Radiofrequency denervation
Your health expert: Mr Michael Mokawem, Consultant Spinal Surgeon
Content editor review by Victoria Goldman, July 2023.
Next review due July 2026.
Radiofrequency denervation is a treatment for neck or back pain that comes from your facet joints. It’s also called facet joint denervation. These pairs of small joints link the bones in your spine together.
What is radiofrequency denervation?
Radiofrequency denervation uses radiofrequency waves to block nerves around the facet joints in your back or neck. 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 or sedation. The radiofrequency waves heat the tip of the needle. This damages the nerve endings to stop or reduce your pain.
Radiofrequency denervation is sometimes called:
- facet rhizolysis
- radiofrequency ablation
- radiofrequency neurotomy
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. These pairs of small joints link the bones in your spine together. The pain may be caused by arthritis in your spine.
Your doctor will only suggest radiofrequency denervation if other treatments, such as physiotherapy and medicines haven't helped.
Radiofrequency denervation isn’t suitable for everyone. You may not be able to have the procedure if you have an infection.
Preparing for radiofrequency denervation
Before you have radiofrequency denervation, you need to have another procedure called a medial branch block . Your doctor will inject local anaesthetic close to the medial nerves that supply your facet joint. If your pain gets better for at least two days, this means it’s definitely coming from your facet joint. So radiofrequency denervation should help to control it.
You should be able to take all of your usual medicines on the day of your treatment, but check this with your doctor in advance. If you are taking blood-thinning medicines, you will need to stop these for a few days. Your doctor may ask you to stop taking aspirin as well.
What happens during radiofrequency denervation?
You’ll have radiofrequency denervation in hospital. You can have the treatment and go home on the same day – you won’t need to stay overnight.
To have the procedure, you lie on your front. Your doctor:
- cleans your skin
- injects a local anaesthetic to numb any pain
- may offer you a sedative to help you relax
Then they’ll put a needle into the affected area of your back or neck. They’ll use X-rays to help them find the right spot. Your doctor may pass a small electric current through the needle to check it’s in the right place. Your doctor may ask what you’re feeling. You may feel tingling or twitching in the muscles in your back if the needle is next to the nerve that’s causing the problem.
Once the needle is in place, your doctor will apply radiofrequency waves. They may also inject local anaesthetic and a steroid to reduce any discomfort after the procedure.
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, or one area at a time. This is because they can only give you a maximum amount of anaesthetic in one go.
What to expect afterwards
After your treatment, you’ll be monitored in a recovery room. You may have to lie flat for 30 minutes or more. Your nurse may:
- check your blood pressure or pulse
- 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 afterwards so you'll need someone 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 worry if this happens. 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. Your doctor will give you advice about what you can do and when.
How well does radiofrequency denervation work?
Radiofrequency denervation doesn’t work for everyone. Studies looking at how well it works have had mixed results. But some people find the procedure helps them to:
- keep mobile
- stay 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 6 out of 10 patients had significantly less pain after treatment. So, speak to your doctor about whether it’s likely to work for you.
You may not notice any benefits for the first four to six weeks. You should keep doing gentle exercise and physiotherapy during this period. Radiofrequency denervation works best if you continue to:
- follow an exercise programme (gradually increasing your activity level)
- have physiotherapy for core stability exercises
- do activities such as Pilates
- keep your weight within a healthy range
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 at least 3 months and sometimes 10 months or longer. If the treatment works really well, it may reduce your pain for 12 months or even for up to 2 or 3 years. When it wears off, you may be able to have the treatment again. You may be able to have the treatment several times.
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:
- mild bruising or tenderness where you had the injection, for up to a week after the procedure
- numbness in your back, for up to three weeks
- pain that feels worse at first, before it settles down
- prickling, sore skin on your back (like sunburn) 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.
- Contact your doctor if the injection site is warm or red, and you feel hot and unwell. You may have an infection that needs treating with antibiotics.
- A nerve in your spine may get injured in the procedure, 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 get 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 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?
A facet joint injection involves injecting local anaesthetic and steroid directly into your facet joint. If your pain gets better for two or more days, it’s coming from your facet joint and radiofrequency denervation may be helpful. See our preparing for radiofrequency denervation section .
Radiofrequency denervation uses radiofrequency waves to block nerves in your back or neck. This stops you feeling pain. For more information, see the section on what is radiofrequency denervation?
Steroid joint injections
If you have a painful joint from an injury or arthritis, for example, your doctor may offer you a joint injection of a corticosteroid (steroid) medicine.
Epidural injections for lower back and leg pain
Medial branch blocks
Medial branch block injections are sometimes used for painful conditions such as osteoarthritis.
Lower back pain
Lower back pain is very common. It is often caused by straining muscles, tendons or ligaments in your back. Find out everything you need to know about lower back pain.
Back surgery
Back surgery is recommended as a treatment for back pain in certain circumstances. Find out more about the types of surgery for back pain including complications and recovery afterwards.
Other helpful websites
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- Conger A, Burnham T, Salazar F, et al.The effectiveness of radiofrequency ablation of medial branch nerves for chronic lumbar facet joint syndrome in patients selected by guideline-concordant dual comparative medial branch blocks. Pain Med 2020; 21( 5): 902–909
- Personal communication with Mr Michael Mokawem, Consultant Spinal Surgeon
