Radiofrequency Treatment
Radiofrequency treatment delivers controlled energy through a fine, image-guided needle placed next to specific nerves that carry pain signals. It is used in selected cases such as facet joint-related back and neck pain, nerve root pain and trigeminal neuralgia.
- Last updated:
- Medical editor: Prof. Dr. Hüsnü Süslü
At a glance
- Procedure time
- Usually 30-90 minutes, depending on the number of levels treated
- Anaesthesia
- Local anaesthesia, with light sedation if needed
- Hospital stay
- Usually same-day discharge
- Return to daily life
- Usually within 1-3 days; varies by person
Timings are for general information; your individual plan is made after examination and review of your imaging.
Who may benefit?
- People with chronic facet joint-related back or neck pain who had clear relief from a diagnostic block
- People with nerve root pain in the leg or arm that has not eased enough with medication and injections
- People with trigeminal neuralgia that does not respond to, or cannot be managed with, medication
- People with chronic shoulder pain who are not candidates for surgery or have not improved with conservative care
- People with neuropathic pain carried by a specific nerve, such as pain after shingles
Who may not be suitable?
- People who had no clear reduction in pain after a diagnostic block
- People with an active infection at the treatment site or elsewhere in the body
- People with a bleeding disorder or who cannot pause blood thinners on medical advice
- Pregnancy (the procedure uses fluoroscopy)
- People with a pacemaker or defibrillator: treatment can only be planned with a cardiology opinion and special precautions
How is it done?
A diagnostic block of the same nerves first checks whether your pain clearly improves.
The procedure is carried out under sterile conditions with fluoroscopy or ultrasound guidance.
The skin is numbed and a fine needle with an active tip is placed next to the target nerve.
A low-current stimulation test, guided by what you feel, confirms the needle position.
Once the area is numbed, radiofrequency energy is delivered.
After a short period of observation, most people go home the same day.
What is it?
Radiofrequency treatment uses energy generated by a high-frequency electrical current, delivered through a fine needle placed next to a specific nerve that carries pain signals. The procedure is image-guided, and the aim is to reduce the nerve's ability to transmit pain signals for a period of time.
There are two main forms:
- Thermal (conventional) radiofrequency: The needle tip is heated in a controlled way, interrupting conduction in the small sensory nerve that carries the pain for a period of time. It is mostly used for pain arising from the joints of the spine.
- Pulsed radiofrequency: The current is delivered in short bursts and the tissue does not reach a temperature that damages the nerve. It is used to modulate pain signalling in nerve roots and peripheral nerves.
When is it considered?
Radiofrequency treatment is considered when the source of the pain can be traced to a specific nerve. The main uses are:
- Chronic low back pain and neck pain arising from the small joints of the spine (facet joints)
- Pulsed radiofrequency next to the nerve root for nerve root pain in the leg (sciatica) or arm
- Headache and facial pain such as trigeminal neuralgia that does not respond to medication
- Treatment of the nerves supplying the shoulder in chronic shoulder and arm pain
- Neuropathic pain carried by specific nerves, such as pain after shingles
For low back pain, its place is also defined in guidelines. The UK's National Institute for Health and Care Excellence (NICE) recommends considering radiofrequency denervation for people whose pain has not improved with non-surgical treatment, whose pain is thought to come from the nerves supplying the facet joints, and who have responded well to a diagnostic nerve block.
How does it work?
In thermal radiofrequency, heat at the needle tip affects a very small section of the target nerve and interrupts the transmission of pain signals. Because the nerve gradually regenerates, the effect is not permanent; if the pain returns, the procedure can be repeated.
In pulsed radiofrequency, the tissue is not heated. The pulsed electrical field is thought to modulate how the nerve transmits pain. The mechanism is not fully understood, and results vary more from person to person.
For trigeminal neuralgia, the needle is passed through the cheek to reach the trigeminal (Gasserian) ganglion at the base of the skull. The aim is to reduce conduction in the branch that triggers the pain while preserving other facial sensation as far as possible. The possibility of some lasting facial numbness afterwards is discussed in advance.
Before the procedure
For facet joint pain, a diagnostic block of the same nerves with local anaesthetic is done first. After this facet joint injection, you will be asked to record how your pain changes hour by hour. If the pain clearly improves, the nerves are likely to be the source, and radiofrequency treatment can be planned.
You and your doctor will agree how to manage any blood thinners. If you have a pacemaker or another electronic implant, the procedure is planned with a cardiology opinion and special precautions. The aim of the procedure, possible risks and the alternatives are explained before you give your consent.
What happens during the procedure?
Your position depends on the area being treated; for the back and neck you usually lie face down. Once the needle tip is next to the target nerve, two tests are carried out with a low current. In the sensory test, you are asked whether you feel tingling or pressure in the painful area. In the motor test, the team checks that there is no unwanted twitching of the arm or leg muscles.
Because your feedback matters during these tests, deep sedation is not usually used. The area is then numbed and the energy delivered. Depending on how many levels and nerves are treated, the procedure can take from half an hour to an hour and a half.
After the procedure
After a short period of observation, most people go home the same day; do not drive on the day of the procedure. In the first days you may have pain, a burning feeling or skin sensitivity around the treated area. This usually settles within a few weeks, and cold packs and the medicines your doctor recommends can help.
You can return gradually to daily activities over a few days. As pain eases, keeping up with exercise helps you hold on to the movement you have regained. At your follow-up visit, the change in your pain, your daily function and your use of painkillers are reviewed together.
When might you notice results?
After thermal radiofrequency, clear relief usually appears within two to four weeks; temporary pain in the first days can affect this. How long the effect lasts varies from person to person. It usually lasts for months, and the pain may return as the nerve regenerates, in which case repeating the procedure may be considered.
The effect of pulsed radiofrequency is more variable: some people benefit clearly, while for others the benefit is limited. To find out where your pain is coming from and whether this treatment suits you, you can request a consultation.
Before the procedure
- Bring the pain diary you kept in the hours after your diagnostic block
- Talk to your doctor before stopping any blood-thinning medicine
- Tell the team in advance if you have a pacemaker, defibrillator or other electronic implant
- If sedation is planned, check how long you need to fast beforehand
- Arrange for someone to take you home after the procedure
After the procedure
- Rest on the day of the procedure and do not drive
- Use cold packs and the recommended painkillers for any burning or tenderness in the first days
- Return gradually to daily activities over a few days
- Keep up your exercise programme as the pain eases
- Call the clinic if you develop a fever, increasing pain, redness or new weakness
Possible risks and side effects
Like any interventional procedure, there are risks. Your individual risks are discussed during the consultation.
- Pain or a burning sensation at the treatment site for a few days
- A temporary flare of pain or skin sensitivity that can last a few weeks
- Numbness in the area supplied by the treated nerve
- After procedures for trigeminal neuralgia, facial numbness that may be long-lasting
- Infection or bleeding (rare)
- Weakness from an effect on a motor nerve (very rare)
- Pain returning over time, so the procedure may need to be repeated
Used for
- Low Back PainLow back pain is pain felt between the lower edge of the ribs and the creases of the buttocks. Most adults experience it at some point; it often eases within a few weeks, and when it lasts longer, pinpointing its source guides treatment.
- Lumbar Disc HerniationA lumbar disc herniation occurs when the soft centre of a spinal disc pushes through a tear in its tougher outer ring and presses on, or irritates, a nearby nerve root. It can cause back pain and, more typically, pain, numbness or weakness down the leg; in many people symptoms ease over time without surgery.
- SciaticaSciatica is nerve pain that travels from the lower back into the buttock and down the back of the leg. It is a symptom rather than a disease, most often showing that a disc herniation or narrowing around a nerve root is affecting the nerve.
- Spinal StenosisSpinal stenosis is a narrowing of the spinal canal, or of the openings where nerve roots leave the spine, that puts pressure on the nerves. In the lower back it typically causes leg pain and numbness that come on with walking and ease when sitting or bending forward.
- Neck PainNeck pain is felt anywhere from the base of the skull to the shoulders and is very common, usually linked to muscle strain, posture or age-related changes. Most episodes ease within a few weeks; when pain persists, identifying its source becomes important.
- Cervical Disc HerniationA cervical disc herniation occurs when the soft centre of a disc in the neck pushes out and presses on a nerve root or the spinal cord. As well as neck pain, it can cause pain, numbness and weakness spreading into the arm and fingers.
- Headache and Facial PainHeadache and facial pain cover a wide range of conditions, from migraine and tension-type headache to nerve pains such as trigeminal neuralgia and occipital neuralgia. Effective treatment begins with identifying the type of pain and any underlying cause.
- Shoulder and Arm PainShoulder and arm pain can come from the shoulder joint itself, the surrounding muscles and tendons, or the nerves that run from the neck into the arm. Working out whether the pain starts in the shoulder or in the neck is the first step in treatment.
- Upper Back and Chest Wall PainUpper back and chest wall pain is felt between the shoulder blades and around the rib cage, and usually comes from muscles, joints or nerves. With new chest pain, however, urgent causes such as heart and lung problems must be ruled out first.
- Neuropathic PainNeuropathic pain is caused by damage to, or disease of, the nerves that carry sensations such as touch, temperature and pain. It typically burns, shoots or tingles, and often responds poorly to standard painkillers.
Frequently asked questions
Does radiofrequency destroy nerves permanently?
No. Thermal radiofrequency interrupts pain conduction in the target nerve for a period, and the nerve gradually regenerates. The effect therefore usually lasts for months, and the procedure can be repeated if the pain returns.
What is the difference between thermal and pulsed radiofrequency?
Thermal radiofrequency uses heat to switch off conduction in the nerve for a period. Pulsed radiofrequency aims to modulate pain signalling with short bursts of current without heating the tissue; it is mostly used on nerve roots and peripheral nerves.
Why is a diagnostic block done first?
To show that the pain really comes from the targeted nerves. If a block with local anaesthetic clearly reduces the pain, radiofrequency treatment is more likely to help.
Can people with a pacemaker have this treatment?
It requires special precautions in people with a pacemaker or defibrillator. The decision is made with a cardiology opinion and after the device settings have been checked.
References
- 1.Low back pain and sciatica in over 16s: assessment and management (NG59)NICE
- 2.Radiofrequency AblationStatPearls (NCBI Bookshelf)
- 3.Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working groupRegional Anesthesia & Pain Medicine (2020)
- 4.Radiofrequency Ablation (RFA)Cleveland Clinic
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