Anesthesiology | Interventional Pain Medicine
Assistant Professor — University of Toronto
Interventional Pain Physician — Afiya Spine & Pain Institute
Staff Anesthesiologist — Scarborough Health Network
Dorsal root ganglion pulsed radiofrequency neuromodulation is a procedure used to treat certain types of nerve-related pain.
The dorsal root ganglion, often called the DRG, is a small cluster of nerve cells located near the spine. It helps transmit pain and sensory signals from a specific region of the body toward the spinal cord and brain.
Pulsed radiofrequency uses brief pulses of radiofrequency energy near the irritated nerve structure. Unlike traditional radiofrequency ablation, it is not intended to burn or destroy the nerve. The goal is to calm or modulate the pain signal.
This is not the same as an implanted dorsal root ganglion stimulator. No permanent device is implanted.
This procedure may be considered for persistent nerve-related pain, especially when pain travels in a specific nerve pattern and has not improved enough with medication, physiotherapy, time, or other injections.
Nerve irritation may cause sharp, burning, electric, or shooting pain. Some people also feel numbness, tingling, sensitivity, heaviness, or weakness in the affected area.
Common situations include persistent radicular pain from the spine, sciatica-type pain, or other neuropathic pain patterns where a specific nerve level appears to be involved.
The goal is to reduce nerve-related pain, improve function, and make it easier to participate in physiotherapy, walking, strengthening, exercise, or other rehabilitation strategies.
A recent MRI is usually needed before proceeding. The MRI helps confirm the likely pain source, choose the safest approach, and identify the correct nerve level to treat.
You usually do not need to fast for this procedure unless you are specifically told otherwise.
The procedure is usually quick, but the full visit includes check-in, assessment, preparation, and recovery.
Most patients should expect the full appointment to take approximately 60 to 90 minutes, although this can vary depending on clinic flow that day.
The exact target depends on your symptoms, examination, imaging, and the nerve level being treated.
Most patients describe:
Local anesthetic is used to reduce discomfort. The procedure is usually brief.
You may walk and do normal light activity after the procedure. Avoid unusually strenuous activity for the rest of the day.
Do not drive until any numbness, weakness, heaviness, or altered sensation has fully resolved. If you feel lightheaded or weak after the procedure, do not drive.
This procedure is not judged only by the first few hours afterward. The effect can take time to develop.
Some patients notice improvement within days. For others, improvement may take several weeks.
It is common to have temporary soreness or a pain flare before the benefit becomes clear.
The amount and duration of relief varies from person to person. Some patients have substantial relief, some have partial relief, and some do not improve.
The next step depends on how much relief you have after the procedure and how long that relief lasts.
If your nerve pain improves significantly, we may continue to monitor your response and focus on rehabilitation, activity progression, strengthening, or other conservative measures.
If your pain does not improve, or only partially improves, we would usually reassess. This may mean reviewing the MRI again, considering a different target level, considering a different procedure, or discussing whether another specialist opinion is needed.
When symptoms suggest more than one pain source, dorsal root ganglion pulsed radiofrequency neuromodulation may sometimes be performed at the same appointment as lateral branch blocks, medial branch blocks, sacral radiofrequency ablation, or lumbar radiofrequency ablation. This is considered only when there is nerve-related or radicular pain as well as a separate pain pattern that may be appropriate for one of those procedures.
Some patients have more than one source of pain. Dorsal root ganglion pulsed radiofrequency neuromodulation may help nerve-related pain, but it may not explain or treat all of your symptoms.
Keep the needle site dry for 24 hours. Remove bandages after 24 hours.
If you develop a pain flare, this usually improves with time. Ice packs and over-the-counter pain relievers may help if you are allowed to use them. Avoid unusually strenuous activity for the rest of the day.
Dorsal root ganglion pulsed radiofrequency neuromodulation is a deeper spinal procedure performed near sensitive nerve structures.
The most common issues are temporary soreness, bruising, lightheadedness, temporary increase in pain, temporary numbness, or temporary irritation of the treated nerve.
Uncommon risks include bleeding, infection, allergic reaction, medication entering a blood vessel, temporary numbness or weakness, or a dural puncture. A dural puncture can cause a spinal headache that is usually worse when sitting or standing and better when lying down.
Serious complications such as deep infection, nerve injury, spinal cord injury, worsening nerve pain, or paralysis are very rare, but can occur with procedures performed near the spine and nerves.
Seek medical attention if you develop fever greater than 38.5°C, worsening redness or swelling at the needle site, drainage from the needle site, new or worsening weakness, new numbness that does not settle, loss of bladder or bowel control, severe headache after the procedure, or severe worsening pain that does not settle.
The procedure itself, including the clinic visit and use of X-ray guidance, is covered by OHIP.
OHIP does not cover the cost of medications used or prescribed, such as local anesthetic, contrast dye, or other medications. These costs may be covered by private insurance.
The medication cost is usually in the range of $25 to $100, depending on the extensiveness of the procedure, but this may vary.
Unless you are told otherwise, you may usually take your regular medications. Blood thinners require separate review.
It is very important that you tell us if you take blood thinners or antiplatelet medications. These medications may need to be held before this procedure to reduce the risk of bleeding around the spine. Do not stop them on your own. We will give you specific instructions based on the medication and your medical history.
Tell us before the procedure if you have ever had an allergy or serious reaction to contrast dye, local anesthetic, or antiseptic skin-cleaning solution.
Tell us if you have diabetes, an active infection, are taking antibiotics, are pregnant or may be pregnant, or have had a recent major change in your health.
Afiya Spine & Pain Institute
301 - 15 Wellesley St W, Toronto, ON M4Y 1G1
Phone: 416-413-7999 | E-Fax: 416-641-4520
For questions or concerns after your procedure, contact the clinic.