Radiofrequency ablation (RFA) heats the small medial branch nerves that carry pain from the spinal facet joints. These nerves slowly regrow, so relief is usually temporary and its length varies from person to person. At YOUNIFY Clinic, a Healthy Aging & Wellness Center based in Bangkok, Thailand, in Silom, a repeat may be considered when the first RFA helped.
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Contents
Key Takeaways
- RFA uses heat to stop the medial branch nerves carrying facet joint pain, but the nerves regrow, so relief is usually temporary.
- How long relief lasts varies from person to person, and relief often builds over a few weeks.
- Diagnosis with medial branch blocks, technique, the underlying spine condition, and rehabilitation all influence the result.
- When the first RFA clearly helped, a repeat is often possible.
How long does radiofrequency ablation last?
Relief after RFA is usually temporary, and its length varies widely: some people stay comfortable for many months, while others notice their usual pain returning sooner.
Each facet joint, a small paired joint at the back of the spine, sends pain signals through two tiny medial branch nerves. Under X-ray guidance, our pain medicine physician places a thin probe beside them and heats the tip to roughly 75–90 °C. The nerve stops carrying pain signals, but the joint itself is not changed. Over the following months the nerve regrows, and the pain may return. Some people have relief for longer than others.
What affects how long RFA relief lasts?
Four things matter most: an accurate diagnosis, careful technique, the underlying spine condition, and what you do while the relief lasts.
1. Accurate diagnosis. For low back pain, the UK's NICE guidance advises RFA only after a positive diagnostic medial branch block, which is why we test with a block first.
2. Technique. The probe must lie along the nerve at each confirmed level, checked on X-ray.
3. The underlying spine condition. If a disc, a nerve root, the sacroiliac joint, or muscle also contributes, RFA addresses only the facet part.
4. Activity and rehabilitation. Strength, posture, and body weight influence how the spine copes once the nerve regrows.
What happens in the weeks and months after RFA?
Most patients go home the same day, feel sore for a few days, and notice relief building over the following weeks.
| Stage | What is common | What to do |
|---|---|---|
| First days | Soreness at the needle sites, sometimes a short flare of the usual pain or a sunburn-like skin sensitivity | Walk gently, use cold packs, and follow your physician's advice on pain medicine |
| The first few weeks | If RFA works, pain often eases gradually | Keep a pain diary and start the gentle exercises you are given |
| The following months | Relief is usually steadiest | Build strength, adjust posture, and return to activity step by step |
| When pain returns | The usual pain may come back as the nerves regrow | Note the date and pattern, and contact us for a review |
What to do while RFA is working
RFA is designed to open a window with less pain, which is the time to build strength.
1. Walk daily and increase the distance gradually.
2. Follow a guided exercise program for the back, hip, or neck and shoulder muscles.
3. Adjust your chair, screen height, and lifting habits.
NICE also suggests exercise programs for low back pain, and we build exercise into every plan.
Can RFA be repeated?
Yes. RFA can often be repeated when the first treatment gave clear, useful relief and the pain returns in the same place and pattern.
UK guidance notes that the nerve may regenerate with time, requiring a repeat, and that research is still defining how often. Before a repeat, we check how much and how long the first RFA helped, whether the pain has changed, and whether new symptoms or imaging need attention. A changed pattern may call for another diagnostic block. If the first RFA did not help, we look for another pain source instead. For the neck, see radiofrequency ablation for neck pain.
How is pulsed radiofrequency different from RFA?
Pulsed radiofrequency (PRF) delivers short bursts of energy that keep the tissue cooler, so it aims to modulate a nerve rather than create a lesion.
Pulsed radiofrequency keeps the tip below the temperature that creates a heat lesion, so it is designed to calm the nerve rather than destroy it. Because the nerve keeps working, PRF is usually considered for different problems, such as pain spreading down an arm or leg from an irritated nerve root. RFA is used for facet joint pain confirmed by blocks.
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 after a procedure
- Pain after a major fall
- Unexplained weight loss
- New difficulty with balance or fine hand movements
When we may advise against a procedure
We may advise against 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 is being considered alongside the procedure
- The expectation is a lasting fix from RFA alone, without exercise or rehabilitation
Physician perspective
[รอ approve] At our clinic, we explain before the first ablation that the nerves usually grow back, so the question is not whether the pain may return but how we respond when it does. We ask you to note when relief began and when pain started to come back, and we use the months of lower pain to build strength. When pain returns, we examine you again first. If it is the same pain in the same place and the first treatment clearly helped, repeating it is often reasonable. If the pattern has changed, we go back to the diagnosis instead of repeating the procedure by habit.
An illustrative example
Illustrative example, not a real patient: a desk-based professional has lower back pain from two facet joints, confirmed by blocks. After RFA, relief builds over the following weeks, and the months that follow are used for a strength program. Later, the same ache returns in the same place. The physician reviews the diary, re-examines the back, and discusses whether a repeat RFA is suitable.
What happens next
1. Send your MRI or X-ray report, a short history, and any previous RFA dates.
2. Our pain medicine physician reviews it.
3. You receive a written plan and a written quotation.
4. If suitable, the procedure is done at our Silom clinic, a 5-minute walk from BTS Sala Daeng.
5. We follow up on your 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). See our radiofrequency ablation page and chronic pain service.
Frequently Asked Questions
How many months does RFA last?
There is no single answer. Some people are comfortable for many months, while others notice pain returning sooner as the nerves regrow. We ask you to keep a diary, so that your own response, rather than an average, guides the next decision.
Is a repeat RFA as effective as the first one?
When the first RFA gave clear relief and the pain returns in the same pattern, a repeat is designed to work the same way. The response cannot be promised, so we review your first result and examine you again before recommending it.
Do I need another medial branch block before a repeat RFA?
Not always. If the first RFA clearly helped and the pain is in the same place, a repeat may go ahead without a new block. If the pain has moved or changed, another block may be advised to confirm the source.
How much does RFA cost in Bangkok, and does insurance cover it?
At YOUNIFY Clinic, the radiofrequency ablation we offer is cooled radiofrequency ablation (Cooled RFA), starting from THB 280,000. The final price is set by our physicians after a diagnostic nerve block. We prepare a medical report and an itemized receipt for your own insurance claim. See RFA and epidural injection costs.
Can I exercise after RFA?
Yes, gradually. Gentle walking is usually encouraged in the first days, and a guided strength program starts as soreness settles. Heavy lifting and intense sport return step by step, based on how you feel and your physician's advice.
What if RFA did not help at all?
This suggests the treated joints may not be the main source, or that another structure is involved. Repeating the same RFA is rarely sensible. Your physician reviews the diagnosis and considers other sources, such as a disc, a nerve root, or the sacroiliac joint.
References
- 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, 2020.
- Strand NH, et al. Advances in radiofrequency ablation: mechanism of action and technology. Annals of Palliative Medicine, 2024 (DOI 10.21037/apm-23-457).
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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