Summary: Doctors used a technique called cooled radiofrequency ablation to reduce hip and shoulder arthritis pain. The procedure is highly safe, with almost no side effects. It could significantly reduce pain in 70-80% of the patients. Shoulder and hip arthritis are very common. Both get worse with time. Many people living with this pain stop responding to standard drug therapy. Then they are left with joint replacement or long-term opioid treatment. But doctors have found a safer way to beat pain in people who cannot have surgery.
Doctors have found a new way to give significant pain relief to people living with chronic hip or shoulder pain due to severe arthritis. It works even for people who get little help from drugs. It can also give long-lasting pain relief and improve how the joint works. New ways to treat severe chronic pain like arthritis matter, because they can cut dependence on opioids. But severe arthritis pain is hard to treat. Arthritis is chronic, and it keeps getting worse. That means in people with the condition, pain keeps increasing.
In most of these patients, doctors start treatment with non-steroidal anti-inflammatory drugs (NSAIDs, like ibuprofen). But as the disease gets worse and pain grows, they often have to turn to opioids. Of course, besides opioids, there are many other treatment options, like intra-articular corticosteroid injections (steroid shots into the joint). Although intra-articular corticosteroid injections are safe and effective, their relief often fades. That is truer as the condition gets worse.
For example, most people may report significant benefits lasting almost six months after the first corticosteroid injection. But this benefit lasts barely three months on subsequent injections. In the end, intra-articular injections only help for a few weeks, so they stop being practical. For many people without good pain relief, joint replacement surgery is the only option. But not everyone can have joint replacement. For example, older adults or people with severe health conditions cannot have such a major surgery. So for them, high-dose opioids remain the only option. And high-dose opioids are associated with many health risks.
Is Cooled Radiofrequency Ablation Safe and Effective for Hip and Shoulder Pain?
The new technique uses no toxic drugs. It is minimally invasive (done through a needle, not an incision). So it is safe for many groups of people. This technique is called cooled radiofrequency ablation (c-RFA). The doctor inserts a needle, places it near the sensory nerves, and uses a specific radiofrequency to “knock out” these nerves. Radiofrequency causes permanent changes in these sensory nerves, so they stop carrying pain signals. It does not kill the nerve cells completely. It significantly reduces the signals they send. That means some feeling is kept, but pain signals are significantly cut.
The study was done on 23 people. Of them, 12 had chronic shoulder pain, and another 11 had hip pain. These people had not responded to standard drug therapy or to intra-articular lidocaine and corticosteroid injections. This procedure is highly safe, as it did not cause any side effects. It also brought significant benefits. All patients reported significantly less pain and better joint function. Doctors reported an impressive 85% pain reduction in those with shoulder pain and 74% pain reduction in those with hip pain. Also, two-thirds of the people in the study reported significant improvement in joint function. So doctors say the method could be a safe alternative to joint replacement surgery and long-term opioid use. It can also help reduce the risk of opioid addiction.
Of course, this procedure is not for mild or moderate cases of arthritis. It is more of a last resort. It is for people who cannot have surgery and for whom opioids are not an option. Note also that knee, shoulder, and hip arthritis account for 95% of all severe cases of arthritis. Doctors say they are still scratching the surface. This technique may also suit chronic pain from other causes. So future studies need to explore its role in cancer pain, pain after amputation, and trauma.
Frequently asked questions
Can radiofrequency ablation be used to treat hip pain?
Yes. In the study described here, 11 of the 23 patients had chronic hip pain from arthritis. Drugs and joint injections no longer controlled it. After cooled radiofrequency ablation, people with hip pain reported a 74% reduction in pain, and those with shoulder pain reported 85%. Two-thirds of all participants also reported clearly better joint function.
How does cooled radiofrequency ablation work?
The doctor places a needle near the sensory nerves that carry pain from the joint. Then a specific radiofrequency is used to “knock out” those nerves. The nerve cells are not killed outright. Their signals are sharply reduced, so some feeling is kept while pain signals drop. No toxic drugs are involved, and the procedure is minimally invasive.
What is the downside of radiofrequency ablation for arthritis?
It is not meant for mild or moderate arthritis. It is a last resort for people with severe hip or shoulder arthritis who cannot have surgery and for whom opioids are not an option. The evidence here also comes from a small study of 23 people. None of them had side effects from the procedure.
Who is a candidate for cooled radiofrequency ablation?
People with severe, chronic hip or shoulder arthritis pain who no longer respond to anti-inflammatory drugs or to steroid and numbing injections into the joint. It suits people who cannot have joint replacement, such as older adults or people with serious health conditions. Without it, they would be left with high-dose opioids.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
