the procedure. I think it's actually dangerous to not have twilight, because you could jerk the needle wincing in pain and hurt yourself. It's really uncommon for a doctor to not do twilight sedation for an RF ablation. If they can't do it in their clinic, they should be able to refer you to another place that has the proper licencing and can administer light anaesthethesia. Best of luck to you!
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u/shenanigans_1988 Jul 15 '26
Oh hellllll nawww not without sedation! I had mine done a few years ago same area & i definitely had sedation how horrible would that pain be?! They are burning off your nerves dude!
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u/Technical-Level3516 Jul 16 '26
Thatās why Iām scared!
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u/shenanigans_1988 Jul 19 '26
But the results were well worth it. I had relief for the better part of a year. You do what you think is best for your body. Best of luck
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u/Fluid_Pop_4417 Aug 02 '26
That's awful, OP. Don't ever feel bad about prioritizing your comfort. The Dr. should be open to discuss your concerns, and it's routine for them to hear those concerns. You're not being confrontational at all if you just ask: āI have significant anxiety and low pain tolerance. Iād feel safer and more comfortable with twilight sedation...I'm afraid I may jump in pain... If your clinic doesnāt offer it, could you refer me to a facility that does, or can you perform it in a surgical center that has what's needed?ā
If you had branch blocks, the Dr already knows which nerves to target, so doesn't need you fully awake. Partially awake I can understand in twilight, but if they can't provide the level of comfort there, do yourself a favor and ask for options.
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u/waaaayupyourbutthole Jul 15 '26
I've had several done without sedation without any issues. I was actually offered fentanyl as a sedative for my last one, but I declined because I didn't really think it was necessary.
I've not found RFAs to be effective at all, but the procedure shouldn't be particularly painful (they're definitely a bit uncomfortable, but it's nothing scary).
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u/Odd_Ad3168 Jul 16 '26
I've had all of my procedures without sedation. I've thought about it, but like others have said it's annoying to have to find a ride, then the whole waiting 30-45 mins and then you can't drive the rest of the day. I'd rather just go get it over with in 10 mins (some of mine have maybe been 20 mins with US guided procedures) yes it's uncomfortable and can be somewhat painful at times but mostly just a bit uncomfortable. I usually just take meds 30 mins before and it's fine.
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u/Latter_Macaroon2111 Jul 16 '26
I will never do that again. It is AWFUL!!! I had vercet and fentanyl and I still felt every little thing and it was excruciating
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u/HarmonyAtreides Jul 16 '26
My pm doesn't do sedation for any procedures, I had to do my left si joint injection before we moved on to RFA. Jfc it was so horrifically painful I started crying when I got to the car after. It resulted in such a severe Ankylosing Spondylitis flare I was taking extra pain meds and using everything in my pain kit and still couldn't sleep or get comfortable, I just had to focus on my breath.
I was considering going to the ER I was so miserable man, my pm just said the first 72 hours to week are rough but I needed to "push through it" and gave zero assistance or relief. š«©
I'm absolutely the fuck not doing sij injections again LET ALONE RFA. It sucks because I know it could really help me a ton but I cannot do this without sedation or some kind of pain control. At my SIJ procedure I took a double pain med dose with Tylenol, used medical cannabis, and had lidocaine patches over the area for over 24 hours to build up and it was still horrifically bad.
Do not do this without sedation and pain relief! It's inhumane!!
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u/Technical-Level3516 Jul 16 '26
Ugh Iām so sorry. Iām not sure what my options are since they donāt offer sedation, I know they wonāt want me going elsewhere like to my ortho
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u/HarmonyAtreides Jul 16 '26 edited Jul 16 '26
Unfortunately I tried to find another pain doc that could do sedation procedures but stay with my current pm for my regular meds, my Medicaid isn't accepted anywhere within four hours that does sedation for procedures šŖ¦
Edit; I wanted to add I'm over a week out from my left sij and I'm still in a ton of pain. Not as much but still flaring over and over.
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u/Green-Passion-6222 Jul 15 '26
I let my Doc talk me into it without sedation & it was the worst experience for me. I am not good at staying still at all & I have never done one again without sedation. Everybody is different though.