Radiofrequency ablation

Radiofrequency ablation uses heat to stop small nerves from sending pain signals. A thin probe placed next to each nerve delivers the heat, which comes from a radiofrequency electrical current.

It most often treats the medial branch nerves, which carry pain signals from the facet joints (the small joints at the back of the spine). It can be done in the neck, the mid back, or the low back.

It is usually offered only after test blocks with numbing medicine (medial branch blocks) have clearly eased the pain for a few hours.

A similar procedure treats pain from the sacroiliac (SI) joint, where the spine meets the pelvis, by heating small nerves behind that joint.

Specialists in pain medicine, physical medicine and rehabilitation, anesthesiology, or radiology usually perform it, most often as an outpatient procedure.

The heat damages a short section of each target nerve, so it stops carrying pain signals from the joint. The nerve’s outer covering is left in place, so the nerve can slowly grow back. This is one reason pain can return months later.

Ablation does not repair the joint or stop wear. The hope is to turn the pain down for months, so it is easier to move and keep up with exercise or physical therapy.

Before

Your care team will ask about blood thinners, diabetes, allergies, and whether you could be pregnant. Tell them if you have a pacemaker, defibrillator, spinal cord stimulator, or other implanted device. These need planning, and the team may check with the doctors who manage your device.

Some blood thinners are paused before some spine procedures, and some are not. The team will tell you what to do. Never stop a blood thinner on your own.

Many clinics ask you to bring a driver, because numbing medicine can leave an arm or leg numb or weak for a few hours, and a driver is usually required if you are given medicine to help you relax.

During

You usually lie face down, or on your side or back for some neck procedures. The skin is cleaned and numbed first. Some clinics offer light medicine to help you relax. You usually stay awake enough to talk with the team.

Guided by x-ray, the clinician places thin probes next to the target nerves. Before any heat is used, the team may send a tiny electrical signal through each probe. You may feel tingling or buzzing, or notice muscles in your back or neck twitch. This helps check that each probe is near the right nerve and away from others. Tell the team right away if you feel the tingling or twitching in your arm or leg.

The area is numbed before the heat is turned on. You may still feel pressure or brief discomfort. Some clinics inject numbing medicine, and sometimes a steroid, before removing the probes, to ease soreness afterward.

The procedure usually takes longer than a test block, depending on how many nerves are treated.

After

Soreness in the treated area is common for several days, and sometimes for a few weeks. Some people notice a burning, sunburn-like feeling, extra-sensitive skin, or a patch of numbness over the treated area. This usually fades within a few weeks.

Relief is not always immediate. Soreness after the procedure can make it hard to tell at first whether it helped. Most people return to light, everyday activity within a day or two. A simple pain diary for the first few weeks helps you and your clinician judge how much it helped.

The evidence is mixed, and experts disagree about how much ablation helps.

Compared with a sham (pretend) procedure, reviews found a modest extra drop in low back pain. The quality of this evidence ranged from very low to moderate. [4] [12]

Three large Dutch trials in 2017 found that adding ablation to an exercise program gave no clinically important extra relief for long-lasting low back pain. Critics say those trials used a technique and a way of choosing patients that may have made ablation less effective. [10] [13]

Studies that choose patients more carefully tend to report better results, but most of these studies had no sham comparison. In one review of them, choosing people with two test blocks and lining the probe up along the nerve was linked with better outcomes at 6 months. [14]

In a small, careful trial in the neck, relief typically lasted about 8 to 9 months after ablation, compared with about a week after a sham procedure. [9]

In 2025, a review of many trials rated the evidence for ablation of spine joints as very low certainty, and an international guideline strongly recommended against it for long-lasting neck or back pain. Pain specialty society guidelines say it may help well-selected people. The UK’s NICE guideline supports considering it for some people with long-lasting low back pain after a positive medial branch block. [1] [2] [11] [16] [18]

When it works, relief often lasts several months to about a year, and sometimes longer. Pain often returns as the nerves grow back. If the first treatment helped for at least a few months, a repeat treatment often helps again. [1] [2]

For the SI joint, a 2025 specialty guideline found that ablation can ease pain for at least 3 to 6 months in selected people. The large Dutch trial found only a small benefit that was not clinically important, and the 2025 international guideline’s strong recommendation against ablation includes the SI joint. [3] [10] [11]

Most research is on the low back, with less on the neck and very little on the mid back.

Common and short lived

• Soreness or a flare of pain in the treated area for days to a few weeks.
• Burning or extra-sensitive skin, or a patch of numbness, over the treated area, usually fading within weeks.
• After procedures high in the neck, feeling dizzy or off balance for days to a few weeks.
• If a steroid is used, higher blood sugar for a day or two in people with diabetes.

Less common

• Nerve pain (neuritis) that lasts longer than a few weeks.
• Loss of nerve supply to small back muscles. Researchers are still studying whether this matters over time.

Rare but serious

• Infection or bleeding.
• Heat injury to a nearby spinal nerve, which can cause lasting numbness or weakness.
• A skin burn, usually from an equipment problem or a poorly placed grounding pad (a sticky pad on the skin that completes the electrical circuit).
• Effects on a pacemaker, defibrillator, or stimulator, which is why planning ahead matters.
• Very rarely, after treatment at several neck levels, weakness of the muscles that hold the head up. Many clinicians limit how many neck levels they treat at one visit.

Other downsides

• Relief is not permanent for most people, and repeat treatments may be needed.
• It takes time: usually a test block first, then the ablation, then a few weeks to see the full effect.

Get emergency care right away for weakness or numbness in the arms or legs that is getting worse or has not worn off when your team said it would, balance trouble that is getting worse, new trouble controlling your bladder or bowels, or, after a neck procedure, signs of a stroke such as loss of balance, vision changes, a drooping face, or trouble speaking. Call your care team the same day for a fever, redness or drainage in the treated area, pain that is severe and getting worse, or dizziness that is not easing.