Cooled radiofrequency ablation (Cooled RFA) is designed to interrupt the small medial branch nerves that carry pain from the facet joints of the neck. At YOUNIFY Clinic, a Healthy Aging & Wellness Center based in Silom, Bangkok, Thailand, it follows a diagnostic block that confirms the source. Relief is temporary because nerves regrow, and its length varies.
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Key Takeaways
- Cooled RFA is designed to interrupt the medial branch nerves that carry facet joint pain, without surgery.
- A diagnostic medial branch block comes first, and Cooled RFA is considered only when that block clearly eases your usual pain.
- The procedure is image-guided and needle-only, and most patients go home the same day.
- Relief is temporary because nerves regrow, and the procedure can be repeated when it helped.
- Cooled RFA starts from THB 280,000 and a diagnostic block from THB 22,000.
What is facet joint neck pain?
Facet joint neck pain comes from the small paired joints at the back of the cervical spine, and it often feels like a deep ache that is worse when you look up or turn your head.
With age, injury, or years of looking down at screens, these joints can become worn and irritated. They send pain signals through tiny nerves called medial branches, and the ache may spread to the back of the head or the shoulders. Pain that runs down the arm with numbness or weakness points more toward a nerve root, which needs a different approach.
Who may be a candidate for Cooled RFA?
Cooled RFA may suit adults whose neck pain has lasted for months, has not settled with conservative care, and eases clearly after a diagnostic medial branch block.
Physical therapy, posture changes, and medication usually come first. Our pain medicine physician reviews your history, examines your neck, and studies your imaging before suggesting any procedure. Cooled RFA is not intended for pain caused mainly by a compressed nerve root, pressure on the spinal cord, or an unstable spine.
Why does a diagnostic block come first?
A diagnostic medial branch block tests whether the facet joints are truly the source of your pain before any nerve is treated.
Facet joint pain does not always show clearly on an MRI or X-ray. Under X-ray guidance, our physician places a small amount of local anesthetic beside the target nerves, and you keep a short pain diary. If your usual pain eases clearly while the anesthetic works, Cooled RFA can be discussed. If it does not, the result still helps, because it points the search elsewhere. For the lower back, UK guidance from NICE advises radiofrequency treatment only after a positive diagnostic medial branch block, and we apply the same principle to the neck. See why we test with a block before RFA.
What is Cooled RFA, and how is it different?
Cooled RFA uses a radiofrequency probe with internal water cooling, which lets the physician create a larger treatment zone around the target nerve than conventional RFA at a lower tip temperature.
The aim is to stop the medial branch nerve from carrying pain signals, while the joint itself is left in place. Other clinics may offer conventional radiofrequency ablation, while at YOUNIFY Clinic the radiofrequency option is Cooled RFA only. We do not describe it as better or longer-lasting than other methods, and your physician explains what current evidence does and does not show.
What happens on the day?
Cooled RFA is done under local anesthetic, with light sedation if needed, and most patients go home the same day.
1. We confirm your consent, your medicines, and your plan for any blood thinners.
2. The skin is numbed, and under fluoroscopy (live X-ray) our physician guides a fine needle to each target nerve.
3. The position is checked on X-ray and may be tested with a small electrical signal.
4. The water-cooled probe delivers radiofrequency energy at each confirmed level.
5. You rest while we observe you, then go home with an adult companion, without driving that day.
What is recovery like, and what are the risks?
Most patients feel sore for a few days, and relief, when it comes, often builds over the following weeks.
Common short-term effects include soreness at the needle sites, a temporary flare of the usual pain, and skin that feels numb or sensitive like sunburn. Less common risks include bleeding, infection, burning nerve irritation for a period, and brief unsteadiness after upper neck levels. Serious nerve or spinal cord injury is rare, and X-ray guidance is used to reduce that risk. Once soreness settles, a guided exercise program helps you build strength, improve posture, and restore movement.
How long does relief last?
Relief is temporary, because the treated nerves regrow over time, and how long it lasts varies from person to person.
UK guidance notes that treated nerves may regenerate with time, so the procedure may need repeating. When Cooled RFA clearly helped and the same pain returns in the same place, a repeat can be considered after a new examination. If the pattern has changed, we return to the diagnosis instead.
Which neck and back procedures does YOUNIFY offer?
Cooled RFA is one of six image-guided, needle-only spine procedures at YOUNIFY Clinic, and the right one depends on where the pain comes from.
| Procedure | Main use | Price |
|---|---|---|
| Diagnostic medial branch block (MBB) | Tests whether facet joints cause the pain | Starting from THB 22,000 |
| Cooled radiofrequency ablation (Cooled RFA) | Facet joint pain confirmed by a block | Starting from THB 280,000 |
| Facet joint injection (steroid or prolotherapy) | Medicine placed at an irritated facet joint | Quoted after physician assessment |
| Epidural steroid injection (ESI) | Arm or leg pain from an inflamed nerve root | Starting from THB 129,000 |
| Selective nerve root injection | Pain from one specific nerve root | Quoted after physician assessment |
| Epidural balloon neuroplasty | Persistent nerve pain with suspected scar tissue | Starting from THB 170,000, including a one-day hospital stay and basic blood tests |
After epidural balloon neuroplasty, most patients can fly home 3 to 5 days after the procedure.
When to see a doctor urgently
Seek emergency care if neck pain comes with:
- New weakness in an arm or leg
- Loss of bladder or bowel control
- Numbness in the saddle area
- Fever, or redness and discharge at a needle site
- Pain after a major fall
- Unexplained weight loss
- New trouble with balance or fine hand movements
When we may advise against a procedure
We may advise against 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 is being considered
- A pacemaker or other implanted device has not been reviewed
- The expectation is a lasting fix without exercise or rehabilitation
Physician perspective
An illustrative example
Illustrative example, not a real patient: an office worker has a deep ache on one side of the neck that spreads to the back of the head and worsens when turning to reverse the car. Imaging shows facet joint wear, and a diagnostic block clearly eases the usual pain while it works. After Cooled RFA, the neck is sore for some days, and the following weeks are used for guided exercise.
What happens next
1. Send your MRI or X-ray report and a short history of your neck pain.
2. Our pain medicine physician reviews it.
3. You receive a written plan and a written quotation.
4. If suitable, the block and later Cooled RFA are done at our Silom clinic, a 5-minute walk from BTS Sala Daeng.
5. We follow up on your recovery, pain diary, and exercise program.
Interpreters and coordinators support every language on our website, online messages are answered 24 hours a day, and the clinic is open daily from 11:00 to 20:00. Send your imaging for a physician review by WhatsApp (+66 81 556 9696, https://wa.me/66815569696) or LINE (https://lin.ee/5MIGher), or visit our neck pain service and chronic pain service.
Doctors
Dr. Rarinthorn Choomsai Na Ayuthaya
Pain Medicine / Anesthesiologist
Diploma of Pain Medicine
View full profile
Frequently Asked Questions
Is Cooled RFA better than conventional RFA?
We do not describe it that way. Cooled RFA uses internal water cooling so the physician can create a larger treatment zone at a lower tip temperature, which is how it is designed to work. Whether that makes a difference for you cannot be promised, and your physician explains the current evidence before you decide.
Does Cooled RFA for the neck hurt?
The skin is numbed with local anesthetic, and light sedation can be added if needed. Most patients feel pressure and some discomfort during needle placement rather than sharp pain. Soreness for a few days afterward is common and usually settles with rest, cold packs, and the pain medicine your physician advises.
Do I always need a medial branch block first?
Before a first Cooled RFA, yes, because the block confirms that the facet joints carry your pain. Before a repeat, a new block may not be needed if the first Cooled RFA clearly helped and the pain is unchanged, but your physician decides after examining you again.
How much does Cooled RFA cost in Bangkok, and does insurance cover it?
At YOUNIFY Clinic, Cooled RFA starts from THB 280,000 and a diagnostic medial branch block starts from THB 22,000, confirmed in a written quotation after physician review. Coverage depends on your own policy, and we prepare a medical report and an itemized receipt for your claim. See Cooled RFA and ESI costs.
Can Cooled RFA replace neck surgery?
They address different problems. Cooled RFA is designed for pain from the facet joints, while surgery is considered for a compressed nerve root or spinal cord, instability, or progressive weakness. Our physician explains which path fits your findings, and says so when a surgical opinion is the right next step.
Can I travel to Bangkok for Cooled RFA from abroad?
Yes. You can send your imaging first, so that our physician can review it before you travel. The diagnostic block and Cooled RFA are done on separate days, so your written plan lists the visits you need. Interpreters and coordinators support every language on our website, and online messages are answered 24 hours a day.
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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