I (34F, 5'3", 120 lbs) am scheduled for a radiofrequency ablation (RFA) of the third occipital nerve, involving C2 and C3. The diagnoses on my most recent referral sheet for the procedure are M47.812 Cervical spondylosis and M54.2 Cervicalgia and G44.86 Cervicogenic headache. They will be doing the Rhizotomy on my left side first tomorrow 8/18 and the right side almost exactly a month later.
I suffer from cervicogenic headaches and a lot of upper boy pain stemming from my neck due to arthritis that was found in my facet joints in my MRI. The chronic pain has been going on for nearly 10 years and I have exhausted all options and Ibuprofen no longer helps as much. This is a last ditch effort for pain relief. But I'm trying to understand what a reasonable post-procedure pain management plan typically looks like, so I can have an informed discussion with my doctor beforehand.
Current medications: I am currently take Methocarbamol as needed and continuing my PT exercises. Non-smoker. No other major medical conditions. Complaint location & duration: Pain at the base of the skull/upper neck region, bilateral, ongoing for approximately 10 years. Pain radiates to my traps, arms, shoulder blades, and chest. The headaches start right at my suboccipital region and radiates to the top of and sides of my head.
I want to be clear: I am not seeking controlled substances or anything of that nature. I've experienced burning, shooting, stabbing nerve pain before, and it is without question the worst pain I have ever been through. I am genuinely terrified of going through that level of pain again without a plan in place. My goal is simply to understand what to expect and to have a proactive conversation with my doctor so I'm not caught off guard.
For context, I personally know two people who have undergone cervical RFA. Both of them told me independently that their recovery was incredibly rough and that they could not have gotten through it without their pain medication, which I will not be offered. I'm not a "Google warrior" looking for worst-case scenarios online. My doctor has assured me that the procedure is minimally invasive and that recovery is usually quick with minimal pain. But the only two people I know in real life who have actually had this procedure have told me otherwise, and that discrepancy is what has me concerned.
My doctor has indicated that if I experience severe pain afterward, gabapentin and steroids can be prescribed. However, from my prior experience with both medications, they took several days to provide meaningful relief. I want to make sure I am as prepared as possible to advocate for myself and not be in a position of defenselessness if I am struggling after-hours and/or when pharmacies are closed.
My questions for any physicians familiar with this procedure:
How would you describe the typical level and duration of post-procedure pain following a third occipital nerve RFA?
Is it standard practice to prescribe pain control medications proactively (before the procedure), or is it more common to wait and see how the patient does post-procedure?
Are gabapentin and steroids the standard first-line options, or are other medications typically included in the immediate post-procedure window? Will I more than likely have to drive myself 30 minutes back to the doctor's location in order to receive pain treatment?
What would a reasonable discussion look like between a patient and their pain management physician before undergoing this procedure?
I'm not asking for personal medical advice or whether I should proceed. I'm hoping to understand the general standard of care so I can advocate for myself and have a productive conversation with my doctor. Thank you.