Radiofrequency Ablation

If back or neck pain has hung on for months and injections or physical therapy only helped for a while, radiofrequency ablation (RFA) may be the next step. Our pain physicians perform RFA at offices in Plainview, New Hyde Park, Ronkonkoma, and Yonkers, NY, and Clifton, NJ.

What radiofrequency ablation actually treats

Most RFA in a pain practice targets facet joint pain — pain from the small paired joints running up the back of your spine. When those joints become arthritic or irritated, tiny nerves called the medial branch nerves carry the pain signal to your brain. RFA uses radiofrequency energy to heat and interrupt those specific nerves, so the signal no longer gets through.

It’s commonly used for chronic pain in the lower back and neck that hasn’t responded to at least a few months of conservative care — medication, physical therapy, and injections. It is not a first step, and it isn’t for every kind of back pain. Pain that radiates down the leg from a herniated disc, for example, is usually a different problem with a different fix.

Am I a candidate? How medial branch blocks decide it

The honest answer depends on a test. Before recommending RFA, your physician will usually perform a diagnostic medial branch block — a numbing injection at the same nerves RFA would target. If the block gives you strong, short-term relief, it’s good evidence the facet joints are the source of your pain. If it doesn’t, RFA probably isn’t your answer, and we’ll say so rather than proceed.

Many insurers want this test done twice. For example, the Medicare coverage policy for New York (CMS LCD L35936, Facet Joint Interventions for Pain Management) covers a first RFA only after at least two diagnostic medial branch blocks, each giving at least 80% relief of your main pain. Two positive blocks make it much less likely that the first result was a fluke. Other plans set their own rules, and our team checks them before we schedule.

RFA tends to fit when:

• Your pain is mainly in the back or neck itself, not shooting down a limb
• It’s lasted several months despite conservative treatment
• Two diagnostic blocks each gave you strong, temporary relief
• You’d rather avoid long-term pain medication or surgery

What happens on the day

RFA is an outpatient procedure. You go home the same day, but you’ll need someone to drive you. Here is how a typical visit goes:

• Check-in and prep. We review your health history and medicines, including blood thinners, and answer your questions.
• Positioning and numbing. You usually lie on your stomach, or in another position for some neck levels. The skin is numbed with local anesthetic. Light sedation to help you relax is optional.
• Needle placement. Using live X-ray, your doctor guides a thin needle next to each target nerve.
• Safety test. A small electrical signal checks the position. You may feel tingling or a muscle twitch. This is why you stay awake enough to answer questions.
• Treatment. The tip of the needle is heated to quiet the nerve. Each level is numbed first.
• Recovery and home. You rest briefly, get written instructions, and head home.

According to Cleveland Clinic, RFA takes from about 15 minutes to two hours, depending on the area and how many nerves are treated. Relief can start right away for some people, or within about 10 days to three weeks for others.

It’s normal for the area to feel sore for several days as the treated nerves settle. For a day-by-day guide, see our RFA recovery and aftercare guide.

How long relief lasts

When RFA works, relief usually lasts about six to twelve months (Cleveland Clinic). Some people get longer relief and some get less, so we can’t promise a specific number. RFA does not work for everyone, even after positive blocks.

The treated nerves can slowly grow back, which is why pain may return. When it does, RFA can be repeated. Insurers set rules for repeats. New York Medicare (LCD L35936), for example, covers a repeat RFA at the same spot when the first one gave at least 50% improvement in pain for at least six months, or a similar gain in daily function. RFA generally gives longer relief than a steroid injection, which is why it’s worth considering when injections keep wearing off.

Where we do it

Cost and insurance

What you pay depends on your plan, your deductible and copay, and how many spine levels are treated. The diagnostic blocks are usually billed as separate visits. Because these numbers vary so much, we don’t post a single price. Our team checks your benefits and any prior authorization before your procedure, so you know what to expect.

Frequently asked questions

How long does it take to recover from radiofrequency ablation?

Most people return to normal activity within a day or two, avoiding strenuous activity for the first 24–48 hours. The treated area can stay sore for about a week while the nerves settle.

Is radiofrequency ablation painful?

During the procedure you’re numbed and kept comfortable, and it’s usually well tolerated. Afterward, expect temporary soreness at the site for several days — an ice pack helps.

Are you awake during the procedure?

Usually yes. RFA is typically done with local anesthetic while you’re awake but relaxed, which lets your physician confirm the correct nerves are being treated. You’ll still need a ride home.

Is radiofrequency ablation considered surgery?

No. It’s a minimally invasive, nonsurgical procedure done through a needle under X-ray guidance — no incision and no stitches.

What’s the downside of radiofrequency ablation?

The relief is temporary because nerves regrow, so the procedure may need repeating. There’s also short-term soreness, and a small risk of the usual needle-procedure complications, which your physician will review with you.

What if radiofrequency ablation doesn’t work for me?

It doesn’t work for everyone, which is exactly why the diagnostic block comes first — to improve the odds before you commit. If RFA isn’t the answer, we’ll walk you through other options rather than repeat something that didn’t help.

How many nerve blocks do I need before radiofrequency ablation?

Usually two. Many insurers, including New York Medicare under LCD L35936, require two diagnostic medial branch blocks that each give at least 80% relief of your main pain before a first RFA. Other plans set their own rules, and we check them before scheduling.

Can radiofrequency ablation be repeated?

Yes. The treated nerves can grow back, so pain may return after several months. RFA can then be repeated. New York Medicare, for example, covers a repeat when the first treatment gave at least 50% improvement for at least six months. Other plans have their own rules.

Does insurance cover radiofrequency ablation?

Often, when it’s medically necessary and the diagnostic blocks were positive. In New York, we accept most major plans, including Medicare, workers’ compensation, and no-fault. In New Jersey (Clifton), we accept PPO and POS plans and personal injury/auto PIP only. We verify your benefits before your procedure.