Nerve Ablation (Radiofrequency Ablation): Purpose & Risks

Nerve ablation, also called radiofrequency ablation, is a procedure that helps relieve chronic pain—one of the most challenging conditions to treat. About 84% of adults in the United States suffer from chronic lower back pain at some point in their lives.

Nerve ablation uses radiofrequency currents to target nerves that transmit pain signals to the brain. It helps to relieve spine and neck pain, pain from tumors, joint pain from arthritis, and chronic lower back pain.

Healthcare providers, including pain management specialists, anesthesiologists, and surgeons, can perform nerve ablation in a hospital or clinic.

Nerve ablation most often helps to relieve facet joint-mediated pain—or pain that starts in the facet joints that connect the vertebrae in your neck, mid-back, or lower back. Thermal energy targets areas containing nerves that are responsible for transmitting or regulating the sensation of pain.

Healthcare providers recommend nerve ablation when a condition does not improve with traditional treatments like medications or physical therapy. A few conditions that nerve ablation can treat are:

• Spine and neck pain
• Joint pain from arthritis
• Chronic lower back pain
• Face pain from trigeminal neuralgia 
• Pain due to tumors

There are different types of nerve ablation based on the nerve’s specific characteristics. Common types include:

• Thermal radiofrequency ablation: This is the most common technique. It uses radiofrequency current to produce heat, which damages the nerve transmitting pain.
• Pulsed radiofrequency ablation: This technique delivers bursts of radiofrequency current (20 milliseconds over a 120-second interval) instead of a continuous flow of current.
• Cooled radiofrequency ablation: This technique uses a continuous flow of water to cool the electrode that generates current, preventing it from reaching very high temperatures.
• Cryoneurolysis: This technique directly uses cryoprobes, which produce ice balls of different sizes at a very cold temperature of about -94 degrees Fahrenheit (-70 degrees Celsius) to damage the targeted nerve.

Undergoing nerve ablation can be scary, just like any other procedure. Talk to your healthcare provider to understand what to expect during the procedure. A few things to keep in mind are:

• Location: Nerve ablation is an outpatient procedure performed by pain management specialists, anesthesiologists, and surgeons at a hospital or clinic.
• Clothing: You need to change into a hospital gown for the procedure, so you may want to wear comfortable clothes and leave your jewelry at home.
• Fasting: Your healthcare provider will let you know if you can have food or water or if you should avoid consuming anything a few hours before the procedure.
• Medications: Tell your healthcare provider about any medications you are taking. They may recommend stopping anticoagulant medications, including aspirin and Coumadin (warfarin), since they can interfere with the procedure.
• Documents: You may want to carry photo identification and your insurance card on the day of the procedure.
• Emotional support: Ask your healthcare provider if you can bring someone with you on the day of nerve ablation.
• Insurance coverage: Check with your insurance company to see if they will cover the costs of your nerve ablation.

During nerve ablation, a small needle is inserted into the nerve where the pain occurs. An active electrode is inserted through the needle, which sends a current. The heat from the current destroys the surrounding tissues and nerves, relieving the pain. After the procedure, your healthcare team monitors you for a few hours before you can go home.

Before the test, your healthcare provider will ask you about your medical history, as well as your pain location and severity. Providers often recommend X-rays or other imaging tests to identify what might cause the pain.

They will then recommend a diagnostic block test, which helps identify the nerve causing the pain and predict whether you will get relief from nerve ablation.

Diagnostic block tests involve injecting a local anesthetic agent, commonly lidocaine, into the pain region. Results are positive if people experience 50% or more pain relief after the injection, and positive results often indicate that nerve ablation will be useful for you.

Your healthcare team also uses an intravenous (IV) line to administer fluids or general anesthesia (only upon instruction by the healthcare provider).

During the Procedure

For the nerve ablation procedure, you will change into a hospital gown and lay comfortably on the procedure table. Your surgical team will clean the skin and inject a local anesthetic to numb the area where the needle will be inserted.

A needle or cannula is then inserted through the skin where you feel the pain. The target area is determined using fluoroscopic guidance, which produces a continuous X-ray image on a monitor.

Following the insertion, an active electrode is passed through the needle. Painful symptoms are stimulated to confirm the target location. After this, a local anesthetic agent is sent through the needle, followed by a radiofrequency current.

The current produces heat that helps destroy the nerve, transmitting pain signals to the brain. The procedure can take between 15 minutes to about an hour to complete.

After the Procedure

After nerve ablation, your healthcare team will monitor you for a few hours. You can typically go home on the same day of the procedure, but it’s safest to arrange for someone to drive you home.

Your healthcare provider may prescribe medications for pain at the treatment site. They will also give you instructions on how to clean the treatment site to prevent infections.

Nerve ablation is a low-risk and safe procedure that often does not lead to adverse complications. Although rare, nerve ablation can cause a few complications, including:

• Bleeding at the needle site
• Worsening of pain at the needle site
• Infection at the needle site
• Nerve damage
• Numbness in the face
• Spinal cord injury

Pregnant people must talk to their healthcare providers to understand whether they can undergo the procedure.

Nerve ablation can effectively relieve chronic pain within the first four weeks of the procedure. One study found that nerve ablation can relieve facet-mediated lower back pain for 6-12 months and up to two years.

Your healthcare provider can tell you how long your pain relief may last. The nerve may grow back, leading to a recurrence of pain. In these cases, some healthcare providers may recommend repeating nerve ablation.

Nerve ablation is a procedure that reduces pain by targeting nerves that transmit or regulate pain signals to the brain.

Your healthcare provider uses a diagnostic block test to understand whether nerve ablation will help relieve your pain. The procedure generally takes place at a hospital or an outpatient clinic. You can usually go home on the same day as the procedure.

Pain relief from nerve ablation can last up to two years. Follow up with your healthcare provider to understand how long the pain relief will last for you.