What Is Radiofrequency Ablation for Back Pain?
Radiofrequency ablation (RFA) is a minimally invasive procedure that uses heat to disable the small nerves carrying pain signals from the facet joints in your spine. It does not repair the joint itself. Instead, it interrupts the pain message, giving relief that typically lasts six to twelve months before the nerve regrows. A diagnostic nerve block is always done first to confirm the right nerve.
Key takeaways
- RFA targets medial branch nerves that supply the facet joints, not the spinal cord or major nerves.
- A diagnostic block must be done first. If the block does not relieve your pain, RFA is unlikely to help.
- Relief usually lasts six to twelve months. Nerves can regrow, so the procedure may need repeating.
- It is a day-case procedure, and most people return to normal activities within a week or two.
- Accurate diagnosis matters. Standing imaging can reveal alignment issues that pinpoint which joints are under stress.
How does radiofrequency ablation work?
RFA works by heating and disabling a specific nerve so it can no longer transmit pain signals to your brain. A thin, insulated needle is guided to the target nerve, usually a medial branch nerve, using X-ray imaging. The tip of the needle delivers a controlled heat lesion, typically between 60 and 80 degrees Celsius, for around 60 to 90 seconds.
The medial branch nerves are tiny sensory nerves. Each one carries pain information from a single facet joint. They do not control movement, so disabling them does not affect your strength or mobility. You may also hear this procedure called radiofrequency denervation or medial branch ablation. The names describe the same technique.
Who is a good candidate for radiofrequency ablation?
The best candidates are people with chronic back or neck pain that comes specifically from the facet joints. This is often linked to facet joint arthropathy, where the small joints at the back of the spine become worn or inflamed. RFA is not suitable for all types of back pain.
- Pain confirmed by a successful diagnostic nerve block
- Chronic facet joint pain lasting more than three months
- Pain that has not responded well to physiotherapy or medication alone
- Pain on one or both sides of the spine, often worse with extension or twisting
- Pain caused by disc problems, nerve compression, or spinal stenosis
- Pain that a diagnostic block did not relieve
- Widespread pain without a clear facet joint source
- Active infection or bleeding disorders
A note on MRI and soft tissue. EOS standing imaging excels at showing bones, joints and whole-body alignment under load. For soft tissue structures like discs, ligaments or nerves, MRI is usually the better tool. Your consultant may recommend both, depending on your symptoms.
What are the signs your back pain comes from facet joints?
Facet joint pain has some characteristic patterns, though it can mimic other conditions. A pain specialist uses a combination of your history, examination and imaging to narrow it down.
Leaning backwards or twisting often makes the pain worse, because it loads the facet joints directly.
Pain is usually felt on one side of the spine, close to the midline. It can refer into the buttock or thigh but rarely below the knee.
The joints stiffen overnight. Pain is often worst first thing in the morning and eases once you start moving.
Pure facet joint pain does not usually cause numbness, tingling or weakness in the legs. If you have those symptoms, there may be another cause.
Important: If you develop sudden numbness, weakness in your legs, or any loss of bladder or bowel control, seek urgent medical attention through your GP, 111, or A&E. These symptoms need immediate assessment, not a scan booking.
What are the steps before and during RFA?
Radiofrequency ablation is never the first step. A careful diagnostic process comes before the procedure, and patient selection is the most important factor in whether it works.
Your consultant reviews your history and examines you. Imaging helps identify which joints are affected. Standing, weight-bearing scans can be especially useful here because they show how your spine and pelvis align under real-life load.
A small amount of local anaesthetic is injected around the medial branch nerve under X-ray guidance. If your pain reduces significantly, it confirms the facet joint as the source. Without a successful block, RFA should not go ahead.
Done as a day case under local anaesthetic or light sedation. The insulated needle is placed next to the target nerve under X-ray guidance. A small electrical test confirms the correct position before the heat lesion is applied.
You can usually go home the same day. Your treating team will advise on when to resume normal activity and whether to combine RFA with physiotherapy to get the best results.
How long does RFA take to work and how long does it last?
Most people notice the full benefit of radiofrequency ablation within two to four weeks. During the first few days, it is common to feel some soreness at the needle site, and occasionally the pain feels temporarily worse before it improves.
Relief from RFA typically lasts six to twelve months. This varies from person to person. Because the treated nerve is a living structure, it can regrow over time. When it does, pain may gradually return. The good news is that the procedure can be repeated if the first one worked well.
Physiotherapy alongside RFA is often recommended. The pain-free window gives you a chance to strengthen the muscles supporting your spine, which may help reduce how quickly pain returns.
Wondering whether your back pain could be linked to facet joint problems? A standing spine scan can show how your joints are loading when you are upright.
Book a free video consultationWhy does standing imaging matter before treatment?
Most conventional imaging, including standard X-rays, CT and MRI, is done while you are lying down. In that position, gravity is removed and the muscles relax. This can hide alignment shifts and joint stresses that only show up when you are standing and weight-bearing.
Your body works as a connected chain from your feet to your head. A tilt in the pelvis, for example, changes how load passes through the lumbar facet joints. Pain may appear in the lower back, but the underlying cause could be an asymmetry further down the chain. If that asymmetry is missed, treating only the painful joint may give short-lived results.
ScanAlign, weight-bearing standing imaging captures your full skeleton in a single upright scan using about 90% less radiation than a standard X-ray, around ten times less. This whole-body view helps clinicians see which joints are genuinely overloaded, so that any procedure, including RFA, is targeted at the right level.
Frequently asked questions
Most people feel some pressure and a brief burning or aching sensation when the heat is applied. Local anaesthetic numbs the area first, and sedation is available. Discomfort is usually mild and short-lived.
Relief typically lasts six to twelve months. The nerve can regenerate over time, so pain may gradually return. If the first procedure worked well, it can usually be repeated.
A diagnostic block is a small injection of local anaesthetic around the medial branch nerve. If it temporarily relieves your pain, it confirms that specific nerve is carrying the pain signal. This test is essential, because RFA is only likely to help if the block was successful.
A steroid injection reduces inflammation around a joint or nerve and provides temporary relief. RFA disables the nerve itself, so the pain signal is interrupted for a longer period. They target different aspects of the problem and are sometimes used together as part of a treatment plan.
Yes. Because the nerve can regrow, the procedure may need repeating when pain returns. Many people have RFA more than once, and studies suggest repeat procedures tend to be just as effective as the first.
Most people go home the same day and return to normal activities within a week or two. Some soreness at the needle site is normal for a few days. Your treating clinician will give specific guidance based on your situation.
No. RFA targets the medial branch nerves that supply the facet joints. It is not designed for disc-related pain or sciatica, which involve different structures. Accurate diagnosis is important to make sure RFA is the right option for you.
A standing, weight-bearing scan shows how your spine and pelvis align when you are upright. This can reveal which facet joints are genuinely overloaded, helping your consultant target the right level and giving RFA the best chance of success.
No. You can book a standing spine scan directly as a self-pay patient without a GP or consultant referral.
EOS uses about 90% less radiation than a standard X-ray, around ten times less. It captures a full standing image of your skeleton in a single low-dose scan, making it one of the lowest-radiation options available for whole-body skeletal imaging.
Find out what is causing your back pain
A free video consultation with our team can help you understand whether a standing spine scan is the right next step, before you commit to any procedure.
Book a free video consultationAuthor: Abbas Dhami (Specialist Diagnostic Radiographer)
Sources
- National Institute for Health and Care Excellence (NICE). Radiofrequency denervation for chronic low back pain. Interventional procedures guidance IPG 545. 2016.
- Cohen SP, Bhaskar A, Bhatia A, et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Regional Anesthesia & Pain Medicine. 2020;45(6):424-467.
- NHS. Back pain: treatment overview. nhs.uk/conditions/back-pain.
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.