Caudal epidural pulsed radiofrequency treatment: A new horizon in pain management

Written in association with: Dr Yasser Mehrez
Published: | Updated: 13/08/2024
Edited by: Conor Lynch

Caudal epidural pulsed radiofrequency (PRF) treatment is an innovative approach to managing chronic pain, particularly in the lower back and legs. This minimally invasive technique utilises electrical pulses to modulate nerve activity, providing significant pain relief without the need for more aggressive interventions such as surgery. Here to explain more is esteemed pain management specialist, Dr Yasser Mehrez

What is caudal epidural PRF treatment?

Caudal epidural PRF treatment involves the delivery of pulsed radiofrequency energy through a needle inserted into the caudal epidural space at the base of the spine. Unlike continuous radiofrequency ablation, which uses heat to destroy nerve tissues, PRF employs short bursts of high-frequency electrical current to alter the transmission of pain signals. This method is believed to cause less damage to surrounding tissues while effectively reducing pain.

 

Who can benefit from this treatment?

This treatment is primarily recommended for patients suffering from chronic lower back pain, sciatica, and certain types of neuropathic pain that have not responded well to conventional therapies. Candidates for caudal epidural PRF typically include those who have tried physical therapy, medications, and other non-invasive treatments without satisfactory results.

 

How is the procedure performed?

The procedure is usually performed on an outpatient basis. After administering local anesthesia to minimise discomfort, a physician uses fluoroscopic guidance to accurately place the needle in the caudal epidural space. Once in position, pulsed radiofrequency energy is delivered for a few minutes. Patients may experience mild discomfort during the procedure, but it is generally well-tolerated.

 

What are the expected outcomes?

Patients undergoing caudal epidural PRF treatment often report significant pain relief within weeks, with effects lasting several months to a year. The procedure has been shown to improve mobility and quality of life, allowing patients to engage in daily activities with less pain. However, the degree of pain relief can vary based on individual factors, including the underlying cause of pain and overall health.

 

What are the risks and side effects?

As with any medical procedure, caudal epidural PRF treatment carries some risks, including infection, bleeding, and nerve damage, though these are rare. The most common side effects are temporary pain at the injection site and mild post-procedural discomfort.

By Dr Yasser Mehrez
Pain medicine

Dr Yasser Mehrez is a leading consultant in pain medicine, anaesthesia and intensive care. He currently practices at his NHS and private clinic in Milton Keynes where he treats all types of chronic pain using advanced techniques such as fluoroscopic and ultrasound guided interventional pain management procedures. Dr Mehrez leads a team of clinicians, psychologists, physiotherapists and nurses to deliver a high standard multidisciplinary pain service to his patients.

He has a special interest in treating back, neck, joint and facial pain, post-surgical scar pain, neuropathic pain and cancer pain using minimally invasive procedures. These include epidural injections, pulsed radiofrequency treatments, neuromodulation, removal of epidural adhesions and many more. Dr Mehrez ensures his patients receive the best long-term pain relief using a range of sophisticated medicines and techniques.

Dr Mehrez spent most of training in major institutions. He has gained extensive experience in pain medicine including multidisciplinary planning through working closely with other specialties. For example he has started joint clinics with the spinal surgical team,  joint efforts with urology teamed also primary care teams to allow the patient to clear understanding of their treatment options and to access the agreed line of treatment in timely manner. Dr Mehrez uses up to date treatments and technology to help his patients to benefit from advances in the growing specialty of pain medicine.

Dr Mehrez was trained at South Thames School in London; he spent a year at Guy’s and St Thomas' Hospital Pain Management Centre practicing the most advanced techniques in neuromodulation and pain management. He now works as a Lead Clinician at Milton Keynes University Hospital NHS trust, at his private clinic and teaches as an honorary clinical lecturer at the University of Buckingham Medical School. He is also a professional member of the Neuromodulation Society of the United Kingdom and Ireland, The British Pain Society and the International Association for the Study of Pain.

He is actively involved in the day-to-day running and strategic planning for the pain services in Milton Keynes. He is continuously involved in planning and redesigning the pain service in the area by advising, communicating and educating the services in the community. He is also in charge of monitoring pilot community pain services and introduced patient information booklets and various leaflets currently used at the clinic. He's actively involved in the education of his junior colleagues, general practitioners, nursing staff and most importantly, his patients.

For information leaflets on individual treatments, please use the search function on the Royal College of Anaesthetists website (link in websites below).

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