Chronic pain doesn’t just hurt-it steals your life. You can’t sleep well. You can’t walk without limping. You can’t play with your kids or carry groceries. And after months of pills, physical therapy, and cortisone shots that barely help, you’re left wondering: is there anything else?
What Exactly Are Nerve Blocks?
A nerve block is a simple, targeted injection. A doctor uses imaging-usually ultrasound or fluoroscopy-to guide a thin needle right next to the nerve sending pain signals to your brain. Then, they inject a local anesthetic, sometimes mixed with a steroid. The anesthetic shuts down the nerve’s ability to send pain messages. That’s it.
It’s not a cure. It’s a test and a temporary fix. Most people feel relief within minutes. But that relief lasts anywhere from a few hours to a few weeks. If your pain comes back after two weeks, the nerve block didn’t fix the problem-it just paused it.
Here’s why this matters: if you get 80% or more pain relief from a nerve block, it tells your doctor one very important thing-you’ve found the right nerve. That’s the key to deciding if radiofrequency ablation (RFA) is right for you.
What Is Radiofrequency Ablation (RFA)?
RFA is what happens when you take the idea of a nerve block and turn it up a notch. Instead of just numbing the nerve, RFA uses heat to disable it-temporarily.
The procedure starts the same way: imaging guides a needle to the exact nerve causing your pain. But instead of injecting medicine, the doctor sends a small electrical current through the needle. This current heats the tip to between 80°C and 90°C. That heat creates a tiny, controlled burn-just big enough to disrupt the nerve’s ability to send pain signals.
It doesn’t destroy the nerve completely. Your body will eventually repair it. But that repair takes time. Most people get relief for 6 to 12 months. Some, especially with newer cooled RFA techniques, stay pain-free for up to two years.
And here’s the best part: you’re awake during the whole thing. You might get light sedation, but you don’t need general anesthesia. You walk out the same day. Most people are back to normal activities within 24 to 48 hours.
How RFA Differs From Nerve Blocks
Think of a nerve block like turning off a light switch for a few hours. RFA is like pulling out the wiring so the switch won’t work for months.
Here’s how they stack up:
- Duration: Nerve blocks last days to weeks. RFA lasts 6 to 24 months.
- Effectiveness: Nerve blocks help about 30-50% of patients beyond the first few days. RFA helps 70-80% of patients who passed the diagnostic nerve block test.
- Goal: Nerve blocks are diagnostic and temporary. RFA is therapeutic and long-term.
- Cost: A nerve block costs around $500-$1,000. RFA runs $3,000-$5,000-but you won’t need it again for over a year.
And unlike surgery-where you’re out of action for months-RFA has almost no downtime. No hospital stay. No stitches. No major recovery.
Who Is a Good Candidate for RFA?
RFA isn’t for everyone. It’s for people who’ve already tried the basics: physical therapy, NSAIDs, maybe even steroid injections-and still hurt.
The best candidates are those who:
- Have chronic back or neck pain from facet joints (common after 45)
- Got at least 80% pain relief from a diagnostic nerve block
- Don’t want to rely on opioids long-term
- Want to stay active without surgery
It’s also now used for knee osteoarthritis, sacroiliac joint pain, and even chronic headaches from occipital neuralgia. A 2023 study showed 65% of knee osteoarthritis patients had significant pain relief for six months after cooled RFA-compared to only 45% after steroid shots.
But if your pain comes from a herniated disc, spinal stenosis, or severe arthritis, RFA won’t fix the root problem. It only blocks the signal. That’s why the diagnostic nerve block is non-negotiable. If you don’t respond to it, RFA won’t help.
What to Expect During and After RFA
The procedure takes 20 to 45 minutes. You’ll lie on your stomach or side, depending on where the pain is. The area is cleaned and numbed with local anesthetic. Then, under live X-ray (fluoroscopy), the doctor inserts the needle. They’ll test it with a small electrical pulse-you might feel a tingling or mild muscle twitch. That’s normal. It confirms the needle is right on target.
Once they’re sure, they turn on the radiofrequency energy. You might feel warmth, but not pain. You’ll be awake the whole time so you can tell them if anything feels off.
Afterward, your back or neck might feel sore for a few days. That’s not the pain coming back-that’s your body healing around the treated nerve. Some people get mild swelling or numbness in the area. That usually fades in a week.
Full pain relief doesn’t hit right away. It takes 2 to 4 weeks for the nerve to fully stop sending signals. That’s when most people notice they can bend, walk, or sleep without pain for the first time in months.
What Are the Risks?
RFA is low-risk. But nothing’s perfect.
- Temporary nerve irritation: About 5-10% of people feel a burning or tingling sensation for 1-2 weeks. It fades.
- Inaccurate placement: If the needle isn’t right, the treatment won’t work. That’s why imaging is critical. Without it, failure rates jump to 15%.
- False positive nerve block: If the diagnostic block was misleading, RFA won’t help. This happens in 20-30% of cases if the block wasn’t done properly.
- Recurrence: The nerve grows back. That’s why relief isn’t permanent. But most people get 12+ months of relief before needing another session.
Severe complications-infection, nerve damage, paralysis-are extremely rare when done by a trained specialist.
How RFA Compares to Other Options
Let’s say you have chronic lower back pain. Here’s what your options look like:
- Physical therapy: Helps 60-70% of people-but pain often returns within 6 months.
- NSAIDs (like ibuprofen): Only works for 30-40% long-term. Plus, they can wreck your stomach and kidneys if used too long.
- Steroid injections: Last 1-3 months. Repeat injections can weaken tissues over time.
- Spinal fusion surgery: Has a 10-15% complication rate. Recovery takes 6-12 months. Costs $50,000+
- Spinal cord stimulator: Works well but costs $20,000-$50,000. Requires surgery to implant a device.
- RFA: Costs $3,000-$5,000. Outpatient. 70-80% success rate. No implants. No long recovery.
For many people, RFA is the sweet spot: more effective than shots, less risky than surgery, and cheaper than implants.
What’s New in RFA?
The field is evolving fast.
Cooled RFA uses a special needle that circulates cold fluid inside. This lets the heat spread further without burning the skin. It creates a larger lesion-up to 10mm wide-so it’s better for bigger nerves like those around the knee. Studies show it lasts longer than traditional RFA.
Pulsed RFA doesn’t use heat at all. It sends short bursts of electricity that change how the nerve sends signals without damaging it. It’s newer, less invasive, and may be better for people who can’t handle heat. Early results are promising for facial pain and sciatica.
The FDA approved the first pulsed-field ablation system for spinal pain in 2022. It’s still new, but it could be the next big thing-faster recovery, no heat damage, and potentially longer-lasting results.
Why RFA Is Becoming Standard Care
More than 350,000 RFA procedures are done in the U.S. every year. Why? Because the opioid crisis forced a change.
Medicare data shows that after RFA, patients cut their long-term opioid use by 22%. That’s huge. It’s not just about pain relief-it’s about safety.
Major medical groups like the American Society of Anesthesiologists now recommend RFA as a second-line treatment-after physical therapy and injections, but before surgery. Level I evidence backs it up for chronic facet joint pain.
And it’s not just for backs. New studies show success with sacroiliac joint pain (70% relief at 6 months), plantar fasciitis, and even chronic headaches.
The global RFA market is expected to hit $8.5 billion by 2028. That’s not hype-it’s demand.
Final Thoughts: Is RFA Right for You?
If you’ve been living with chronic pain for over six months and nothing’s worked, RFA might be your next step. But only if you’ve already had a successful diagnostic nerve block.
It’s not magic. It won’t cure arthritis. It won’t fix a bad disc. But it can give you back your life-for a year or more-without drugs, without surgery, without months of recovery.
Ask your pain specialist: "Did my nerve block work well enough to qualify for RFA?" If the answer is yes, then you’ve already done the hardest part. The rest is just a 30-minute procedure.
Chronic pain doesn’t have to be your forever story. There’s a middle ground between pills and surgery. And for thousands of people every year, that middle ground is RFA.
How long does pain relief last after RFA?
Most people get relief for 6 to 12 months. With newer cooled RFA techniques, relief can last up to 24 months. The nerve eventually regenerates, so the pain may return-but not right away. Many patients get a second RFA when needed.
Is RFA better than a nerve block?
It depends on your goal. Nerve blocks give short-term relief and help diagnose the pain source. RFA gives long-term relief by disabling the nerve. If your nerve block worked well, RFA is the next logical step for lasting results.
Does RFA hurt?
The injection site is numbed, so you won’t feel pain during the procedure. You might feel pressure or a mild tingling when the nerve is tested. Afterward, some soreness is normal for a few days, but it’s usually less than the pain you had before.
Can RFA be used for knee pain?
Yes. Cooled RFA targeting the genicular nerves around the knee has become a standard treatment for osteoarthritis. Studies show 65% of patients had significant pain relief for 6 months, compared to 45% with steroid injections.
What if RFA doesn’t work?
If you didn’t get relief, it likely means the wrong nerve was targeted. That’s why the diagnostic nerve block is so important. If it wasn’t done correctly, RFA won’t help. Talk to your doctor about repeating the diagnostic block with better imaging or exploring other causes like disc issues or referred pain.
How do I know if I’m a good candidate?
You’re a good candidate if: you’ve had chronic pain for over 6 months, conservative treatments didn’t help, and you got at least 80% pain relief from a diagnostic nerve block. Common conditions include facet joint pain, sacroiliac joint pain, and knee osteoarthritis.
Is RFA covered by insurance?
Yes, most major insurance plans-including Medicare and Medicaid-cover RFA when it’s performed after a successful diagnostic nerve block and for approved conditions like chronic back or knee pain. Always check with your provider, but coverage is standard in most cases.
Next steps? If you’re considering RFA, start with a diagnostic nerve block. Don’t skip it. It’s the only way to know if your pain source is correct. And if you’ve already had one and it worked? Talk to your pain specialist about scheduling RFA. You might be one appointment away from getting your life back.