What Is Radiofrequency Ablation — And Does It Work?

Radiofrequency ablation (RFA) is one of the most effective and durable interventional pain procedures available for certain types of chronic spine pain. For patients with the right diagnosis, RFA can provide relief lasting 12 to 18 months or longer — sometimes years. Yet it remains underutilized, partly because patients and even some referring physicians are not sure what it involves.

This article explains how RFA works, which conditions it treats, what to expect during the procedure and recovery, and how to know if you might be a candidate.

How Radiofrequency Ablation Works

RFA uses heat energy generated by radio waves to disrupt the function of specific nerve fibers. When applied to the small nerves (called medial branch nerves) that carry pain signals from the facet joints of the spine to the brain, the procedure effectively interrupts that pain pathway — providing significant relief without surgery, implants, or opioids.

The procedure is performed under fluoroscopic (live X-ray) guidance. A thin needle is advanced to the precise location of the target nerve. A small amount of electrical current is first used to confirm correct placement (you may feel a familiar "twitch" or reproduction of your usual symptoms, which confirms the needle is at the right location). Radiofrequency energy is then delivered through the needle, heating and ablating a small segment of the nerve.

The procedure typically takes 30 to 60 minutes. Most patients go home the same day. Mild soreness at the procedure site is common for a few days, followed by gradual improvement over 1 to 4 weeks as the nerves fully respond.

Which Conditions Does RFA Treat?

RFA is most commonly used for facet joint arthritis — a degenerative condition affecting the small joints on the back of each vertebra. Facet joint pain is one of the most common causes of axial (non-radiating) low back and neck pain, particularly in patients over 50.

RFA is also used for:

• Cervical facet pain — neck pain and headaches arising from the upper cervical joints
• Lumbar facet pain — lower back pain, often worse with extension, that doesn’t radiate to the legs
• Sacroiliac (SI) joint pain — lateral hip and buttock pain confirmed by diagnostic SI joint injections
• Thoracic facet pain — mid-back pain, less common but effectively treated with the same approach

How Long Does RFA Last?

Most patients experience meaningful relief within 2 to 6 weeks of the procedure. The average duration of benefit is 9 to 18 months. After that time, nerves can regenerate, and a repeat procedure is typically just as effective as the first.

A minority of patients experience very long-lasting relief (2+ years) or find that the nerve does not regenerate significantly. A smaller minority have minimal response, which is why the diagnostic block step is so important in selecting candidates appropriately.

Is RFA Covered by Insurance?

Yes — radiofrequency ablation is covered by most major commercial insurance plans and Medicare when properly documented and medically indicated. The documentation typically must show: failed conservative care, appropriate imaging, and positive response to diagnostic nerve blocks. Our office handles prior authorization for RFA in-house.

Am I a Candidate for RFA?

You may be a good candidate if you have:

• Chronic axial (non-radiating) back or neck pain lasting more than 3 months
• Pain that responds temporarily to local anesthetic blocks
• Imaging consistent with facet arthritis or SI joint disease
• Tried and not fully responded to physical therapy and anti-inflammatory medications

The best way to know is to schedule a consultation. Dr. Qureshi will review your history, examine you, and determine whether diagnostic blocks are appropriate as a next step.