Radiofrequency Ablation for Back and Neck Pain: How It Works and Why the Setting Matters

Radiofrequency ablation (RF) quiets low back and neck pain from arthritic facet joints. A probe, placed under live X-ray, cuts off the tiny medial branch nerves that carry the pain signal to the brain. At the Padda Institute it is done awake in the office. And only after two diagnostic medial branch blocks confirm the right pain circuit.

If you live with ongoing low back or neck pain, part of the problem may be your facet joints — the small hinge joints of the spine. When these joints wear down with arthritis, they can send a steady alarm to the brain. Radiofrequency ablation, or RF, is built to cut off that one pain signal. This article covers four things. What the procedure targets. Why it can be done safely in an office without sedation. How the Padda Institute confirms you are a candidate first. And why your metabolism affects how long relief lasts.

What nerves does radiofrequency ablation target?

Radiofrequency ablation is a tool that cuts off a pain signal at its source. For facet back and neck pain, that source is a set of tiny nerves called the medial branch nerves — the small wires that carry pain from an arthritic facet joint to the brain. RF uses a probe to cut off those nerves so the signal goes quiet. These nerves are tiny. They sit close to parts you do not want to touch. So the probe must be placed with sub-millimeter precision, lying parallel to the nerve. In this clinic’s view, pain is a signal that something has drifted out of balance. It is not just a diagnosis to be silenced.

Are you awake during radiofrequency ablation?

Placing the probe right takes nonstop fluoroscopic imaging — live X-ray guidance — not doing it “by feel” or with ultrasound alone. It also needs your nervous system to stay online. During RF, the physician does sensory and motor testing. You confirm you feel a buzz in your usual pain spot. The team checks that your arms or legs are not twitching. A twitch would mean the probe is too close to the wrong nerve. We call routine sedation unnecessary and counterproductive here, because it cuts that feedback loop. It also adds the body stress of anesthesia, which can add to brain fog and slower recovery after. In this practice’s view, staying awake is itself a safety check. The procedure can be done safely in a physician’s office, not only in a surgery center.

Who is a candidate for radiofrequency ablation?

An MRI showing arthritis is not enough on its own to justify RF. An image is a picture, not a map of where your pain really comes from. Before offering ablation, this clinic has you pass two separate diagnostic medial branch blocks. In each, a tiny amount of local anesthetic numbs the suspect nerves. If your pain drops by about 80% for the duration of the anesthetic, that points to the right pain circuit. We repeat the test a second time just to rule out a placebo response. Only then do we consider RF. That way the procedure aims at a signal we have proven, not one we guessed.

Why does back pain come back after radiofrequency ablation?

Here is the part many patients are not told. RF is a local fix, but your body is a whole system. Treat the nerve while the body stays inflamed — what this clinic calls being “on fire with meta-inflammation” — and pain can come back faster and harder. Dr. Padda ties this to your metabolic terrain. In his view, insulin resistance, a diet heavy in processed carbs and industrial seed oils, and higher HbA1c levels make nerves more excitable (quicker to fire). They also make your mitochondria (the cell’s power plants) less efficient. So RF buys you a window when the pain signal is quiet. Use it. Move your body, sleep better, and switch to real, nutrient-dense food. This clinic backs low-carb or ketogenic eating to lower body-wide inflammation. These nutritional and metabolic claims reflect this practice’s approach rather than settled standard care. Individual results vary.

Frequently asked questions

Will I be asleep during radiofrequency ablation, and is it painful?

This clinic does RF with you awake, not sedated, because staying awake allows sensory and motor testing. That testing helps place the probe right and safely. Local anesthetic numbs the area. Being awake lets you confirm the probe is in the right spot. Individual results vary.

For which nerves the probe targets and what ablation does to them, read Facet Joint Pain and the Medial Branch Nerves: What Ablation Actually Does.

How long does relief from radiofrequency ablation last?

Relief can last many months when the right nerves are treated with precise imaging. But the procedure cuts off a signal. It does not cure the joint underneath. If body-wide inflammation is left alone, pain can return sooner. That is why this clinic pushes nutrition and metabolic health. Individual results vary.

Do I need to change my diet or medications for the procedure to work?

This clinic sees RF as buying a window of less pain. Use that window to improve metabolism, sleep and movement. We push you to cut processed carbs and industrial seed oils. These dietary approaches are practice-based rather than a guaranteed fix. Do not start, stop, or change any medication without consulting your physician. Individual results vary.

For how diet drives the body-wide inflammation that brings pain back, read How Inflammation and Diet Drive Chronic Pain and Hormone Problems.

How does radiofrequency ablation for back pain work?

Arthritic facet joints send pain through tiny medial branch nerves to the brain. In radiofrequency ablation, the physician lays a probe parallel to those nerves with sub-millimeter precision under live X-ray. Then the probe cuts them off so the pain signal goes quiet. At the Padda Institute it is done in the office with you awake. That way sensory and motor testing can confirm placement.

Is an MRI enough to know if I need radiofrequency ablation?

No. An MRI showing arthritis is a picture, not a map of where your pain comes from. This clinic requires two separate diagnostic medial branch blocks first. A tiny amount of local anesthetic numbs the suspect nerves. Your pain must drop by about 80% for the duration of the anesthetic. If that happens again on the second test, the right pain circuit is confirmed.

How successful is ablation for back pain?

Success depends on treating the right nerves and on the body around them. This clinic confirms the pain circuit with two diagnostic blocks before ablation. It places the probe with live imaging. Relief can last many months when the right nerves are treated. But if body-wide inflammation is left alone, pain can return faster. So we use the quiet window to improve movement, sleep and food. Individual results vary.

Where are you located and how do I book?

Padda Institute Center for Interventional Pain Management, 4477 Woodson Rd, Suite 100, St. Louis, MO 63134. Book at painmd.tv/appointment/ or call (314) 481-5000.

Key takeaways

• RF cuts off the medial branch nerves that carry pain from arthritic facet joints in the back and neck.
• This clinic does it awake with live imaging. Sensory and motor testing then confirm a precise, safe probe spot.
• Candidacy is confirmed with two diagnostic medial branch blocks (about 80% relief, repeated to rule out placebo), not by MRI alone.
• Next step: ask the Padda Institute whether diagnostic blocks and RF fit your back or neck pain. Then address the metabolic drivers that affect how long relief lasts.

This article is educational and is not a substitute for evaluation, diagnosis, or treatment by a physician. Individual results vary. Do not start, stop, or change any medication without consulting your physician.

Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP — Board Certified in Anesthesiology, Pain Medicine, Interventional Pain Management, Addiction Medicine, and Obesity Medicine. Last reviewed July 2026.

Dr. Gurpreet Singh Padda, MD, MBA, MHP