Radiofrequency Neurotomy (RFN) for Chronic Joint and Spinal Pain

Radiofrequency neurotomy (RFN), also known as radiofrequency ablation, is a well-established interventional procedure used to treat chronic pain arising from joints that has not responded to conservative treatments, such as medications and physical therapy.

The primary goal of this day-surgery procedure is to interrupt pain signalling to the brain, providing an extended window of relief that helps patients regain a significant degree of physical function and comfortably engage in rehabilitation.

Common Clinical Indications for RFN

Radiofrequency neurotomy is highly target-specific and is primarily used to address pain originating from the following anatomical locations:

• Facet Joint Pain: Neck pain arising from the cervical facet joints of the spine and/or back pain arising from the lumbar facet joints. Common underlying causes include spinal injuries, localized osteoarthritis, degenerative disc disease, or structural shifts such as spondylolisthesis.
• Sacroiliac Joint Pain: Pain arising from the joints connecting the sacrum at the base of the spine to the pelvis and hips. This discomfort is typically experienced in the lower back, buttocks, or upper thighs, and can sometimes radiate further down the legs.
• Occipital Neuralgia and Cervicogenic Headaches: Severe headaches originating from irritation of the occipital nerves or pathologies within the upper cervical spine. Triggers include trauma (such as whiplash injuries), arthritis, nerve entrapment, or localized tissue infections.
• Other Conditions: RFN can also be used to target chronic shoulder pain (by treating the suprascapular nerve) and specific nerve pathways involved in Complex Regional Pain Syndrome (CRPS).

Technical Modalities: Traditional vs. Pulsed RFN

Depending on the specific nerve being treated and the nature of your pain, specialists utilize one of two primary radiofrequency modalities:

Traditional Radiofrequency Neurotomy

Traditional RFN aims to eliminate pain by safely creating a thermal lesion on the pain-generating nerves. This is achieved by delivering an alternating electrical current to the nerve via an electrode encased within a specialized needle inserted parallel to the nerve path.

The dense electrical current generates controlled heat (above 60°C) at the tip of the needle to disrupt the nerve's transmission capabilities.

• For spinal facet joint pain, the medial branch nerves are targeted.
• For sacroiliac joint pain, the lateral branch nerves are targeted.

Pulsed Radiofrequency Neurotomy

Pulsed radiofrequency neurotomy (pRFN) is a modified, non-destructive variation of traditional RFN. Instead of continuous heat, electrical bursts are applied to the pain-generating nerve at a much lower temperature (below 42°C) for short intervals. Rather than destroying the tissue, the electrical field modulates the nerve activity, specifically desensitising the pain-conducting "C" nerve fibres without damaging structural pathways.

Step-by-Step: What to Expect During the Procedure

The Diagnostic Phase

Before an RFN is scheduled, a diagnostic nerve block must be conducted to confirm that the suspected joint or nerve path is the true source of your pain. This is a simple preliminary test where a local anaesthetic is injected adjacent to the target nerves. If you achieve significant short-term pain relief from this block, the result is positive, and you can proceed to the RFN procedure.

The Day-Surgery Procedure

1. Preparation: The RFN procedure is performed in a day-surgery setting under light sedation administered by an anaesthetist. A special grounding or earthing pad is placed on the skin at the back of your leg.
2. Guidance: The specialist performs the procedure under real-time fluoroscopic X-ray guidance to ensure pinpoint accuracy during needle placement next to the target nerve.
3. Testing: Once the needle is positioned, sensory and motor nerve stimulation testing is conducted to verify proper placement. You will be asked to let the doctor know when you feel a faint tingling or pulsing sensation.
4. Treatment: After confirmation, the radiofrequency treatment commences. Each localized lesion takes approximately 90 seconds, and at least two lesions are typically performed at each target level. You may feel a mild, completely normal aching sensation or brief muscle contraction during this phase.

Post-Procedure Outcomes

The results of a radiofrequency neurotomy are highly individualized and depend on your underlying condition. Most patients experience substantial pain relief and a major restoration of daily mobility within a few weeks of the procedure.

Typically, the pain-free window lasts between 12 to 24 months. While treated nerves will eventually regenerate over time—potentially causing symptoms to return—the procedure can be safely repeated if necessary to maintain long-term pain control.

References & Further Reading:

• International Association for the Study of Pain
• Arthritis Victoria: Osteoarthritis
• National Institute of Arthritis and Musculoskeletal and Skin Diseases: Osteoarthritis
• PubMed Health: Osteoarthritis Overview
• Garne MR, Alshameeri Z, and Khanduja V. Osteoarthritis: genes, nature–nurture interaction and the role of leptin. Int Orthop. 2013.
• Thijssen E, van Caam A, van der Kraan PM. Obesity and osteoarthritis, more than just wear and tear. Rheumatology. 2015.
• Papathanasiou I et al. Molecular changes indicative of cartilage degeneration and osteoarthritis development in patients with anterior cruciate ligament injury. BMC Musculoskelet Disord. 2016.
• Goodwin JL, Kraemer JJ and Bajwa ZH. The use of opioids in the treatment of osteoarthritis: when, why, and how? Curr Pain Headache Rep. 2005.

If you are suffering from long-standing back, neck, or joint pain that has failed to improve with conservative care, consult your General Practitioner about a formal referral. Contact Hunter Pain Specialists on (02) 4985 1800 or visit our official Contact Us page to discuss your options.