Chronic neck or back pain can sometimes come from small joints in the spine called facet joints. When the nerves that carry pain signals from these joints have been identified as a likely source of pain, radiofrequency ablation, or RFA, may be considered to reduce those signals.
Radiofrequency ablation is a minimally invasive pain management procedure that uses controlled thermal energy to treat a small, targeted portion of a sensory nerve. It is commonly considered for back pain or neck pain related to the facet joints, and may also be used in selected patients with sacroiliac joint pain.
At Regenerative Spine and Pain Specialists, Dr. Zwade Marshall and Dr. Jennifer Xiong evaluate your symptoms, examination findings, imaging, previous treatments, and response to diagnostic blocks to determine whether RFA or another treatment may be appropriate.
Request an Appointment or call (404) 618-0995 to schedule an evaluation at our Fayetteville, Marietta, or Atlanta office.
What Is Radiofrequency Ablation?
Radiofrequency ablation, also called radiofrequency neurotomy or radiofrequency nerve ablation, is a minimally invasive procedure used to reduce pain signals from selected sensory nerves.
During the procedure, a physician places a specialized needle near the targeted nerve using image guidance. Radiofrequency energy then creates a controlled area of heat at the tip of the needle. This changes the nerve tissue so that it is less able to transmit pain signals from the painful joint to the brain.
For spinal facet pain, the nerves commonly treated are called medial branch nerves. These small nerves carry pain signals from the facet joints but do not control the major muscles of the arms or legs.
RFA does not repair arthritis, reverse degenerative changes, or permanently remove the nerve. The treated nerve may eventually recover or regrow, which is one reason pain can return over time.
Radiofrequency ablation is generally performed as an outpatient procedure and is one part of a broader treatment plan that may also include exercise, rehabilitation, medications, or other interventional treatments when appropriate.
Who May Be a Candidate for Radiofrequency Ablation?
Your pain management provider may consider radiofrequency ablation when your symptoms and diagnostic evaluation suggest that pain is being carried by a specific set of nerves.
You may be evaluated for RFA if you have:
- Persistent neck or low back pain suspected to originate from the facet joints
- Pain associated with spinal arthritis or degenerative facet joint changes
- Selected sacroiliac joint pain
- Symptoms that have not improved enough with conservative treatment
- Temporary, meaningful pain relief after a diagnostic nerve block
- A clinical examination and treatment history that support the suspected pain source
For facet-mediated pain, a medial branch block is commonly used before RFA to test whether the targeted nerves are contributing to your pain. Your response to the diagnostic block helps your physician decide whether radiofrequency ablation should be considered.
RFA is not appropriate for every type of neck or back pain. Pain caused primarily by an irritated spinal nerve, disc herniation, spinal stenosis, muscle strain, or another source may require a different treatment approach.
What Conditions Can Radiofrequency Ablation Help Treat?
Radiofrequency ablation is most often considered when a specific sensory nerve has been identified as a likely pathway carrying pain from a joint or other targeted structure.
Conditions and pain patterns that may lead to an RFA evaluation include:
Facet Joint Pain
The facet joints are small joints at the back of the spine that help guide movement. Arthritis, degeneration, or irritation of these joints may contribute to chronic neck or low back pain. If diagnostic medial branch blocks temporarily reduce the pain, RFA may be considered to target the corresponding medial branch nerves.
Arthritis-Related Spine Pain
Arthritis and degenerative changes can affect the facet joints and contribute to persistent spinal pain. Treatment is based on whether the facet joints are actually identified as a likely pain source rather than on imaging findings alone.
Chronic Neck Pain
Some cases of chronic neck pain are related to cervical facet joints. When diagnostic blocks support that diagnosis, cervical medial branch RFA may be considered.
Chronic Low Back Pain
Some cases of chronic low back pain are related to lumbar facet joints. Lumbar medial branch RFA may be considered after an appropriate diagnostic evaluation.
Sacroiliac Joint Pain
Selected patients with pain arising from the sacroiliac joint may be evaluated for radiofrequency treatment of the sensory branches that carry pain signals from the area. Other treatment options may include sacroiliac joint injections, depending on the diagnosis and treatment plan.
Why Are Diagnostic Nerve Blocks Performed Before RFA?
Imaging can show arthritis or other structural changes, but an abnormal scan does not always identify which structure is actually causing pain.
For facet-related pain, a medial branch block temporarily numbs the small nerves that carry pain signals from the suspected facet joint. Your response provides diagnostic information about whether those nerves are likely contributing to your symptoms.
If the block produces the degree of temporary relief expected under your treatment plan and applicable clinical or insurance requirements, your physician may discuss radiofrequency ablation as a longer-lasting treatment option. A diagnostic block does not guarantee that RFA will provide relief, and the criteria used before proceeding can vary by patient and insurance plan.
Types of Radiofrequency Ablation for Pain Management
The specific nerves targeted during radiofrequency ablation depend on the suspected source and location of your pain.
Cervical Medial Branch RFA
Cervical RFA targets selected medial branch nerves in the neck when cervical facet joints have been identified as a likely pain source. It may be considered for appropriately selected patients with chronic facet-related neck pain.
Lumbar Medial Branch RFA
Lumbar RFA targets selected medial branch nerves in the lower back. It may be considered when lumbar facet joints are believed to be contributing to chronic axial low back pain and diagnostic blocks support that conclusion.
Sacroiliac Joint Radiofrequency Treatment
For selected sacroiliac joint pain, radiofrequency energy may be used to treat sensory branches associated with the SI joint. The exact technique and target nerves can differ from facet joint RFA.
Not every radiofrequency technique is appropriate for every patient. Your physician will determine whether RFA is recommended, which nerves should be targeted, and whether another treatment better fits your diagnosis.
How Does Radiofrequency Ablation Work?
Before the procedure begins, you will be positioned so your physician can safely reach the targeted area. The skin is cleaned, and local anesthetic is used to numb the treatment site. Sedation may be used in selected cases based on the procedure and clinical plan.
Your physician uses fluoroscopy, a form of real-time X-ray guidance, to position a specialized radiofrequency needle near the intended nerve. Sensory or motor stimulation may be used to help confirm appropriate positioning before treatment.
A small electrode passes through the needle. Radiofrequency energy is then delivered to create controlled heat at the target, producing a small lesion in the nerve tissue that reduces its ability to transmit pain signals.
More than one nerve may be treated during the same session when clinically appropriate. After treatment, the needles are removed and you are monitored before discharge.
Procedure time varies depending on the treatment area and number of nerves being treated. Your care team will provide instructions specific to your procedure.
What to Expect Before, During, and After Radiofrequency Ablation
Before the Procedure
Your care team will provide instructions based on your medical history and the specific area being treated.
Before your appointment, tell your provider if you:
- Take blood-thinning or antiplatelet medications
- Have an active infection, fever, or illness
- Have allergies to medications or contrast material
- Are pregnant or may be pregnant
- Have a pacemaker, implanted electrical device, or other implanted medical device
- Have experienced a previous reaction to a pain procedure
- Have had recent changes in your health
Do not stop prescription medications, including blood thinners, unless the prescribing or treating clinician specifically instructs you to do so.
Follow the office instructions regarding eating, drinking, medications, and transportation. If you are preparing for an upcoming appointment, our patient forms are available online.
During the Procedure
You may feel a brief pinch or burning sensation when local anesthetic is administered. During needle positioning and testing, some patients notice pressure, tingling, muscle twitching, or temporary discomfort.
Fluoroscopic imaging helps your physician identify the relevant anatomy and guide the radiofrequency needle to the planned location. Testing may be performed before the radiofrequency energy is applied.
If you experience intense or unusual symptoms during the procedure, tell your physician immediately.
After the Procedure
Soreness, tenderness, muscle spasm, or a temporary increase in pain can occur around the treatment area. Some patients also notice temporary numbness.
Your care team will provide specific instructions regarding driving, medications, activity, bathing, and returning to work or exercise. Many patients resume normal activities relatively quickly, but follow the instructions provided for your individual procedure.
Contact the office if you develop symptoms that concern you. Seek urgent medical attention for severe or rapidly worsening symptoms such as significant new weakness, loss of bowel or bladder control, difficulty breathing, signs of serious infection, or other symptoms identified in your discharge instructions.
Risks, Side Effects, and Safety Considerations
Radiofrequency ablation is a minimally invasive procedure, but every medical procedure involves potential risks and side effects.
Temporary effects may include:
- Soreness or bruising at the needle site
- A temporary increase in pain
- Localized tenderness or muscle spasm
- Temporary numbness or altered sensation
- Temporary irritation of the treated nerve
Less common complications can include:
- Bleeding
- Infection
- Allergic or medication-related reactions
- Injury to a nearby nerve or other structure
- Persistent numbness, weakness, or new pain
Complications are uncommon, but the type and severity of risk depend on the treatment location, your anatomy, medications, medical conditions, and the nerves being treated.
Your physician will review the potential benefits, limitations, alternatives, and risks that are relevant to your individual situation before recommending the procedure.
How Soon Can Radiofrequency Ablation Start Working?
Results vary from patient to patient.
Some people notice improvement relatively soon after the procedure, while for others it may take several days or a few weeks for the full effect to become apparent.
It is also possible to experience temporary soreness or an increase in pain after RFA before symptoms improve. This does not necessarily predict the eventual result of the procedure.
Radiofrequency ablation does not provide meaningful relief for every patient. Your response to treatment helps your physician determine what should come next in your pain management plan.
How Long Can Relief From Radiofrequency Ablation Last?
The duration of relief after radiofrequency ablation varies.
For appropriately selected patients, relief may last for several months. Some patients experience benefit for approximately six to twelve months or longer, while others experience shorter relief or little change.
The duration may depend on factors such as:
- The source and location of the pain
- The nerves treated
- Your response to diagnostic blocks
- How long symptoms have been present
- Your overall health and activity level
- Whether the treated nerve recovers or regrows
- Your individual response to the procedure
RFA reduces pain signaling rather than permanently curing the underlying arthritis or degenerative condition. When pain is reduced, the goal is often to support greater comfort with movement, rehabilitation, work, exercise, or daily activities.
Can Radiofrequency Ablation Be Repeated?
The nerves treated during RFA can recover or regrow over time. If that happens, pain may gradually return.
Repeat radiofrequency ablation may be considered when a previous procedure provided meaningful improvement and the returning symptoms are consistent with the same pain source.
A repeat procedure is not automatically appropriate for every patient. Your provider may reassess your symptoms, physical examination, treatment history, and current diagnosis before recommending another RFA. Diagnostic block requirements and insurance criteria may also vary.
If the first RFA does not provide meaningful improvement, repeating the same procedure without reconsidering the diagnosis may not be the appropriate next step.
What Happens If Radiofrequency Ablation Does Not Work?
Not responding to radiofrequency ablation does not mean that there are no other treatment options.
If you do not experience meaningful improvement, your provider may reconsider the likely source of your pain and review your examination findings, imaging, diagnostic block response, and previous treatments.
Depending on your diagnosis, the next step could include:
- Physical therapy or rehabilitation
- Changes to medications
- Additional diagnostic testing or imaging review
- Reassessment of whether the facet or sacroiliac joint is the primary pain source
- Facet joint injections or another diagnostic approach when appropriate
- An epidural steroid injection if the symptoms are instead related to spinal nerve irritation
- Other interventional pain management options
- Referral for surgical evaluation when clinically appropriate
Pain can come from joints, discs, nerves, muscles, and other structures. Our goal is to identify the likely pain generator and recommend treatment based on your individual diagnosis rather than relying on one procedure for every type of pain.
Why Choose Regenerative Spine and Pain Specialists?
Regenerative Spine and Pain Specialists provides comprehensive interventional pain management for patients with spine-related and chronic pain conditions.
Our physicians, Dr. Zwade Marshall and Dr. Jennifer Xiong, are Harvard-trained, double-board certified anesthesiologists and interventional pain management specialists.
Dr. Marshall is the founder and chief medical officer of Regenerative Spine and Pain Specialists and completed his anesthesiology residency and interventional pain management training at Harvard-affiliated Brigham and Women’s Hospital.
Dr. Xiong completed her anesthesiology residency and fellowship training in interventional pain management at Harvard Medical School’s Brigham and Women’s Hospital. Her approach emphasizes compassionate, patient-centered care focused on function and quality of life.
Our approach to radiofrequency ablation includes:
- Individualized evaluation before recommending a procedure
- Use of diagnostic nerve blocks when clinically appropriate
- Fluoroscopic image guidance
- Targeted treatment based on the suspected source of pain
- Non-surgical and minimally invasive options when appropriate
- Access to additional pain management treatments when RFA is not the right option
- Care focused on function and quality of life rather than promising a specific outcome
Radiofrequency Ablation Care in Fayetteville, Marietta, and Atlanta
Regenerative Spine and Pain Specialists offers radiofrequency ablation evaluation and treatment through our offices in Fayetteville, Marietta, and Atlanta.
Fayetteville
Our Fayetteville pain management clinic is located at:
874 West Lanier Ave., Suite 250
Fayetteville, GA 30214
Marietta
Our Marietta pain management clinic is located at:
3939 Roswell Road, Suite 240
Marietta, GA 30062
Atlanta
Our Atlanta pain management clinic is located in Buckhead at:
371 E Paces Ferry Rd NE, Suite 802
Atlanta, GA 30305
Evaluation, follow-up, and procedure scheduling may vary by location. Our team will let you know where your appointment or procedure will take place based on your treatment plan.
For questions about scheduling, call (404) 618-0995 or contact Regenerative Spine and Pain Specialists.
Frequently Asked Questions About Radiofrequency Ablation
Radiofrequency ablation is a minimally invasive procedure that uses controlled heat to treat a small, targeted portion of a sensory nerve. The goal is to reduce the nerve’s ability to carry pain signals from the painful area to the brain.
RFA is commonly considered for appropriately selected patients with facet-related neck or low back pain and may also be considered for selected sacroiliac joint pain. Your provider will determine whether your symptoms, examination, diagnostic blocks, and treatment history make RFA appropriate.
A medial branch block temporarily numbs the small nerves that carry pain signals from a suspected facet joint. If the block provides the expected temporary relief, that information can support the decision to consider radiofrequency ablation of those nerves.
Local anesthetic is used to numb the treatment area, but patients may still notice pressure, tingling, muscle twitching, warmth, or temporary discomfort during parts of the procedure. Experiences vary, and you should tell your physician about intense or unusual symptoms.
Procedure time varies depending on the area being treated and the number of nerves targeted. Your total visit also includes preparation, positioning, treatment, and monitoring afterward.
Some people notice improvement soon after treatment, while others may take several days or a few weeks to notice the full effect. Temporary soreness or increased pain can occur before symptoms improve.
Relief varies considerably. Some appropriately selected patients experience improvement for several months, often around six to twelve months or longer, while others have shorter relief or limited benefit. The treated nerve can recover or regrow over time.
Repeat RFA may be considered if a previous procedure provided meaningful relief and the returning symptoms are consistent with the same pain source. Your provider will reassess your condition and any applicable diagnostic or insurance requirements before recommending another procedure.
Potential effects include temporary soreness, bruising, increased pain, muscle spasm, numbness, or nerve irritation. Less common complications can include bleeding, infection, medication reactions, or injury to a nearby nerve or structure. Your physician will discuss risks relevant to your health and treatment area.
Follow the transportation instructions provided by your care team. Whether you need a driver can depend on the specific procedure, medications, and sedation plan.
Your provider may reassess the likely source of your pain, review the response to previous diagnostic blocks, reconsider imaging or examination findings, and discuss other treatments. The next step depends on the structure believed to be causing your symptoms.
Regenerative Spine and Pain Specialists offers radiofrequency ablation at our Fayetteville, Marietta, and Atlanta, Georgia locations. Our scheduling team will confirm the appropriate location for your evaluation and procedure.
Schedule an Appointment for Radiofrequency Ablation Evaluation
Persistent neck, back, or sacroiliac joint pain can interfere with work, sleep, exercise, and everyday activities. If your pain may be coming from targeted sensory nerves associated with a painful joint, radiofrequency ablation may be one option to consider.
Dr. Zwade Marshall and Dr. Jennifer Xiong can evaluate your symptoms, review your previous treatment and diagnostic blocks, and help determine whether radiofrequency ablation or another treatment better fits your condition.
Request an Appointment online or call (404) 618-0995 to schedule with Regenerative Spine and Pain Specialists.
Patients can also review our financial options or contact our office with questions before scheduling.