ArcaMax

DEAR DR. ROACH: Could you please comment on radiofrequency ablation (RFA) for chronic shoulder pain with rotator cuff disease? I'm 78 in good health with arthritis and a small separation of the rotator cuff. I've received epidurals that do work very well. I don't want to keep getting them, but I also don't want surgery. My shoulder orthopedic doctor dismisses RFA out of hand. "Nothing there to burn," he says.

I've researched this, and it seems like it's being done, but I want to make sure that this is legit. I have full insurance, so I don't think there is anything to lose. -- P.L.

ANSWER: One approach in people with chronic pain of many different kinds is to damage the nerves that carry pain information. There are many approaches to damaging pain nerves, but using radiofrequency electromagnetic waves to heat and damage nerves is one common way. In the shoulder, the RFA electrode is typically cooled. Although the target nerves are damaged, other structures that are inside and around the shoulder (bones, tendons and muscles) aren't damaged by the intense heat.

Studies have shown that RFA can improve pain, with 70% of participants in one trial having over 50% relief. Unfortunately, the pain nerves aren't damaged forever. Over time, they can regrow, and the pain can come back. The same study showed continued relief in 60% of participants who had pain relief at 6 months, then 50% at 12 months.

However, this study didn't have a control group, so it's unclear how much of the pain relief might be due to the placebo. Although there's promise with RFA for chronic shoulder pain, I can't fully recommend it as the level of evidence that I demand isn't there.

Money is not the only thing you have to lose with a treatment like this, as any treatment has the potential for side effects. The major theoretical concern with RFA of the shoulder is that the treatment will damage not only the pain nerves but the motor nerves as well. These nerves carry information from your brain that tells your muscles to move. Damage to these nerves could lead to weakness of the muscles. Fortunately, the techniques used in RFA are specifically designed not to damage these motor nerves, and muscle damage isn't reported.

Anesthesiologists/pain medicine specialists typically perform this procedure, so your surgeon might not be up-to-date with the latest information on this treatment.

DEAR DR. ROACH: My grandson has a stage IV diffuse anaplastic Wilms tumor. My question is, why are pediatric cancers so underfunded where research is concerned? Recently, I virtually attended a meeting with many professionals, including one of the world's experts, and it highlighted the lack of funding, which is sad. We're still battling. -- R.R.K.

ANSWER: I'm baffled as well. All cancers deserve ample funding. Unfortunately, in the past year, cancer funding for all types of cancer dramatically decreased. This is a political decision, not a scientific one, which has caused disruption in many ongoing important studies.

An overwhelming proportion of Americans support increased funding for cancer research. Let your local politicians know. Every American should have the contact information for their United States representatives and senators. I hope your grandson does well.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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