Radiofrequency ablation for chronic pain

The procedure will be performed with x-ray or ultrasound guidance, using a needle, a microelectrode, and radiofrequency current. It takes about 1 to 2 hours for the procedure. The procedure can be performed at your health care provider's office or a clinic.

Your provider will give you a medicine (sedative) through your vein (IV) to relax you.

• You will be lying on your stomach, back, or your side for the procedure.
• A local anesthetic will be used to numb the area being treated.
• While using a machine that generates a radiofrequency current, a hollow needle will be inserted through the skin and guided with an x-ray or ultrasound to the correct site.
• A microelectrode is passed through the needle. You will feel a tingling sensation. This helps ensure the needle is placed correctly.
• Once the needle and electrode are placed correctly, you'll be given additional numbing medicine.
• The radiofrequency current runs through the electrode, heating and destroying the nerve tissue. You will feel mild discomfort during this process.

RFA is used to treat pain that doesn't improve with medicines or physical therapy. This includes pain due to various causes:

• Arthritis of the spine (ankylosing spondylitis) and sacroiliac joint
• Arthritis in the larger joints such as shoulder, hip, knee
• Cancer
• Shingles infection (postherpetic neuralgia)
• Amputation

You may have minor side effects after the procedure. These may include:

• Leg numbness (only for a few hours after the procedure)
• Temporary mild increase of your normal discomfort (2 to 3 days)

Risks of ablation procedures may include:

• Infection
• Bleeding
• Nerve injury
• A temporary increase in pain

Always tell your provider what medicines you are taking. This includes any medicines, supplements, or herbal supplements you bought without a prescription. You may be asked to temporarily stop taking medicines that keep your blood from clotting. These medicines are called blood thinners. This includes over-the-counter medicines and supplements such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and vitamin E. Many prescription medicines are also blood thinners.

Also:

• Ask your provider about which medicines you may continue taking on the day of the procedure.
• Tell your provider if you have a bleeding disorder, an active infection, or allergies to local anesthesia.

A bandage may be placed over the injection site and you will rest in a recovery room for about 30 minutes.

Below are the simple tips to follow after the procedure:

• You can eat and drink and take your regular medicines after the procedure ends.
• Do not drive or do any vigorous activity for 24 hours after the procedure.
• Do not bathe or shower for two days following the procedure.
• You may resume your normal activities the next day.

You may have pain due to the procedure or may notice some swelling where the needle was inserted. A cold pack may help.

The procedure can provide pain relief which may last up to 12 months and even longer.

Radiofrequency neurotomy; Radiofrequency lesioning

Basi HK, Rosenquist RW. Spine injections. In: Steinmetz MP, Benzel EC, eds. Benzel's Spine Surgery. 5th ed. Philadelphia, PA: Elsevier Saunders; 2022:chap 73.

Martens JM, Fiala KJ, Kalia H, Abd-Elsayed A. Radiofrequency ablation and pulsed radiofrequency ablation for the sympathetic nervous system. In: Abd-Elsayed A, ed. Radiofrequency ablation techniques. Philadelphia, PA: Elsevier; 2024:chap 16.

Updated by: Mark Gjolaj, MD, MBA, Anesthesiology and Pain Medicine Specialist, The Permanente Medical Group and Clinical Assistant Professor Adjunct, Stanford Health Care, Stanford, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.