What it is
Radiofrequency ablation (RFA) uses a precisely placed needle and a brief pulse of radiofrequency energy to heat — and disable — the small medial branch nerves that carry pain signals from arthritic facet joints in your spine. The pain-sensing nerve is interrupted; the joint itself is left alone.
The body eventually regenerates these nerves, which is why relief is long-lasting but not permanent. When the pain returns, the procedure can typically be repeated.
Who it helps
You may be a candidate if you have:
- Chronic neck or low back pain that comes from arthritic facet joints
- Pain confirmed to be facet-mediated by diagnostic medial branch blocks
- Pain that hasn't responded to medication, PT, or other conservative care
- Pain that worsens with extension, rotation, or standing
- Recurrent pain after a previously successful set of facet joint injections
Diagnostic blocks come first. Before RFA, we perform one or two short-acting numbing blocks of the suspected nerves. If those temporarily relieve your pain, RFA is highly likely to give you long-lasting relief. If they don't, RFA isn't the right tool — and we'll redirect to a treatment that fits.
What the procedure looks like
Pre-Procedure Visit
We confirm the diagnosis, review your block results, walk through what to expect, and give you clear instructions on medications to pause beforehand.
Day of the Procedure
You'll be positioned face-down on a procedure table. The skin is cleaned and numbed. Mild sedation is available but most patients do well with local anesthetic alone.
Image-Guided Needle Placement
Using live X-ray (fluoroscopy), thin RFA needles are placed alongside the target medial branch nerves. We test the position with a brief stimulation to confirm we're in the right spot.
Heat Application
Each nerve is heated for about 60 to 90 seconds — enough to disable it, brief enough that the surrounding tissue is unaffected. The whole heating phase takes a few minutes per level.
Recovery and Follow-Up
You'll rest briefly and head home the same day. Some patients feel relief immediately; for most, the full benefit develops over 2 to 4 weeks as inflammation from the procedure itself settles.
Risks and what to watch for
RFA is one of the most well-studied interventional pain procedures and has an excellent safety profile when performed under image guidance. The most common side effects are mild and temporary: soreness at the needle sites for a few days, and occasionally a brief flare-up of the pain before relief sets in.
Serious complications are rare. Call us right away if you develop fever, increasing weakness, severe new pain, or any signs of infection at the procedure site.
What to expect afterward
- Take it easy the rest of procedure day — no heavy lifting or strenuous activity
- Most patients return to normal activities within 24 to 48 hours
- You may feel a temporary increase in pain for a few days as the nerves "go quiet" — this is expected
- Resume or continue physical therapy as soon as comfortable — RFA opens a window to rebuild strength
- Track your pain in a simple log so we can measure how well the procedure worked
Frequently asked questions
How long does the relief last?
Typically six to eighteen months — sometimes longer. When pain eventually returns, the procedure can usually be repeated with similar results.
Will the procedure hurt?
You'll feel pressure and brief warmth during the heating phase. Most patients are surprised at how tolerable it is — especially given the size of the long-term payoff.
Can I drive home afterward?
If you've had any sedation, no — bring a driver. With local anesthetic only, most patients can drive themselves; we'll confirm at your visit.
Is it covered by insurance?
Yes, in most cases — including Medicare. Coverage typically requires that diagnostic blocks first confirm facet-mediated pain. We verify your specific coverage before scheduling.
What if it doesn't work?
It happens occasionally, even when the diagnostic blocks looked good. If you don't get the expected relief, we reassess — sometimes a second pass is needed, sometimes the pain generator is somewhere else and we redirect.