Facet joint pain comes from the small joints at the back of the spine. A diagnostic medial branch block tests whether these joints are the source by numbing the nerves that carry their pain. At YOUNIFY Clinic, a Healthy Aging & Wellness Center in Silom, Bangkok, people with a clear, temporary response may then be offered Cooled RFA.
Contents
Key Takeaways
- Facet joint pain comes from the small paired joints at the back of the spine and is often worse when leaning back, twisting, or getting up after rest.
- Because scans cannot confirm the source, Cooled RFA, which uses a water-cooled radiofrequency probe on the medial branch nerves, is offered only after a positive diagnostic block.
- Relief after Cooled RFA is temporary because the nerves regrow, its length varies by individual, and the procedure can be repeated when it helped.
- A medial branch block is priced starting from THB 22,000 and Cooled RFA starting from THB 280,000, confirmed in a written quotation.
What is facet joint pain?
Facet joint pain starts in the facet joints, the small paired joints where each vertebra meets the one below it at the back of the spine.
Facet joints are true synovial joints, like a knee or finger joint, and they guide and limit how the spine bends and twists. With wear, posture, or strain, they can become irritated and send pain signals through two tiny nerves at each level, the medial branch nerves.
What are the symptoms of facet joint pain?
Facet joint pain is usually an ache on one or both sides of the spine that is worse with certain movements and after rest.
- Lower back pain that may spread to the buttock, groin, or thigh, usually stopping above the knee
- Neck pain that may spread toward the shoulders or upper back
- Stiffness that is worse in the morning or after sitting still
- Pain that increases when leaning back, twisting, or turning the head
Pain that shoots below the knee or down the arm with numbness or tingling points more toward an irritated nerve root, which is assessed differently.
Why does the diagnostic block come first?
The block comes first because scans cannot show which joint is painful: facet wear on X-ray and MRI is common in people with no pain.
A diagnostic medial branch block is a test that points the way: if numbing the medial branch nerves clearly eases your usual pain for a short time, those joints are likely a key source. For chronic low back pain, UK guidance advises radiofrequency denervation only after a positive diagnostic medial branch block. Some physicians use two blocks on separate days to reduce false-positive results (why we test with a block first).
What does a diagnostic medial branch block involve?
A medial branch block is a short, image-guided injection of a local anesthetic next to the medial branch nerves, and most patients go home the same day.
1. You lie face down, or on your side with the neck supported.
2. The skin is numbed with a local anesthetic.
3. Using fluoroscopy (live X-ray), our pain medicine physician guides a thin needle beside each target nerve and places a small amount of local anesthetic.
4. You rest briefly, test the movements that usually hurt, and record your pain in a diary over the following hours.
The effect is short-lived because the anesthetic wears off. The block is a test, not the final treatment. It is priced starting from THB 22,000.
What is Cooled RFA, and who is it for?
Cooled radiofrequency ablation (Cooled RFA) is a needle-based procedure for people whose facet joint pain has been confirmed by a positive diagnostic medial branch block.
Cooled RFA uses a radiofrequency probe with internal water cooling. This lets the physician create a larger treatment zone around the target nerve than conventional RFA, at a lower tip temperature. The treated medial branch nerves then carry fewer pain signals, while the joint itself is not changed. Some studies report that the rounded treatment zone allows the probe to capture the nerve from a range of angles. Other clinics may offer other forms of radiofrequency treatment; at YOUNIFY Clinic, the option for facet joint pain is Cooled RFA.
Under a local anesthetic, with or without light sedation, our pain medicine physician uses fluoroscopy to place the probe beside each confirmed nerve, checks the position on X-ray, and then delivers the treatment. Most patients go home the same day. Cooled RFA is priced starting from THB 280,000, confirmed in a written quotation after assessment.
Where does a facet joint injection fit?
A facet joint injection places a corticosteroid, to calm inflammation, or prolotherapy, intended to support the body's own repair response, into or around the joint. Whether it suits you is decided after a physician assessment, and it is quoted after that assessment.
| Diagnostic medial branch block | Cooled RFA | Facet joint injection | |
|---|---|---|---|
| Purpose | Test whether the facet joints are the source | Longer-acting relief after a positive block | Treat the joint directly when suitable |
| What is used | Local anesthetic near the medial branch nerves | Water-cooled radiofrequency probe beside the nerves | Corticosteroid or prolotherapy into or around the joint |
| Typical effect | Short-lived | Temporary, as the nerves regrow | Varies by individual |
| Price | Starting from THB 22,000 | Starting from THB 280,000 | Quoted after physician assessment |
All three are guided by fluoroscopy, and most patients go home the same day.
What is recovery like after Cooled RFA?
Most patients go home the same day, feel sore at the needle sites for a few days, and notice relief building gradually rather than straight away.
Some people have a short flare of their usual pain or a sunburn-like skin sensitivity over the treated area. After light sedation, someone should take you home, and you should not drive that day. The period of lower pain is the time to build strength, adjust posture, and return to activity with a guided exercise program.
How long does relief from Cooled RFA last?
Relief is temporary, because the treated nerves slowly regrow, and its length varies from person to person.
In studies, the length of relief differs between people: one retrospective study of Cooled RFA for lower back facet pain reported clear improvement at the 2 to 6 month follow-up, with pain partly returning in some people between 6 and 12 months. When the first treatment clearly helped and the same pain returns, Cooled RFA can be repeated after a review. Research is still defining how often repeat treatment is best.
What are the risks?
Both procedures are minimally invasive, but no procedure is free of risk, and your physician explains the risks that apply to you before you consent.
- Soreness or bruising at the needle sites, or a temporary flare of the usual pain
- Numbness or sensitivity of the skin over the treated area after Cooled RFA
- Uncommon: infection, bleeding, or a reaction to a medicine
- A small dose of X-ray from fluoroscopy
When to see a doctor urgently
Seek emergency care if neck or back pain comes with:
- New weakness in an arm or leg
- Loss of bladder or bowel control
- Numbness in the saddle area
- Fever with back pain, or redness and discharge at a needle site
- Pain after a major fall
- Unexplained weight loss
When we may advise against a procedure
We may advise against a block or Cooled RFA, or suggest waiting, when:
- Blood thinners cannot yet be managed safely
- There is an active infection
- You are pregnant, since X-ray guidance is used
- The pain source is not confirmed by a diagnostic block
- Diabetes is poorly controlled and a corticosteroid injection is being considered
- The expectation is a lasting fix from a procedure alone, without exercise or rehabilitation
Physician perspective
An illustrative example
Illustrative example, not a real patient: an office worker has had lower back pain for many months that is worse when standing up after sitting and when leaning back. An MRI shows wear that is common at this age. A diagnostic medial branch block at two levels brings a clear, short-lived drop in pain. After a review, Cooled RFA is discussed together with a strength program and a follow-up plan.
What happens next
1. Send your MRI or X-ray report and a short history of your pain.
2. Our pain medicine physician reviews it.
3. You receive a written plan and a written quotation.
4. If suitable, the block, and Cooled RFA if the block is positive, are done at our Silom clinic, a 5-minute walk from BTS Sala Daeng.
5. We follow up on your pain diary and exercise program.
Send your imaging and a short history for a physician review by WhatsApp (+66 81 556 9696, https://wa.me/66815569696) or LINE (https://lin.ee/5MIGher). Messages are answered 24 hours a day, the clinic is open daily 11:00–20:00, and interpreters and coordinators are available for every language on our site. See our back pain, neck pain, and chronic pain pages.
Doctors
Dr. Rarinthorn Choomsai Na Ayuthaya
Pain Medicine / Anesthesiologist
Diploma of Pain Medicine
View full profile
Frequently Asked Questions
Why do I need a medial branch block before Cooled RFA?
Scans cannot show which facet joint is causing the pain. The block numbs the medial branch nerves for a short time, and a clear drop in your usual pain suggests those joints are the source. Cooled RFA is offered only after this positive response, so it is aimed at the right target.
What is the difference between Cooled RFA and conventional RFA?
Both use radiofrequency energy on the medial branch nerves. Cooled RFA circulates water inside the probe, which lets the physician create a larger treatment zone at a lower tip temperature. It should not be assumed to work better for everyone. At YOUNIFY Clinic, Cooled RFA is the radiofrequency option we offer for facet joint pain.
Does a medial branch block or Cooled RFA hurt?
The skin is numbed first, and light sedation may be used for Cooled RFA. Many people describe pressure or a brief ache rather than sharp pain, although experiences differ. Soreness at the needle sites for a few days is common.
How much do a medial branch block and Cooled RFA cost in Bangkok, and does insurance cover them?
A diagnostic medial branch block is priced starting from THB 22,000 and Cooled RFA starting from THB 280,000, and a facet joint injection is quoted after physician assessment. Your price is confirmed in a written quotation. We prepare a medical report and an itemized receipt for your own insurance claim.
Can Cooled RFA be repeated if the pain comes back?
Yes, when the first treatment gave clear relief and the same pain returns in the same place. Before a repeat, we examine you again and check whether the pattern has changed. A new pattern may call for another diagnostic block, or a search for a different pain source.
What if the medial branch block does not help?
That is useful information. It suggests the facet joints are not the main source, so Cooled RFA is unlikely to help and is not offered. Your physician then considers other sources, such as a disc, a nerve root, or the sacroiliac joint.
References
- Cascio MA, Dua A, Varacallo MA. Lumbosacral Facet Syndrome. StatPearls, NCBI Bookshelf, updated 2025.
- Low back pain and sciatica in over 16s: assessment and management (NG59). National Institute for Health and Care Excellence (NICE), via NCBI Bookshelf, 2016, updated 2020.
- Lumbar radiofrequency facet joint denervation. Academy of Medical Royal Colleges, Evidence-Based Interventions programme, reviewed 2024.
- Candan B, Gungor S. Cooled-radiofrequency neurotomy for the treatment of chronic lumbar facet (zygapophyseal) joint pain: a retrospective study. Medicine (Baltimore), 2021.
- McCormick ZL, et al. A pragmatic randomized prospective trial of cooled radiofrequency ablation of the medial branch nerves versus facet joint injection of corticosteroid for the treatment of lumbar facet syndrome: 12 month outcomes. Pain Medicine, 2023.
Medical Note
This article is for general information and does not replace medical examination, diagnosis, or treatment. If symptoms are severe, changing quickly, or urgent, seek medical care promptly.
Individual results may vary. Please consult a doctor before treatment.
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