Radio Frequency Ablation

The procedure follows a straightforward sequence.

1. A local anaesthetic numbs the treatment area. Mild sedation is available if needed.
2. Using X-ray guidance, the doctor inserts a needle toward the facet joint and its nerves.
3. You stay awake during the procedure. You may be asked to report any tingling, which helps confirm correct needle placement.
4. Once placement is confirmed, radiofrequency current is applied to each nerve for about 90 seconds.
5. This heat disrupts the nerve’s ability to transmit pain signals, which can reduce pain from that joint.

Radiofrequency ablation may suit patients with facet joint pain. This includes arthritis of the neck, lower back, or upper back. It is generally considered when medication or physical therapy has not given adequate relief.

Doctors typically recommend radiofrequency ablation after a positive diagnostic nerve block. This test involves injecting a small amount of numbing medication near the suspected joint. If the nerve block reduces pain by at least 50%, it is considered positive. The numbing effect wears off within two to four hours. The usual pain then returns. A positive result helps confirm the facet joint as the pain source before proceeding with ablation.

Singapore Paincare uses the Painostic® methodology to guide this decision. Painostic looks beyond imaging alone. It assesses pain patterns, underlying pathology, pain perception, and psychological factors together. This multi-dimensional assessment, combined with the diagnostic nerve block described above, helps our pain specialists judge whether radiofrequency ablation is likely to address your specific pain source before recommending it.

Radiofrequency ablation is typically performed as day surgery. Most patients go home on the same day. Many return to work or their usual activities the following day, without needing an extended period of bed rest. Pain relief can begin immediately or take a few weeks to become noticeable, as the treated nerve responds to treatment.

The benefit from Radio Frequency Ablation may last for more than 2 years in 80% of cases and about 6–8 months for the remaining 20%. Radio Frequency Ablation may be repeated in 6–8 months for those whose nerves regenerate after the procedure, or the particular facet joint gets inflamed again, and the similar pain returns.

It is important that the patient participates in regular rehabilitation and exercises after the procedure, to strengthen the core muscles supporting the spine and reduce the physical stress on the facet joints.

If the procedure only partially reduces the pain, the remaining pain usually comes from chronically damaged ligaments, joints or discs. Prolotherapy (an injection of concentrated hypertonic solution such as concentrated glucose into the ligaments) may be a helpful addition to strengthen ligaments/tendons and tighten the loosened/distorted joints. With this additional therapy, pain is relieved and the joints can function normally. Periodic injection with steroids may also significantly reduce chronic lower-back pain.

Radiofrequency ablation is generally well tolerated, but like any procedure, it carries some risk. Serious complications such as nerve injury or paralysis are rare.

Temporary numbness in the treated area is expected. This usually resolves within 6 weeks to 2 months.

A minority of patients experience a temporary neuropathic pain reaction after treatment. This can feel like burning, tingling, or increased numbness. In one published case series of ablation at the C2-3 spinal level, this occurred in about 19% of patients. Symptoms typically resolved within an average of 2.6 months, though a small number of cases took longer (Gazelka et al., Journal of Pain Research, 2014). Your doctor can advise how this may apply to your specific treatment site.

Other general procedural risks are possible but uncommon. These include bruising, infection, or bleeding at the needle site. Discuss your individual risk profile with your pain specialist before proceeding.