What Is Radiofrequency Ablation?
Radiofrequency ablation (RFA), also called radiofrequency neurotomy, is one of the most effective minimally invasive procedures I perform at my pain management practice in Hoffman Estates, Illinois. This technique uses controlled heat generated by radio waves to target the specific nerves carrying pain signals from an arthritic joint or damaged structure in the spine. By disrupting these nerve pathways, RFA can provide substantial pain relief lasting 6 to 18 months — and in many cases, even longer.
As a triple board-certified pain management specialist, I have performed thousands of radiofrequency ablation procedures and consider it one of the most reliable tools in my treatment arsenal for the right patient and the right condition.
How Radiofrequency Ablation Works
The science behind RFA is elegant in its simplicity. A small needle-like probe is guided to the target nerve using real-time fluoroscopy (X-ray guidance). Once properly positioned — and after confirming the correct nerve through sensory and motor testing — the tip of the probe is heated to a precise temperature, creating a small lesion on the nerve that interrupts its ability to transmit pain signals. The procedure does not damage surrounding tissue, and the targeted nerve fibers eventually regenerate, which is why the pain relief is long-lasting but not permanent. When pain does return — typically after 9 to 18 months — the procedure can be repeated with similar success.
There are several types of radiofrequency ablation available. Conventional (thermal) RFA uses continuous heat at approximately 80 degrees Celsius to create the lesion. Cooled radiofrequency ablation uses internally cooled probes that allow the creation of larger, more spherical lesions, which can be particularly effective for the sacroiliac joint where the target nerves are less predictable in their location. Pulsed radiofrequency delivers short bursts of energy at lower temperatures and is sometimes used near nerve roots where permanent thermal lesioning would be inappropriate.
Conditions Treated with RFA
Radiofrequency ablation is most commonly and effectively used for several specific pain conditions. Facet joint pain in the cervical (neck) and lumbar (lower back) spine is the most established indication. The facet joints are small paired joints at each level of the spine, and they commonly develop arthritis that causes localized pain. RFA of the medial branch nerves that supply these joints can provide dramatic relief. Sacroiliac joint pain responds well to cooled radiofrequency ablation of the lateral branch nerves. This is particularly valuable because the SI joint can be challenging to treat with injections alone, and cooled RFA provides a longer-duration solution. Knee pain from osteoarthritis can be treated with genicular nerve RFA, targeting the nerves that supply sensation to the knee joint. This is an excellent option for patients who are not candidates for knee replacement or who want to delay surgery. Occipital neuralgia and certain chronic headache conditions may benefit from RFA of the occipital nerves.
The Diagnostic Process: Why We Do Blocks First
One of the principles I follow rigorously in my practice is that radiofrequency ablation should almost always be preceded by diagnostic nerve blocks. Here’s why: if I inject a small amount of local anesthetic onto the medial branch nerve and your pain improves significantly — even temporarily — it confirms that the nerve I’m targeting is indeed the one carrying your pain signals. This two-step process (diagnostic block followed by ablation) dramatically improves the success rate of RFA. Patients who have a positive response to diagnostic blocks have an approximately 80 to 90 percent chance of achieving meaningful pain relief with the subsequent ablation.
At my Hoffman Estates clinic, I typically perform two sets of diagnostic medial branch blocks before proceeding to RFA, as this dual-confirmation approach is supported by the strongest evidence and results in the highest success rates.
What to Expect During the Procedure
RFA is performed as an outpatient procedure — you’ll go home the same day. The entire process typically takes 30 to 60 minutes depending on how many levels are being treated. You’ll lie on your stomach on a procedure table with fluoroscopic guidance overhead. The skin is numbed with local anesthetic, and the radiofrequency probes are carefully positioned using X-ray guidance. Before creating the lesion, I perform sensory and motor testing to confirm proper probe placement and ensure safety. You may feel a brief period of warmth or mild discomfort during the lesioning itself, which lasts approximately 60 to 90 seconds per nerve. Most patients tolerate the procedure very well with only local anesthesia, though mild sedation is available if preferred.
Recovery and Results
Recovery from RFA is straightforward. You may experience some soreness at the procedure sites for 1 to 2 weeks — this is normal and represents the body’s response to the thermal lesion. Ice, gentle stretching, and over-the-counter pain medications can manage this temporary discomfort. Most patients return to normal activities within a few days, though I recommend avoiding strenuous exercise for about a week. The full benefit of RFA typically develops over 2 to 4 weeks as the targeted nerve fibers undergo the changes that block pain transmission. Many of my patients tell me this is the point where they realize just how much pain they had been living with — when it’s finally gone, the improvement in quality of life can be remarkable.
Is Radiofrequency Ablation Right for You?
RFA may be an excellent option if you have chronic neck or back pain that has been present for more than 3 months, your pain is localized to the spine rather than radiating significantly into the arms or legs, you’ve had a positive response to diagnostic medial branch blocks or lateral branch blocks, conservative treatments like physical therapy and medications have provided insufficient relief, or you want a longer-lasting solution than repeated steroid injections.
RFA may not be ideal if your pain is primarily caused by disc herniation or nerve root compression (other treatments are better suited), if you have active infection, if you are on blood thinners that cannot be safely held, or if you have an implanted pacemaker or defibrillator (though this is not always a contraindication).
Schedule Your Evaluation
If you’re dealing with chronic spine or joint pain and want to learn whether radiofrequency ablation could help, I invite you to schedule a consultation at my Hoffman Estates practice. I serve patients from Schaumburg, Arlington Heights, Palatine, Barrington, Elk Grove Village, Rolling Meadows, and the greater Chicago area.
Call (847) 981-3630 to schedule your appointment, or visit keithschmidtmd.com to learn more about our comprehensive pain management services.
Keith Schmidt, MD, is a triple board-certified pain management specialist at 1555 Barrington Road DOB 3, Suite 2400, Hoffman Estates, IL 60169.