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Radiofrequency Treatment for Facet Joint Back Pain: Thermal Radiofrequency Denervation and Pulsed Radiofrequency

Radiofrequency Treatment for Facet Joint Back Pain

By Mr Ahmed-Ramadan Sadek, Neurosurgeon · 12 min read

🎧 Listen to this guideAudio version coming soon. Narrated in Mr Sadek’s voice using AI voice technology, from a script he has reviewed.

On this page

Key points

  • Radiofrequency treatment for facet joint pain comes in two types. Thermal radiofrequency denervation (ablation) heats a small section of the nerve to stop it carrying pain until it regrows. Pulsed radiofrequency uses short bursts of current, keeps the tissue below the temperature that destroys nerve, and aims to change how the nerve signals.
  • Thermal treatment is the type NICE suggests considering for selected people. NICE’s review did not assess pulsed treatment, so it neither recommends nor advises against it.
  • Either type follows a diagnostic medial branch block that gave good, short-lived relief. In Mr Sadek’s practice, treatment is typically performed about 6 weeks after a positive block, and the choice of type is made with you by the treating specialist.
  • Evidence for both is mixed; relief after pulsed treatment seems shorter.
  • Serious complications are rare. Keep up exercise alongside treatment.

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After the procedure, call 999 or go to A&E if you have back pain and:

  • Pain, tingling, weakness or numbness in both legs.
  • Loss of feeling around your genitals or your bottom (anus).
  • Changes in your bladder or bowels, such as difficulty peeing, or peeing or pooing yourself.
  • Changes in how your genitals feel during sex, or new problems getting or keeping an erection or reaching orgasm.
  • Chest pain.

Numbness or heaviness in a leg for a few hours can follow the local anaesthetic.[1] The symptoms above are different. Do not drive yourself to A&E: ask someone to take you, or call 999.[2] See also our warning signs page.

Facet joint pain in brief

The facet joints are small paired joints at the back of each spinal level, supplied by small nerves called the medial branches.[3] Our guide to lumbar facet joint injections and medial branch blocks covers the joints and typical symptoms, and our degenerative disc disease guide covers related age changes. No symptom, examination finding or scan reliably proves that a facet joint is the cause.[3] Estimates of how often it is the main source of long-term back pain range from about 10 to 15 in 100[4] to 40 to 60 in 100.[3] For new back pain, see acute back pain.

The pathway: a test block, then treatment

Step 1: the diagnostic medial branch block

Under X-ray, local anaesthetic is placed next to the medial branch nerves. If your usual back pain eases clearly while they are numb, the facet joints are likely to be an important source.[3][5] NICE says radiofrequency denervation should only follow a positive response to this block.[6] NICE advises against spinal injections as a treatment for low back pain, so here the block is a test.[6]

What counts as a positive block?

There is no single agreed threshold, and NICE does not set one.[6] An international consensus group recommends counting more than 50% pain relief as positive; people with 80% or more relief are more likely to do well, but many with less still benefit.[5] Research on how common facet pain is has used a stricter 75% to 100%.[3] Relief due to resting more, extra painkillers or sedation should not count.[5] One block is usual practice,[3][5] though at least one NHS unit asks for two.[7]

Step 2: radiofrequency treatment, about 6 weeks later

Relief from a block is expected to be short; radiofrequency treatment aims for longer relief.[3][8] In Mr Sadek’s practice, treatment is typically performed about 6 weeks after a positive diagnostic medial branch block. Whether thermal or pulsed treatment is used is decided with you by the treating specialist.

The two types of radiofrequency treatment

In both, a fine insulated needle is guided by X-ray to lie beside each target nerve, and its position is checked with a small test current before treatment.[1][9]

Thermal radiofrequency denervation (ablation)

The needle tip heats the nerve continuously, usually to 80 to 90°C for 1 to 3 minutes, making a small heat lesion that stops it carrying pain signals.[5] The outer sheath of the nerve is left intact, so the nerve can regrow over months and pain may return.[5][3]

Pulsed radiofrequency

Pulsed treatment is more neuromodulatory: short bursts of current are sent down the needle, with pauses that let heat disperse. In trials the tip was usually held at about 42°C, often for 120 seconds per nerve,[10][11][12] below the temperature that destroys nerve. It aims to change how the nerve carries pain signals without blocking its other signals.[7] How it works is not fully understood. An animal study found less nerve damage than after thermal treatment.[13]

Diagnostic medial branch blockThermal radiofrequencyPulsed radiofrequency
What it doesNumbs the nerves with local anaestheticContinuous heat destroys a small section of nerveShort bursts of current next to the nerve
Needle tip temperatureNo heatingUsually 80 to 90°CAbout 42°C on average
PurposeA test of whether the facet joints are the sourceTreatment: stops pain signals until the nerve regrowsTreatment: changes how the nerve signals
Usual duration of effectHoursAbout 7 to 10 months on average, sometimes much longerOften a few months (about 4 months on average to 3 to 18 months reported)
NICE positionRequired before radiofrequency denervationConsider for selected people after a positive blockNot assessed

Simplified summary.[6][3][5][14][11][7] Figures vary between studies.

What NICE says

NICE guideline NG59 says to consider referral for radiofrequency denervation in chronic low back pain when non-surgical treatment has not worked, the main source of pain is thought to be structures supplied by the medial branch nerves, and localised back pain scores 5 or more out of 10. It should only follow a positive diagnostic block, and no scan is needed first.[6] This is a consider recommendation, based on evidence the committee judged mostly moderate to low quality.[3]

NICE’s evidence review covered thermal treatment only: pulsed radiofrequency was specifically excluded.[3] So NICE neither recommends nor advises against pulsed treatment; it has not assessed it.

How well does it work?

Thermal radiofrequency

The evidence conflicts. A 2015 Cochrane review of 23 trials (1,309 people) found moderate-quality evidence that facet denervation eased pain more than a placebo procedure in the short term, by about 1.5 points out of 10, but no high-quality evidence overall.[15] In the Dutch MINT facet trial (251 people, not blinded), adding thermal treatment to exercise made a difference of only 0.18 points at 3 months, which is not clinically important.[16] NICE’s review of seven trials found benefit for pain and quality of life,[3] and a 2022 network meta-analysis found moderate evidence of benefit over sham.[17] Selection matters: in one US trial, 33 in 100 people treated without a block were helped at 3 months, against 64 in 100 after two positive blocks.[4] The consensus group concluded that carefully selected people may benefit.[5]

Pulsed radiofrequency

The evidence is limited and of low certainty. A 2022 network meta-analysis found fair evidence that pulsed treatment eased pain more than a sham procedure in the longer term, but only 76 people had pulsed treatment.[17] Without a comparison group, reported success ranges from about 6 in 10 of 114 people (for about 4 months on average)[11] to 97% of 60 people at 6 months in an Italian records review;[18] such figures probably overstate the effect.

Thermal compared with pulsed

A 2019 systematic review of three small trials (103 people) found pulsed treatment less effective for pain and function.[19] In one trial of 60 people, the benefit of pulsed treatment had faded by 6 months, while thermal treatment still helped at a year.[20] In another of 50 people, the groups did not differ significantly at 3 months, but only the thermal group improved significantly.[10] Studies of 118 and 142 people found similar early results but better long-term results, and fewer repeat procedures, after thermal treatment.[21][12] A 2020 meta-analysis ranked pulsed treatment below thermal at 6 months, though differences were not significant.[22] Pulsed treatment is intended to be less destructive to the nerve.[13][23]

How long does relief last, and can it be repeated?

After thermal treatment, relief usually lasts 7 to 9 months in one review[14] or about 10 months in another; in one cohort over half had complete relief for a median of 15 months, and some people are helped for more than 5 years.[5] NICE’s committee thought trials showed at least 6 to 12 months.[3] After pulsed treatment, reported relief ranges from about 4 months on average in people who responded[11] to 3 to 18 months in one NHS leaflet;[7] in one trial it had faded by 6 months.[20]

A repeat thermal treatment in the lower back worked for 33 to 85 in 100 people whose first treatment had worked in one review,[14] and the consensus group puts success at 80 in 100 or more after at least 3 months of benefit. It advises repeating no more than twice a year,[5] while NICE’s committee urged caution until there is more long-term evidence.[3] Pulsed treatment can also be repeated: in one series 18 people had relief of similar length the second time.[11] It needed repeating more often than thermal treatment in one study,[21] and there is no agreed interval.

Who may it suit?

Adults with moderate or severe back pain for 3 months or more, mainly in the back, that has not improved with non-surgical treatment, and a clear positive block.[6] NICE’s committee listed suggestive features: tenderness beside the spine, pain worse on leaning back or twisting, no sciatica, and no signs of sacroiliac joint pain.[3]

It may not suit you if leg pain is the main problem (see nerve root injections),[3] if the pain comes from the sacroiliac joint (see sacroiliac joint pain), or if the block did not help.[6] Infection, pregnancy, a pacemaker or other implanted electrical device, and metal screws from previous spinal surgery all need discussing first.[9][5] NICE does not require a scan beforehand;[6] our MRI guide explains when scans help.

Before the procedure

  • Blood-thinning medicine: tell the team early, as extra preparation may be needed. Do not stop it unless advised.[9][5]
  • Diabetes: if a steroid is also injected, blood sugar may rise for a while.[7][1]
  • Allergies, infection, pregnancy, or a pacemaker or implant: tell the team.[9]
  • Eating, drinking and transport: follow your hospital’s instructions, and arrange for someone to drive you home.[7][9][1]

What happens on the day

  1. It is a day case. The procedure is explained and you sign a consent form.[7][9]
  2. A sticky pad goes on your skin, often the thigh, to complete the electrical circuit.[1][9]
  3. You lie on your front and the skin is cleaned. Some units offer sedation.[1][7] Local anaesthetic numbs the skin; it stings briefly.[9]
  4. Using X-ray, a needle is guided to each nerve.[1]
  5. A small test current checks the position: you may feel tingling or pressure, then a throbbing or twitch in your back. Say at once if you feel it in your leg.[1][9]
  6. The nerve is treated: for thermal treatment, heating for about one and a half minutes in one NHS unit, when you may feel some pain;[1] for pulsed treatment, often about 2 minutes per nerve in studies.[10][11] Some units then inject local anaesthetic and sometimes a steroid.[1][7]

This is repeated at each level treated.[1] Expect to be in hospital for about 2 to 4 hours.[7][9]

After the procedure

  • Soreness or bruising at the needle sites usually improves within a few days, and pain may flare for a few days.[9][7] After thermal treatment, one NHS unit says a flare should settle within a month.[1]
  • Any benefit may be felt straight away or take a few days to several weeks.[1][7]
  • Do not drive for at least 24 hours, or until fit. Ideally have someone with you overnight.[1][9]
  • Build up activity gradually; return to work depends on your job.[9][7]

Use any spell of lower pain to build up activity. NICE recommends staying active and considering group exercise,[6] and the consensus group suggests physiotherapy for the back muscles before and after radiofrequency treatment.[5]

Risks

Your own risk depends on your health.

Risks of both types

  • Soreness at the needle sites and a temporary increase in pain for a few days: common.[7][9]
  • Bruising: a collection of blood (haematoma) after 0.1 to 0.4 in 100 lumbar nerve blocks[5] to about 1 in 100 across all spinal levels.[24]
  • Fainting or feeling faint: 1 or fewer in 100 facet nerve blocks in one study[24] to about 5 in 100 medial branch blocks in another.[25]
  • Infection: rare; none in 116 thermal procedures in one series.[26][9] Significant bleeding or a severe allergic reaction: very rare.[9][7]
  • Nerve root injury: nerve root irritation in about 1 in 1,000 lumbar facet nerve blocks, with no lasting damage;[5] no new weakness or numbness in 116 thermal procedures.[26] NICE’s committee knew of no reports of paralysis or death after radiofrequency denervation.[3]
  • Nerve pain after repeated treatments: 3 of 118 people in one study, after either type.[21]
  • Interference with pacemakers or stimulators: avoided by planning with the device team.[5]
  • Radiation: X-rays add slightly to the normal lifetime risk of cancer.[7] One US audit found a typical lumbar medial branch block used about 12 seconds of X-ray screening;[27] treating several levels may take longer. Tell the team if you might be pregnant.[1]

Risks specific to thermal treatment

  • Longer-lasting pain or nerve irritation (neuritis): local pain beyond 2 to 3 weeks after about 0.5 in 100 treated nerves[26] to 3.3 in 100 procedures; nerve irritation pain in about 6 to 7 in 100; persistent back pain in about 9 in 100 in one study, with nerve-type pain beyond 3 months in 3 of 68 people.[5]
  • Numbness or altered skin sensation over the back: from about 4 in 100 (settling within 3 weeks)[12] or 5 in 100 in a trial reviewed by NICE[3] to 6 of 34 people (back numbness for up to 3 weeks) in another study.[5]
  • Back muscle effects: the treated nerve also supplies a small deep back muscle (multifidus). Thinning of this muscle has been seen on scans, but in most people this causes no problems.[5] Temporary back muscle weakness occurred in 1 of 70 people in one study.[12]
  • Burns: rare, usually from equipment faults or grounding pad problems; over the back they are extremely unlikely.[5]
  • Heat near metal implants: after spinal fusion, the needle must be kept away from screws.[5]

Risks specific to pulsed treatment

  • Trials of pulsed treatment were small and reported few or no side effects.[19][12]
  • A sunburn-like prickling feeling over the skin, which may last a few weeks.[9]
  • Skin burns, including from the grounding pad: listed as very rare in NHS leaflets.[9][7]
  • No useful relief: about 4 in 10 did not respond in one series.[11]

When to get help afterwards

For emergencies, see the red box above. Ask for an urgent GP appointment or get help from NHS 111 if the skin around the needle sites becomes painful, hot and swollen, or if you have back pain and feel hot, cold, shivery or generally unwell.[28][2] Call 999 or go to A&E if redness comes with a very high temperature, a fast heartbeat or breathing, feeling dizzy or faint, or confusion.[28] Contact your treating team if leg numbness has not worn off within a few hours.[1]

Alternatives

  • Staying active and exercise: NICE suggests a group exercise programme; manipulation or massage only alongside exercise.[6]
  • Psychological support for coping with pain. In July 2026 NICE withdrew its recommendations on psychological therapy and combined physical and psychological programmes, partly because some underlying research was retracted.[29] In the MINT trials, everyone had exercise with psychological support if needed.[16]
  • Painkillers: discuss with your GP or pharmacist; NICE advises against several types for long-term back pain.[6]
  • Surgery is rarely appropriate: NICE advises against spinal fusion for low back pain outside research, and against disc replacement.[6]
  • No further procedure: back pain often comes and goes.[8]

Questions to ask

  • How much relief did my block give, and what do you count as positive?
  • Do you recommend thermal or pulsed treatment for me, and why?
  • How many levels and sides will be treated? Will I have sedation or a steroid?
  • What should I do about my blood-thinning medicine, diabetes or implanted device?
  • If the pain comes back, can it be repeated, and after how long?
  • What exercise or physiotherapy should I do afterwards?

Frequently asked questions

What is the difference between thermal and pulsed radiofrequency?

Both use a needle placed next to the medial branch nerves. Thermal radiofrequency denervation, also called ablation, heats the nerve continuously, usually to 80 to 90°C, to destroy a small section so it stops carrying pain until it regrows.[5] Pulsed radiofrequency sends short bursts of current, keeping the tip at about 42°C on average,[10][12] and aims to change how the nerve signals rather than destroy it.[7] Thermal treatment is the type NICE reviewed; pulsed treatment was not assessed.[3]

Does radiofrequency treatment hurt?

It can be uncomfortable. The skin is numbed first, which stings briefly, and some units offer sedation.[1][7] You may feel tingling, pressure or a twitch in your back during the test stimulation, and some pain while the nerve is treated.[1][9] Afterwards the needle sites may be sore and your pain may flare for a few days.[9][7] After thermal treatment, one NHS unit says a flare should settle within a month.[1]

How long does radiofrequency treatment last?

It varies. After thermal treatment, relief usually lasts about 7 to 10 months on average, and some people are helped for more than 5 years.[14][5] After pulsed treatment, reported relief ranges from about 4 months on average in people who responded[11] to 3 to 18 months in one NHS leaflet,[7] and in one trial it had faded by 6 months.[20] Some people get no useful relief from either.[11][4]

Why do I need a medial branch block first?

Because no symptom, examination or scan reliably shows that the facet joints are causing your pain.[3] Numbing the medial branch nerves with local anaesthetic is a test: if your usual pain eases clearly, the joints are likely to be a source.[5] NICE says radiofrequency denervation should only follow a positive block.[6] What counts as positive varies, often more than 50% relief.[5] In Mr Sadek’s practice, treatment is typically performed about 6 weeks after a positive block.

Does NICE recommend radiofrequency treatment for back pain?

NICE suggests considering thermal treatment for some people. Guideline NG59 says to consider it for chronic low back pain when non-surgical treatment has not worked, the pain is thought to come from structures supplied by the medial branch nerves, it is moderate or severe, and a diagnostic block was positive.[6] NICE’s review did not assess pulsed radiofrequency, so it neither recommends nor advises against it.[3]

Can radiofrequency treatment be repeated?

Yes, if it helped. A repeat thermal treatment in the lower back worked for 33 to 85 in 100 people whose first treatment had worked in one review,[14] and a consensus group advises repeating it no more than twice a year after at least 3 months of benefit.[5] Pulsed treatment can also be repeated, with relief of similar length in one series,[11] though it needed repeating more often than thermal treatment in another study.[21]

Can I drive and go back to work after radiofrequency treatment?

Not straight away. Arrange for someone to drive you home. NHS units advise not driving for at least 24 hours, and not until you feel fit to, ideally with someone staying with you overnight.[1][9] When to return to work depends on your job, so discuss it with your team.[9] Build up activity gradually; staying active and exercising are recommended by NICE.[7][6]

When should I seek urgent help after the procedure?

Call 999 or go to A&E if you have back pain with pain, tingling, weakness or numbness in both legs, loss of feeling around your genitals or bottom, or new bladder or bowel problems.[2] Ask for an urgent GP appointment or contact NHS 111 if a needle site becomes painful, hot and swollen, or you feel hot, shivery or unwell.[28][2] If redness comes with a very high temperature, a fast heartbeat, dizziness or confusion, call 999.[28] See our warning signs page.

Further reading

References

  1. East Kent Hospitals University NHS Foundation Trust, Kent Centre for Pain Medicine and Neuromodulation. Radiofrequency denervation of facet joints: information for patients (EKH131). Last reviewed November 2025. Link
  2. NHS. Back pain. NHS website; page last reviewed 5 March 2026. Link
  3. National Guideline Centre for NICE. Low back pain and sciatica in over 16s: assessment and management. Invasive treatments: methods, evidence and recommendations (NG59), chapter 23: radiofrequency denervation for facet joint pain. November 2016. Link
  4. Cohen SP, Williams KA, Kurihara C, et al. Multicenter, randomized, comparative cost-effectiveness study comparing 0, 1, and 2 diagnostic medial branch (facet joint nerve) block treatment paradigms before lumbar facet radiofrequency denervation. Anesthesiology. 2010;113(2):395-405. Link
  5. Cohen SP, Bhaskar A, Bhatia A, et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Reg Anesth Pain Med. 2020;45(6):424-467. Link
  6. National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management (NG59). Recommendations. Published 30 November 2016; last updated 29 July 2026. Link
  7. The Dudley Group NHS Foundation Trust, Pain Management. Pulsed radiofrequency: patient information leaflet (DGH/PIL/00968, version 5). Review date September 2029. Link
  8. Academy of Medical Royal Colleges. Evidence-Based Interventions: lumbar radiofrequency facet joint denervation. Published January 2020; last reviewed September 2024. Link
  9. Aneurin Bevan University Health Board. Pulsed radiofrequency treatment for the management of pain (ABUHB/PIU 1747/1). March 2025; expiry March 2028. Link
  10. Kroll HR, Kim D, Danic MJ, et al. A randomized, double-blind, prospective study comparing the efficacy of continuous versus pulsed radiofrequency in the treatment of lumbar facet syndrome. J Clin Anesth. 2008;20(7):534-537. Link
  11. Mikeladze G, Espinal R, Finnegan R, Routon J, Martin D. Pulsed radiofrequency application in treatment of chronic zygapophyseal joint pain. Spine J. 2003;3(5):360-362. Link
  12. Li SJ, Zhang SL, Feng D. A comparison of pulsed radiofrequency and radiofrequency denervation for lumbar facet joint pain. J Orthop Surg Res. 2023;18(1):331. Link
  13. Vatansever D, Tekin I, Tuglu I, Erbuyun K, Ok G. A comparison of the neuroablative effects of conventional and pulsed radiofrequency techniques. Clin J Pain. 2008;24(8):717-724. Link
  14. Smuck M, Crisostomo RA, Trivedi K, Agrawal D. Success of initial and repeated medial branch neurotomy for zygapophysial joint pain: a systematic review. PM R. 2012;4(9):686-692. Link
  15. Maas ET, Ostelo RW, Niemisto L, et al. Radiofrequency denervation for chronic low back pain. Cochrane Database Syst Rev. 2015;(10):CD008572. Link
  16. Juch JNS, Maas ET, Ostelo RWJG, et al. Effect of radiofrequency denervation on pain intensity among patients with chronic low back pain: the Mint randomized clinical trials. JAMA. 2017;318(1):68-81. Link
  17. Li H, An J, Zhang J, et al. Comparative efficacy of radiofrequency denervation in chronic low back pain: a systematic review and network meta-analysis. Front Surg. 2022;9:899538. Link
  18. Sansone P, Giaccari LG, Lippiello A, et al. Pulsed radiofrequency for lumbar facet joint pain: a viable therapeutic option? A retrospective observational study. Pain Ther. 2020;9(2):573-582. Link
  19. Contreras Lopez WO, Navarro PA, Vargas MD, Alape E, Camacho Lopez PA. Pulsed radiofrequency versus continuous radiofrequency for facet joint low back pain: a systematic review. World Neurosurg. 2019;122:390-396. Link
  20. Tekin I, Mirzai H, Ok G, Erbuyun K, Vatansever D. A comparison of conventional and pulsed radiofrequency denervation in the treatment of chronic facet joint pain. Clin J Pain. 2007;23(6):524-529. Link
  21. Çetin A, Yektaş A. Evaluation of the short- and long-term effectiveness of pulsed radiofrequency and conventional radiofrequency performed for medial branch block in patients with lumbar facet joint pain. Pain Res Manag. 2018;2018:7492753. Link
  22. Shih CL, Shen PC, Lu CC, et al. A comparison of efficacy among different radiofrequency ablation techniques for the treatment of lumbar facet joint and sacroiliac joint pain: a systematic review and meta-analysis. Clin Neurol Neurosurg. 2020;195:105854. Link
  23. Chua NH, Vissers KC, Sluijter ME. Pulsed radiofrequency treatment in interventional pain management: mechanisms and potential indications, a review. Acta Neurochir (Wien). 2011;153(4):763-771. Link
  24. Manchikanti L, Malla Y, Wargo BW, et al. Complications of fluoroscopically directed facet joint nerve blocks: a prospective evaluation of 7,500 episodes with 43,000 nerve blocks. Pain Physician. 2012;15(2):E143-E150. Link
  25. Kennedy DJ, Schneider B, Casey E, et al. Vasovagal rates in flouroscopically guided interventional procedures: a study of over 8,000 injections. Pain Med. 2013;14(12):1854-1859. Link
  26. Kornick C, Kramarich SS, Lamer TJ, Sitzman BT. Complications of lumbar facet radiofrequency denervation. Spine (Phila Pa 1976). 2004;29(12):1352-1354. Link
  27. Cohen SL, Schneider R, Carrino JA, et al. Radiation dose practice audit of 6,234 fluoroscopically-guided spinal injections. Pain Physician. 2019;22(2):E119-E125. Link
  28. NHS. Cellulitis. NHS website; page last reviewed 18 April 2024. Link
  29. National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s (NG59): update information, and July 2026 exceptional surveillance decision. Last updated 29 July 2026. Link

This article is general information and is not a substitute for advice about your own situation. Please speak to your GP or specialist before making any change to your treatment.

Last checked: October 2026