Radiofrequency ablation, often shortened to RFA, is one of those procedures that sounds more intimidating than it is. In the hands of a board certified pain doctor, it becomes a precise, outpatient technique that can meaningfully reduce chronic pain without surgery, open incisions, or prolonged downtime. I have recommended and performed RFA for thousands of patients over the years, from stoic construction workers who cannot climb ladders anymore because of back pain, to caregivers who dread every car ride due to neck spasms and headaches that radiate from the base of the skull. The promise is simple: if a small nerve wire keeps transmitting pain from a worn joint or irritated structure, quiet the signal at its source. When it works well, patients often say they get their mornings back.
What radiofrequency ablation actually does
RFA uses a specialized needle to deliver energy from a radiofrequency generator to a small segment of nerve tissue. The goal is to stop that nerve from conducting pain signals from a target structure, usually a spinal facet joint or the sacroiliac joint. The energy produces controlled heat, commonly around 80 to 90 degrees Celsius at the tip of the probe for a set period, often 60 to 150 seconds, which creates a small lesion on the nerve. This lesion interrupts the pain pathway while sparing nearby muscles and major motor nerves. The procedure is image guided, so an interventional pain specialist uses fluoroscopy or sometimes ultrasound to position the probe with millimeter accuracy.
RFA does not “burn” the entire nerve or fix arthritis. Instead, it neutralizes the tiny sensory branches that carry pain from specific structures. The bigger nerve trunks that control strength are left untouched. Because those small sensory branches can regenerate over time, relief may last several months to a couple of years, then fade as the nerve regrows. That finite window is not a flaw, it is the normal biology of peripheral nerves. For many patients, repeating the procedure when pain returns is a fair trade for avoiding daily pills or surgery.
Where it helps and where it does not
The classic use for RFA is chronic spine pain that comes from the facet joints in the neck or lower back. These joints work like the hinges at the back of each vertebra. With age, injury, or repetitive stress, they become arthritic and inflamed. Facet pain tends to feel like a deep ache off to one side of the spine, worse with extension, twisting, or standing after sitting. It often does not radiate below the knee. A back pain doctor or neck pain doctor will often suspect facet pain based on the pattern and exam.
RFA is also well established for sacroiliac joint pain, which can mimic sciatica and make rolling over in bed miserable. The sacroiliac joint is a stout connection between the spine and pelvis. When it becomes irritated, nerve branches along the back of the pelvis carry pain into the buttock and sometimes the groin or thigh. Pulsed radiofrequency, a variant that uses lower temperatures, is sometimes used for occipital neuralgia, which causes headaches starting at the base of the skull, and for certain peripheral nerves that remain sensitive after surgery or trauma. Some knee and hip pain related to osteoarthritis can respond to genicular or articular branch RFA, especially when a joint replacement is not an option or the pain persists after surgery.
RFA is not a first line treatment for sharp leg pain from a new disc herniation compressing a nerve root, and it will not correct spinal instability, severe spinal stenosis with neurogenic claudication, or a structural deformity that needs a surgeon. A pain management physician will usually steer you toward an epidural steroid injection for inflamed nerve roots, physical therapy and activity modification for acute strains, and consultation with a spine surgeon when there are red flags such as progressive weakness or bowel and bladder changes. Matching the tool to the problem is the cornerstone of good pain management care.
The path to RFA runs through diagnostic blocks
Before scheduling RFA, a careful pain management consultation sets expectations and confirms the likely pain generator. That includes a detailed history, focused exam, and targeted imaging if warranted. A pain management specialist will then perform one or two diagnostic nerve blocks. These are short, low volume injections of a local anesthetic around the tiny nerves suspected of transmitting the pain.
If numbing those nerves reduces the pain by a meaningful amount, often 50 to 80 percent or more for the lifespan of the anesthetic, that supports the plan for RFA. If the pain does not change, ablation is less likely to help, and the interventional pain doctor will reconsider the diagnosis. Some practices perform dual comparative blocks using different anesthetics with different durations to strengthen the evidence. This step can feel like an extra hoop, but it saves people from undergoing procedures that won’t deliver.
Anecdotally, I recall a long distance runner in her fifties who swore her pain came from a degenerated disc seen on MRI. Her exam pointed me to the facets. We did a controlled set of medial branch blocks on a Friday afternoon. She called Monday morning ecstatic, pain free all weekend until the numbness wore off. Her RFA held for fourteen months, and she returned to running with a smarter training schedule and regular glute strengthening. Without the blocks, we would have chased the wrong target.
What to expect on the day of the procedure
Most RFA procedures are outpatient, completed in 30 to 60 minutes, and require only light sedation if any. You arrive a bit early, check in, sign consent forms, and the team starts routine monitoring. In the procedure room, a pain treatment specialist cleans the skin and uses local anesthetic to numb the path down to the target nerves. Fluoroscopy provides real time X ray guidance to place the probes. Proper placement matters more than anything else. A few millimeters off, and you miss the lesion.
We run a sensory test through the probe that produces a tingling or pressure in the area you usually feel pain, which helps confirm position. A brief motor test follows to be sure there is no activation of muscles that would indicate proximity to a motor nerve. When placement is secure, we create the lesion. Some physicians inject a drop of steroid and anesthetic after lesioning to reduce post procedure soreness. You rest in recovery for a short period, then go home the same day with instructions.
Plan for a friend or family member to drive for the first 24 hours. Most patients walk out under their own power. A minority feel a sunburn like soreness for a few days. Simple measures like ice packs and over the counter analgesics usually suffice. Light activity is encouraged, while heavy lifting or twisting waits several days. Many people return to desk work the next day.
How long relief lasts and what results look like in practice
When patients ask how long RFA lasts, I give a range and describe what I have seen. For facet joint RFA in the neck or low back, meaningful relief commonly lasts 6 to 18 months. A third of patients get around a year, some up to two years, and a small group closer to six months. When pain returns, a repeat procedure often works again if the original response was strong. For sacroiliac joint targets, results are similar but can be a bit more variable, largely because the joint’s mechanics and referred pain patterns differ among individuals.
The depth of relief matters as much as the duration. A good outcome is not always zero pain. It is the difference between avoiding social plans and participating, between white knuckling a commute and driving without a second thought. I track functional markers: how long you can stand, how many hours of sleep you get, whether you can garden for a weekend without paying for it all week. When the baseline was eight out of ten pain and after RFA you live between two and four, that is a success in the language of a chronic pain specialist.
Risks, safety, and the tedious but important details
RFA is low risk, but no procedure is risk free. Short term soreness at the treatment site is common. Temporary neuritis, which feels like a zinging, superficial burn in the skin, can occur and usually fades within days to weeks. Bleeding and infection are rare in healthy patients. We screen for conditions like bleeding disorders, use sterile technique, and avoid the procedure when there is an active infection. For cervical procedures, there is a small risk of dizziness or headache, typically transient. Serious complications, like nerve injury causing weakness, are very rare when performed by an experienced interventional pain physician using imaging and standard motor testing.
People often ask if RFA causes numbness. The targeted nerves are sensory branches that serve the joint, not the skin, so a dense area of numb skin is uncommon. Most patients describe a vague sense of dullness rather than absent sensation. Another question is whether RFA accelerates arthritis. The medical literature has not shown RFA to worsen joint degeneration. It treats the pain pathway without changing the mechanical structure of the joint.
Medication management matters around the procedure. Blood thinners like warfarin, clopidogrel, or certain novel oral anticoagulants may need adjustments in coordination with your prescribing physician. Diabetics should know that a post lesion steroid, when used, can transiently raise blood glucose. A pain medicine doctor or pain management anesthesiologist will review your full list of medications and medical conditions to minimize risk.
Where RFA fits inside a full pain management plan
RFA works best inside a broader approach. The day you feel better is the window to build strength and restore movement patterns that protect your spine and joints. A pain rehabilitation doctor or physical therapist can help retrain hip hinge mechanics, core stabilization, and hip abductors, which offload the lumbar facets and sacroiliac joint. Sleep, mood, and stress management are not afterthoughts. Chronic pain primes the nervous system, and dialing down the volume requires conditioning and recovery.
A comprehensive pain management doctor sets realistic goals. If you are fifty with arthritic changes across several levels and a job that involves manual labor, the plan will differ from that of a thirty five year old office worker after a whiplash injury. As a pain management provider, I stack the interventions: education and activity modification first, then physical therapy, non opioid medications when appropriate, diagnostic injections, and finally targeted procedures like RFA. Opioids are rarely a good long term solution for axial spine pain. A non surgical pain doctor will prioritize non opioid strategies, reserving them for specific scenarios.
Sometimes RFA creates a bridge, giving you enough relief to tolerate a home exercise program, ergonomic changes, and weight management that in turn reduce load on the joints. Occasionally, it reveals residual pain from a second source, like a sacroiliac joint contributing on top of facet pain. In those cases, a nerve block doctor can map out contributions stepwise so we never guess.
Candid pros and cons from a procedure room perspective
The strongest advantages I see with RFA are its precision and its ability to reduce pain without impairing strength. Patients do not walk out weak or sedated. It is repeatable, which is useful in a chronic condition that fluctuates. Costs vary by region and insurance, but because it is not an operating room procedure and does not require implants, it is generally more accessible than surgery.
On the downside, RFA does not help every type of back or neck pain. If the pain is myofascial, primarily in the muscles, trigger point injection or a structured therapy program may be better. If the pain is inflammatory from a systemic condition like ankylosing spondylitis, rheumatology comanagement is key. If the true driver is instability, like a spondylolisthesis that worsens with standing and improves sitting, RFA may only scratch the surface.
A second limitation is time. Expect the effect to wane as nerves regenerate. A pain management expert will set a calendar for follow up rather than waiting for a crisis. Third, there is an art to patient selection and probe placement. Results correlate with the operator’s experience. This is why I encourage patients to look for a board certified interventional pain specialist or pain medicine physician who performs these procedures routinely and can explain the plan in detail.
How RFA compares to other interventional options
People often weigh RFA against epidural steroid injections. These injections are designed to calm inflamed nerve roots in the canal and foramen. They excel when leg pain or arm pain from a pinched nerve dominates. RFA, by contrast, targets medial branch nerves for facet pain or lateral branch nerves for the sacroiliac joint. If your primary complaint is low back ache worse when you stand and extend, RFA may be more logical than an epidural.
Facet joint injections with steroid can temporize, but they tend to offer shorter relief windows. They are often used as a diagnostic step, but for durable benefit, RFA has the edge in the facet domain. Surgical options like spinal fusion address instability and deformity but come with higher risk, cost, and recovery time. For selected patients, genicular nerve RFA can postpone knee replacement or help after replacement when pain persists without a clear structural cause.
Peripheral nerve stimulation and spinal cord stimulation are separate tools in the interventional toolbox. They use implanted leads to modulate pain signals electrically. They can help neuropathic pain and failed back surgery scenarios. They carry their own risks and benefits, and insurance pathways are distinct. A pain management clinic with a wide range of services can tailor the sequence to your history, imaging, and response to previous treatments.
Who is a good candidate and who should pause
Ideal candidates for RFA have chronic pain that localizes to facet joints or the sacroiliac joint, respond positively to diagnostic nerve blocks, and want to reduce medication use while improving function. They can follow instructions, hold still during the procedure, and commit to post procedure rehabilitation. A pain management medical doctor also looks at comorbidities. Uncontrolled diabetes, untreated bleeding disorders, or active infections need attention first. Pregnancy changes the calculus, because fluoroscopy involves radiation. Many clinics avoid RFA during pregnancy and plan safer timing postpartum.
Past spine surgery is not a disqualifier, but surgical hardware can alter anatomy and imaging. A spinal injection specialist who is comfortable navigating around instrumentation is helpful. People with pacemakers or implantable defibrillators can sometimes undergo RFA safely, but only with cardiology clearance and device management protocols. The equipment used for RFA can interact with the leads, so careful planning matters.
Practical steps to prepare and recover well
Preparation is straightforward. Wear comfortable clothing, follow fasting instructions if sedation is planned, and review medication adjustments with your pain clinic doctor. Bring a list of your medications and allergies. Arrange a ride home. Expect to be at the clinic for a couple of hours even though the procedure itself is brief.
Recovery focuses on gentle movement and avoiding extremes in the first few days. Ice helps with soreness the first 24 to 48 hours. Heat can help later if muscles tighten. Keep the bandage dry for the first day, then normal showers are fine. Serious red flags after RFA are rare, but call your pain control doctor if you develop a fever, increasing redness at the site, new weakness, or unusual numbness that does not follow the expected pattern. Most people can resume normal activities within several days, advancing based on comfort and guidance from their pain therapy doctor or therapist.
Here is a short, practical checklist many of my patients find useful:
- Confirm which medications to hold and for how long with your pain medicine specialist and prescribing doctors. Arrange transportation and light duties at home for 24 hours. Plan a follow up visit 4 to 6 weeks after RFA to measure function and adjust therapy. Start or resume a targeted exercise plan once soreness fades. Track three functional goals, such as standing tolerance, sleep hours, and walking distance, to judge the procedure’s impact.
Real cases, real trade offs
One of my patients, a retired firefighter, had low back pain that flared every time he stood at social events. He had tried physical therapy, chiropractic adjustments, and nonsteroidal medications, with modest relief. Imaging showed multi level facet arthropathy without significant stenosis. Two sets of medial branch blocks each gave him more than 80 percent relief for the expected duration. RFA provided a year of freedom. He still had stiffness in the morning, but he could stand through his granddaughter’s recital without leaning on the wall. The trade off was returning for a repeat treatment the following year, which he viewed as a small price.
Another patient, a young mother after a minor car accident, had persistent neck pain and headaches at the base of the skull. Her exam pointed toward upper cervical facets and occipital nerve irritation. Blocks were convincing. RFA reduced her neck pain by half and eliminated the weekly migraine like headaches she had been fighting, which allowed her to reduce triptan use and resume work. She still needed posture work and shoulder strengthening to maintain the gains. RFA did not replace ergonomics and stress management, it trusted pain doctor enabled them.
Not every story ends with a dramatic turnaround. I have had patients with widespread pain where the facet component was just one piece of a larger central sensitization picture. RFA helped a slice of their pain, but daily function depended on sleep hygiene, cognitive behavioral strategies, and graded activity. Setting expectations clearly during the pain management consultation made that outcome acceptable rather than disappointing.
Choosing the right clinician
The procedure is only as good as the planning and execution. Look for a pain and spine doctor who:
- Is board certified in pain medicine, anesthesiology, PM&R, or neurology with interventional training, and performs RFA regularly. Reviews your history, exam, and imaging rather than scheduling an ablation based on a report. Uses image guidance, sensory and motor testing, and appropriate lesion parameters. Discusses risks, alternatives, and a rehabilitation plan. Tracks outcomes using functional measures, not just pain scores.
Titles vary. You might see pain management surgeon, interventional pain specialist, pain injection doctor, or pain management anesthesiologist. Focus less on the label and more on the clinician’s approach, communication, and volume of similar cases. A comprehensive pain management doctor who offers a spectrum of treatments, from nerve blocks to epidurals to RFA and beyond, can pivot if a particular strategy does not deliver.
Final thoughts from the clinic floor
Radiofrequency ablation is not magic, but it is dependable when used in the right pattern of pain with the right preparation. It is a procedure I return to because it often delivers what chronic pain steals: predictable mornings, longer walks, simple chores without a flare, a drive without bargaining with your spine. It is one tool in a large kit used by pain management experts, and the best outcomes come when it is paired with clear diagnosis, honest expectations, and follow through on strength and mobility.
If you are living with chronic facet or sacroiliac pain and diagnostic blocks point to those joints, a conversation with an interventional pain doctor about RFA is worth your time. Expect a careful workup, a straightforward outpatient procedure, a few days of soreness, and a realistic chance at months of improved function. In a field that often promises too much, that kind of steady, measurable progress is something I trust.