Radiofrequency Nerve Ablation (RFA)

Key Takeaways

• Radiofrequency nerve ablation (RFA) uses focused heat to interrupt pain signals from the affected joint.

• It most often targets the medial branch nerves for chronic, facet‑mediated neck or low‑back pain after diagnostic blocks confirm the source.

• Conventional RF creates a controlled thermal lesion; pulsed radiofrequency delivers short bursts of energy to change nerve signaling without destroying tissue.

• The outpatient procedure is image‑guided (fluoroscopy), typically done with local anesthesia, usually takes less than an hour, and allows a quick return to routine activity.

• Relief commonly lasts months to a year, may be repeated, and carries a low risk of infection, temporary numbness, or rare persistent nerve injury.

What Radiofrequency Nerve Ablation Is and How It Works

In simple terms, radiofrequency waves produce localized heat that coagulates targeted nerve tissue to stop pain signals. For facet joint pain, the procedure usually focuses on the medial branch nerve that carries pain from the cervical or lumbar facet joints. Conventional RF creates a precise thermal lesion at controlled temperatures to denature nerve fibers. By contrast, pulsed radiofrequency uses brief pulses of energy to alter nerve signaling without destroying the nerve. RFA is minimally invasive and performed with imaging guidance so the electrode is placed precisely. It’s usually done with local anesthesia and optional sedation. Recovery is brief, and the procedure can be repeated if pain returns — potentially reducing the need for systemic treatments.

Conditions Treated and Candidate Selection

Who benefits most from radiofrequency nerve ablation depends on the pain source and prior response to treatments. Typical candidates have chronic neck or back pain lasting ≥3 months that maps to the facet joints and who had meaningful relief from diagnostic or medial branch blocks. Confirming facet‑mediated pain with diagnostic blocks is an important step before ablating medial branch nerves. RFA often gives longer relief than nerve blocks and can be repeated if symptoms come back. Patients without confirmed facet‑origin pain or those who did not improve after diagnostic blocks are less likely to benefit.

The Procedure: Preparation, Technique, and Recovery

Preparing for RFA usually means following instructions about stopping certain medications, arranging an anesthesia consultation if deeper sedation is planned, and wearing loose clothing for easy gowning and skin prep. The outpatient procedure generally takes under an hour and is done with local anesthesia and optional oral anxiolytics; general anesthesia is rarely needed. Using fluoroscopic guidance, insulated needles are placed and a small electrode is advanced to the target — commonly the medial branch nerve for facet pain — then radiofrequency current heats the tissue at controlled temperatures to limit surrounding damage. Most people go home the same day; recovery time is short, routine activities are often resumed within 24–48 hours, and mild soreness or bruising may last a few days.

Risks, Side Effects, and Long-Term Outcomes

RFA can provide meaningful pain relief, but knowing the possible complications helps with informed decisions. Common side effects include transient post‑procedural discomfort, bleeding, infection at the entry site, and temporary numbness or weakness; these usually resolve. Serious complications are uncommon but can include persistent nerve injury, allergic reaction, or, in rare cases involving facial nerves, localized hair or skin changes. The duration of relief varies — often several months to a year or longer — and repeat treatments may be needed because nerves can regenerate. Outcomes depend on factors such as the target nerve, lesion size, temperature and time settings, and the accuracy of diagnostic blocks. Long‑term follow‑up helps evaluate benefit and decide about repeat ablation.

Alternatives and Complementary Pain Management Options

Because RFA’s benefits and durability vary, clinicians and patients often consider other or complementary options. Conservative treatment is first‑line: physical therapy, activity modification, weight management, oral medications, and injections can relieve symptoms without ablation. Diagnostic blocks help confirm the facet joint as the pain source before moving to invasive care. When ablation is appropriate, options include conventional thermal RF, cooled radiofrequency for larger lesions, or pulsed RF to modulate pain with less tissue destruction. Complementary care — such as acupuncture, cognitive behavioral therapy, and structured rehabilitation — can lower reliance on procedures and medications. A multidisciplinary assessment helps tailor the best combination of strategies for each person’s goals and response.