Summary: All pain societies in the US have recently updated their guidelines for managing cervical spine joint pain. Under the new rules, one nerve block that gives more than 50% pain relief is enough to consider RF nerve ablation. The old rule said RF ablation could be considered only if two nerve blocks each gave more than 80% relief. The new guidelines say every patient with neck joint pain should get imaging. The societies now say the same thing, to end the confusion and make care the same everywhere.
Cervical spine joint pain or chronic neck pain is very common. It also spreads, causing shoulder pain and even headache. Managing it often means taking medicine for a long time, and sometimes surgery. Surgery may pose a greater threat to health than pills. But surgery can also give permanent relief in many cases. Then a person may be able to live without medicine.
There is another key option. It is minimally invasive, less risky, and may still give lasting relief like surgery. It is called radiofrequency (RF) ablation of the cervical medial branch. Put simply, doctors use radio waves to switch off the nerve. That stops the pain signal and makes relief last longer.
RF ablation is safe and it works, but not everyone will benefit. There have been many guidelines on when to use RF ablation for neck pain. Now all pain societies in the US have updated their guidelines at the same time. This will help end the confusion. It will help all pain doctors use a similar approach for the condition1,2.
RF switches the nerve off for good. So doctors first make sure they have the right nerve, and that shutting it down will help. Before RF ablation, they do a nerve block, or facet block, with numbing medicine. This test wears off. If the nerve block cut the pain, the patient can be considered for RF nerve ablation. That shuts the nerve down for good and brings relief. This whole process of Facet Joint Radiofrequency has shown some promising results for spine joint pain.
The shared guidelines made several changes to keep patients safe and improve neck joint pain care. Many doctors may be surprised that the new guideline calls for imaging before a facet block. The guidelines say imaging does little to diagnose the problem or predict how it will go. But imaging is good for safety and for planning the procedure.
Another big change is how many nerve blocks to do before RF nerve ablation. The old rule was at least two nerve blocks, each giving 80% or more relief. Only then could a patient be considered for RF nerve ablation.
That rule has now changed a lot. The new rule says one nerve block that gives more than 50% relief is enough to move forward with RF nerve ablation. This matters, because doctors think that in neck pain the facet joint is a bigger source of pain. So people with neck spine pain are more likely to benefit from facet joint radiofrequency ablation.
Facet joint injection is a similar early treatment that can help cut opioid use. Many people with long-term neck pain rely on these drugs. Experts say they made these changes because RF nerve ablation works better for neck joint pain than for lumbar pain or low back pain.
These guidelines will have many effects. First, they make care the same for neck joint pain and sciatica nerve pain treatment. Before, there were several guidelines that said different things. Now they all say much the same. That cuts confusion, which is good for patients. The final call is still made by the treating doctor. That doctor is in the best spot to decide if a procedure will work for a given patient.
Shared guidelines help patients in other ways too. Insurance is now more likely to cover the procedure, since all guidelines agree. These guidelines are not fixed. They may change, because medicine keeps moving forward.
The Bottom Line
Padda Institute of Pain Management has a proven record treating spine joint pain and sciatica nerve pain with its own facet joint radiofrequency treatment. Get in touch with our specialists for pain relief.
Frequently asked questions
Who qualifies for radiofrequency ablation of the neck?
Under the new US guidelines, one diagnostic nerve block that relieves more than 50% of your neck pain is enough to consider radiofrequency ablation. The old rule asked for two nerve blocks, each giving 80% relief or more. The guidelines set the bar. Your own doctor makes the final call on whether it fits you.
How does radiofrequency ablation work for neck pain?
The doctor first numbs the suspected nerve with a nerve block, also called a facet block. That test wears off. If it cuts your pain, the doctor uses radio waves to switch off the cervical medial branch nerve. That nerve carries pain from the facet joint. Switching it off stops the pain signal and makes relief last much longer.
Do I need imaging before a cervical facet block?
Yes. The new guidelines call for imaging before a facet block, which surprises some doctors. Imaging does little to diagnose facet joint pain or predict how you will do. But it makes the procedure safer. It helps the doctor plan exactly where the needle goes.
Is radiofrequency ablation safer than neck surgery?
Radiofrequency ablation is minimally invasive. It carries less risk than surgery, which can pose a greater threat to your health. Like surgery, it can give lasting relief. It may let some people with neck facet joint pain live without medicine.
Does radiofrequency ablation work better in the neck or the lower back?
The neck. The experts behind the new guidelines found that radiofrequency ablation works better for neck joint pain than for low back pain. The facet joint is thought to be a bigger source of pain in the neck. So people with neck joint pain are more likely to benefit.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
