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

If you live with ongoing low back or neck pain, part of the problem may be your facet joints — the small hinge-like joints of the spine. When these joints become arthritic, they can send a constant signal of distress toward the brain. Radiofrequency ablation, or RF, is a procedure designed to interrupt that specific pain signal. This article explains what the procedure targets, why it can be done safely in an office without sedation, how the Padda Institute confirms you are a candidate before treating, and why your metabolism affects how long relief lasts.

What radiofrequency ablation targets

Radiofrequency ablation is a tool used to interrupt a pain signal at its source. For facet-related back and neck pain, that source is a set of tiny nerves called the medial branch nerves — the small wires that carry the pain signal from an arthritic facet joint toward the brain. RF uses a probe to interrupt those specific nerves so the signal quiets down. Because these nerves are very small and sit close to structures you do not want to affect, the probe must be placed with sub-millimeter precision, positioned parallel to the nerve. In this clinic’s view, pain is treated as a signal that something has drifted out of balance, not simply a diagnosis to be silenced.

Why the procedure is done awake, with imaging

Placing the probe accurately requires continuous fluoroscopic imaging — live X-ray guidance — rather than doing it “by feel” or with ultrasound alone. It also requires that your nervous system stay online. During RF, the physician performs sensory and motor testing: you confirm you feel a buzz in your usual pain area, and the team checks that your arms or legs are not twitching, which would signal the probe is too close to the wrong nerve. Routine sedation is described here as unnecessary and counterproductive because it removes that feedback loop, and it adds the physiological stress of anesthesia, which can contribute to post-procedure brain fog and slower recovery. In this practice’s view, staying awake is itself a safety mechanism, and the procedure can be performed safely in a physician’s office rather than only in a surgery center.

Earning the procedure: testing before treating

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 is actually coming from. Before offering ablation, this clinic requires you to pass two separate diagnostic medial branch blocks. In each, a tiny amount of local anesthetic is used to numb the suspected nerves. If your pain drops by about 80% for the duration of the anesthetic, that points to the correct pain circuit. The test is repeated a second time specifically to rule out a placebo response. Only after that confirmation is RF considered, so the procedure is aimed at a signal that has actually been identified rather than assumed.

Why your metabolism decides how long relief lasts

Here is the part many patients are not told: RF is a local intervention, but your body is a global system. If the nerve is treated while the body remains inflamed — what this clinic calls being “on fire with meta-inflammation” — pain can return faster and more intensely. Dr. Padda links this to your metabolic terrain: insulin resistance, a diet high in processed carbohydrates and industrial seed oils, and higher HbA1c levels are described as making nerves more excitable and mitochondria less efficient. The practical takeaway is that RF gives you a window in which the pain signal is quiet, and this clinic encourages using that window to move your body, improve sleep, and shift toward real, nutrient-dense food — with low-carbohydrate or ketogenic eating advocated to lower systemic 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 performs RF with you awake rather than sedated, because staying awake allows sensory and motor testing that helps place the probe accurately and safely. Local anesthetic is used to numb the area, and being awake lets you confirm the probe is in the right spot. Individual results vary.

How long does relief from radiofrequency ablation last?

Relief can last many months when the correct nerves are treated with precise imaging guidance, but the procedure interrupts a signal rather than curing the underlying joint. This clinic notes that if body-wide inflammation is not addressed, pain can return sooner, which is why nutrition and metabolic health are emphasized. Individual results vary.

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

This clinic frames RF as buying a window of reduced pain that is best used to improve metabolism, sleep, and movement, and it advocates lowering processed carbohydrates 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.

Where are you located and how do I book?

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

Key takeaways

• RF interrupts the medial branch nerves that carry pain from arthritic facet joints in the back and neck.
• This clinic performs it awake with live imaging so sensory and motor testing can confirm precise, safe probe placement.
• 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, and address the metabolic drivers that affect how long relief lasts.

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

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.

Gurpreet Singh Padda , MD, MBA, MHP