Radiofrequency Treatment: How It Is Done and Who It Is For

Radiofrequency (RF) treatment is an interventional pain procedure in which a thin electrode is placed next to the nerve carrying the pain and a radiofrequency current is used to reduce that nerve’s ability to send pain signals. It is done under fluoroscopy (live X-ray) with local anaesthetic; there is no incision and patients usually go home the same day.

It is used most often for facet joint pain in the lower back and neck, for trigeminal neuralgia and for headaches that start at the back of the neck.

What is radiofrequency and how does it work?

Radiofrequency is an electrical current that changes direction hundreds of thousands of times a second. At the tip of the electrode it heats the surrounding tissue. In pain treatment it is used in two ways:

• Thermal (conventional) RF: the electrode tip is heated to make a small, controlled lesion on the nerve. The nerve cannot carry pain signals for a period of time. The literature mostly recommends 80–90 °C; in our practice we prefer a lower temperature of 65–75 °C.
• Pulsed RF: the current is given in short pulses and the tissue temperature stays at or below 42 °C. The nerve is not cut; pain transmission is altered by the electric field. This is why it is preferred close to motor and sensory nerves.

The choice depends on the target nerve, the type of pain and the nearby structures.

Radiofrequency ablation and pulsed RF: the difference

“Radiofrequency ablation” is also used for heart rhythm disorders, thyroid nodules, varicose veins and some tumours. This article is about pain treatment. In pain medicine, ablation means thermal RF and leaves a long-lasting lesion on the nerve; it is also called rhizotomy, neurotomy or denervation.

Pulsed RF is not ablation: it is not expected to damage the nerve’s structure. Its effect usually lasts less long than thermal RF, but the risk of numbness or muscle weakness is lower. Thermal RF is mostly used for facet pain in the lower back and neck; pulsed RF for nerve root pain and some headaches.

Who is it for?

Radiofrequency is considered when the pain can be traced to a specific nerve and continues despite medication, exercise and physiotherapy. The main uses are:

• Chronic pain from the facet joints of the lower back and neck (medial branch RF)
• Sacroiliac joint pain, between the pelvis and the spine
• Pulsed RF for nerve root pain in the leg or arm
• Trigeminal neuralgia (electric-shock-like pain in the face)
• Occipital neuralgia and migraine-like headaches starting at the back of the neck

Signs of nerve compression such as progressive weakness in a leg or arm, or loss of bladder or bowel control, are not treated with RF; they need urgent assessment and often surgery.

How is radiofrequency treatment done?

• The patient lies face down (sometimes face up for the neck), the skin is cleaned and the point where the electrode enters is numbed. Light sedation is given if needed.
• Using fluoroscopy, the thin electrode is placed next to the target nerve.
• A low-current test comes first: the patient feels the familiar pain or tingling, and the doctor checks that there is no twitching in the leg or arm.
• Once the position is confirmed, the area is numbed and thermal or pulsed RF is applied.

Depending on the number of levels, the procedure usually takes 20–25 minutes.

After the procedure

The effect starts the same day; most patients say their pain has eased by the time they are back in their room. After a few hours of rest the patient walks out with a prescription. There is no restriction on moving the lower back or neck.

In the first days there may be mild tenderness where the electrode entered; in patients who have had pain for a long time this can be more noticeable and is normal. On discharge, tablets and a cream are prescribed to help the muscle spasms settle.

The effect settles over the first two weeks, and the result becomes clearer between two weeks and two months. You are asked back for a check-up after about five days. At the check-up you get advice on lower back and neck movements, and together we draw up a plan to look after your spine while the pain is reduced.

For patients who have had pain for many years or very severe pain, an additional session can be given. Because nerves can regrow over time, the procedure can be repeated if the pain returns months later.

Risks

• Pain or bruising where the electrode entered
• Temporary numbness
• Rarely, infection or bleeding

Patients who take blood thinners, have a pacemaker or neurostimulator, are pregnant or have a feverish illness should mention this before the procedure.

What does the research show?

Results of studies on RF for low back pain are not consistent. A Cochrane review of 23 randomised trials (2015) found that facet joint RF reduced pain more than placebo in the short term, but rated the quality of the evidence as very low to moderate.

In the MINT trials in the Netherlands with 681 patients (JAMA, 2017), adding RF to a standard exercise programme did not produce a clinically important additional difference in pain at three months. Patient selection and technique in this study were later debated.

Reported results vary considerably with patient selection and technique. The results we observe in our own practice are clearly more favourable than those reported in these studies; however, these observations are not based on a published study and do not mean the same result for every patient.

A 2020 guideline prepared jointly by many specialist societies concluded that lumbar medial branch RF may help well-selected patients.

What determines the cost of radiofrequency treatment?

The cost varies from patient to patient and is set after the examination and scans have been reviewed. The main factors are:

• Which nerve and how many levels are treated, one side or both
• Whether thermal or pulsed RF is used, and the electrode used
• Sedation and the setting (operating theatre, fluoroscopy)
• Cover from the Turkish social security system or private health insurance

You can send your scans through the online consultation form and discuss whether RF suits you, and its scope, before an appointment.