Radiofrequency denervation

Expert reviewer, Dr Johann Emmanuel, Consultant in Pain Medicine
Next review due February 2024

Radiofrequency denervation is a treatment for a type of neck or back pain that comes from your facet joints. These pairs of small joints link the bones in your spine together.

This treatment doesn’t work for everyone. If you’re offered radiofrequency denervation it’s important to understand what's involved so you can choose what’s right for you.

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What is radiofrequency denervation?

Radiofrequency denervation is also sometimes called facet rhizolysis, radiofrequency ablation or radiofrequency neurotomy.

The treatment uses radiofrequency waves to block nerves around the facet joints in your back or neck that are causing pain. These nerves are called medial branch nerves. They send pain signals to your brain if your facet joints are inflamed.

The procedure involves putting a needle into your back under local anaesthesia. The radiofrequency waves heat the tip of the needle. This damages the nerve endings, which stops them sending pain signals to your brain.

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Why would I have radiofrequency denervation?

Your doctor may suggest radiofrequency denervation if you have moderate to severe neck or back pain that starts in your facet joints. For example, you may have this pain if you have arthritis in your spine. This can cause your facet joints to become worn down and inflamed.

Your doctor will only suggest radiofrequency denervation if other treatments such as physiotherapy and medicines haven't helped. Your doctor may suggest trying it before considering spinal surgery. It is less invasive than surgery and you can go home on the same day.

Before your doctor can offer you radiofrequency denervation, you need to have another procedure known as a medial branch block. This is where your doctor injects local anaesthetic close to the medial nerves that supply your painful facet joint. If this significantly reduces your pain for at least two days, it confirms that the pain is definitely coming from your facet joint. This means it’s possible that radiofrequency denervation will help to control your pain. You usually have this as part of a wider treatment plan, with other therapies such as exercise.

But radiofrequency denervation isn’t suitable for everyone. For instance, if you have a pacemaker or cardioverter defibrillator, your doctor may offer you a facet joint injection instead. For more information, see our FAQ: What is a facet joint injection? below.

What happens during radiofrequency denervation?

You’ll need to go to hospital to have radiofrequency denervation. You can have the treatment and go home the same day – you won’t need to stay overnight. The treatment usually takes about half an hour to an hour. You can usually go home between one and three hours after the treatment is over.

To have the procedure, you lie on your front. Your doctor then cleans the skin and injects a local anaesthetic to numb any pain. They may offer you a sedative, to help you relax.

Your doctor puts a needle into the affected area of your back or neck, using X-rays to help them find the right spot. To make sure it’s in the right place, the doctor may pass a small electric current through the needle. If it’s next to the nerve that's causing the problem, you might feel tingling or twitching in the muscles in your back. Your doctor may ask what you are feeling as this helps them to position the needle in exactly the right spot.

Once the needle is in place, your doctor will apply the radiofrequency waves. These heat the tip of the needle and destroy the nerve endings. Your doctor may also inject local anaesthetic and a steroid to help with any discomfort you might have after the procedure.

If necessary, you can have several different areas treated at the same time. But some doctors prefer to treat one side of your back at a time. They may ask you to have a couple of procedures, a few weeks apart. This is because they may need to give you the maximum dose of local anaesthetic while treating each side.

What to expect afterwards

After your treatment, you’ll be monitored in a recovery room for a while before going home. You may have to lie flat for 30 minutes or more. Your nurse may check your blood pressure or pulse, and will ask if you're having any side-effects.

You can usually go home between one and three hours after your treatment. You’re not allowed to drive after this procedure so you'll need somebody to take you home. Ideally, someone should stay with you for 24 hours after your procedure.

You'll have some pain afterwards, probably for the first week or two. Sometimes the pain gets worse before it gets better, so try not to be alarmed if this happens to you. Keep taking painkillers and stay active but don’t overdo it. As the pain starts to lessen, you can slowly increase how much you can do. Try going for gentle walks or a swim at first – but be careful not to do too much. Your doctor will give you more advice about what you can do and when.

How well does radiofrequency denervation work?

It’s important to realise that radiofrequency denervation doesn’t work for everyone. Studies looking at how well it works have had mixed results.

But some people do seem to benefit from the procedure. If it works for you, it may help to keep you mobile and off strong painkillers. Doctors have developed guidelines to help them decide who the treatment is most likely to help. In studies where doctors used these guidelines, as many as six out of 10 patients had significantly less pain after treatment. So, speak to your doctor about whether it’s likely to work for you.

Radiofrequency denervation isn't a cure. The damaged nerve endings usually slowly grow back and the pain may return. If the treatment works for you, it may reduce your pain for between six months and two years. But in some people, it can help for longer. If it does work for you, you may be able to have the treatment repeated each time it wears off. It’s a good idea to keep a pain diary as this can help your doctor see how well the treatment has worked for you.

What are the side-effects of radiofrequency denervation?

The side-effects of radiofrequency denervation are usually quite mild and clear up on their own quite quickly. But it's important to be aware of them so you know what to expect.

You may have the following:

  • mild bruising or tenderness in the area where you had the injection, for up to a week after the procedure
  • numbness in your back, lasting up to three weeks
  • pain may feel worse at first, before it settles down
  • prickling, sore skin on your back (feels like sunburn) which can occasionally carry on for a few months
  • numbness or weakness in your legs if you've had a lower back injection – this is rare and usually goes away within minutes or hours of having treatment

More serious complications are rare with radiofrequency denervation. It’s important to contact your doctor if you notice the area where you had the injection is warm or red, and you feel hot and unwell. You may have an infection and you may need treatment with antibiotics.

There is also a risk of injury to a nerve in your spine but this is extremely rare. Your doctor will use X-rays and clinical experience to make sure the needle is in exactly the right place before they start treating the nerve.

If you develop a headache or fever or have ongoing numbness or weakness after getting home, call the unit where you had the procedure.

Deciding on radiofrequency denervation

Your doctor will go through all your treatment options with you, including what to expect from radiofrequency denervation. You will have to give written consent if you choose to go ahead.

Here are a few things to consider that may help you decide.

  • Radiofrequency denervation may help to reduce the pain in your neck or back. This can improve your quality of life and make it easier to get about and carry on with your normal daily activities.
  • If you have less pain after this treatment you may find it easier to exercise, which may help to improve your condition in the long term.
  • Side-effects are generally mild and resolve quickly on their own.
  • You might not get any pain relief from radiofrequency denervation, and the procedure can make your pain worse at first.
  • The procedure isn't a permanent fix. Any pain relief you get is likely to last between six months and two years and you may need further treatment.
  • Although rare, there are some serious potential complications, including infection and nerve damage.

Think about how much you value each of these issues when making your decision to have treatment or not. Different people will put different values on each of these, so how you view them is very individual to you.

Questions to ask your doctor

Think about any questions you would like to ask your doctor before deciding whether or not you want to have radiofrequency denervation. To start you off, here are some examples of questions you may want to ask.

  • What other treatment options do I have to relieve my pain?
  • What can I expect to happen after I’ve had radiofrequency denervation?
  • Will I be able to exercise after the procedure? What type of exercise is best?
  • Should I have physiotherapy after radiofrequency denervation?
  • How can I tell if radiofrequency denervation has worked? How long will it take until I know if it's worked?
  • What is the likelihood of the procedure working? How long will the effects last?
  • Can I have the treatment repeated once the effects have worn off?
  • How many times can I have the treatment?
  • How will you reduce the risk of complications?

Frequently asked questions

  • A facet joint injection is sometimes used as an alternative to radiofrequency denervation in exceptional circumstances – for example if you have a pacemaker or cardioverter defibrillator and radiofrequency denervation isn’t suitable for you.

    During a facet joint injection, your doctor injects local anaesthetic and steroid directly into your facet joint to help reduce inflammation and improve your pain.

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Related information

    • Lumbar facet arthropathy treatment and management. Medscape., last updated March 2020
    • Facet joint disorders and back pain. Spine-health., last updated June 2020
    • Juch JN, Maas ET, Ostelo RW et al. Effect of radiofrequency denervation on pain intensity among patients with chronic low back pain. JAMA 2017; 318(1):68–81. doi: 10.1001/jama.2017.7918
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  • Reviewed by Liz Woolf, Freelance Health Editor, February 2021
    Expert reviewer, Dr Johann Emmanuel, Consultant in Pain Medicine
    Next review due February 2024