Radiofrequency ablation (RFA) is a procedure aiming to shrink the sizes of nodules and tumors or treat pain. RFA is not a cure-all solution, however. Back pain may not go away after RFA or may come back.

RFA is a nonsurgical pain management procedure in which a doctor uses radio waves to heat and destroy tissue near a targeted nerve. This can prevent the nerve from sending pain signals to the brain.

Doctors can use RFA to reduce chronic low back pain in the facet joints or sacroiliac joints. These are joints near the spine that provide stability and flexibility but can also cause low back pain.

RFA is a low risk, minimally invasive outpatient procedure and does not usually require anesthesia. However, the procedure can have side effects and complications, and it does not always lead to successful or permanent pain relief.

This article will explore why RFA may not reduce back pain as intended and what complications might result from the procedure.

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There are various reasons back pain symptoms may not improve, even after RFA:

  • Inaccurate diagnosis: An inaccurate diagnosis of lumbar facet joint (FJ) pain is a main cause of unsuccessful RFA procedures. The authors of a 2018 review describe lumbar FJ pain as “a misunderstood, misdiagnosed, and improperly treated pathology.”
  • Discrepancies in the procedure’s effectiveness: Some research has found that RFA leads to significant, lasting improvements in pain and function, while other research suggests that RFA may not be beneficial. One study went so far as to avoid RFA for low back FJ pain.
  • Inconsistencies in patient selection and clinical guidelines: This discrepancy around RFA effectiveness centers on the inconsistency of rigorous patient selection and adherence to clinical practice guidelines. This inconsistency can lead to an inaccurate diagnosis of lumbar FJ pain before the procedure.
  • Not enough time: The full effects of RFA may not be evident until several weeks or months after the procedure.
  • Excessively high expectations: RFA rarely eliminates pain entirely. RFA is successful if the pain diminishes by 50%, and some doctors lower the success threshold to 30%. Also, pain relief usually does not kick in for about 10 days and may take up to 3 weeks to begin.
  • Co-occurring conditions: Other physical or neurological conditions may contribute to the pain.
  • Varying results: The results of RFA procedures vary, as do the measurements of the procedure’s outcomes. Research shows that some people experience no relief, while for others, pain returns within a few months.
  • Compromised standard of care: Research reports that diminished RFA results stem from the significant number of doctors who do not follow standard practice and lack pain fellowship training or current pain medication board certification.
  • Temporary pain relief: Even with a successful RFA procedure, pain relief may be only temporary. On average, pain relief begins within 10 days and lasts 6–12 months. If the treated nerve regrows, the pain can return.

An accurate lumbar FJ pain diagnosis is essential to clarify that facet joints cause pain. Since FJ degeneration, or facet arthropathy, is the main cause of the lower back pain that RFA may treat, an RFA procedure is likely to succeed only if a diagnosis pinpoints facet joints as the cause of pain.

Issues with initial diagnosis

While doctors may use imaging tests to supplement an FJ pathology diagnosis, there are no definitive tests or physical examinations. Doctors rely on anesthetic nerve block procedures for an FJ diagnosis.

If a nerve block succeeds in numbing the pain, RFA is likely to help too. This is a “positive” result of a nerve block test. Some doctors require two positive nerve blocks before they consider a person a good candidate for RFA.

But false positive results of nerve blocks are common and can lead to inaccurate diagnoses of lumbar FJ pain. These inaccurate diagnoses, in turn, lead to RFA procedures that do not relieve a person’s low back pain because FJ pain was not the cause in the first place.

Consulting a doctor who has experience treating spinal disorders is a good step toward getting an accurate diagnosis.

The number of RFA procedures has surged since the procedure’s introduction in 1975, increasing more than 130% from 2007 to 2016.

However, RFA is controversial. Researchers disagree on almost everything about it, including diagnostic criteria, standards of care, effectiveness, and who the best candidates are.

RFA can have the following benefits:

  • It is generally safe and effective, with few side effects and complications.
  • It treats the common problem of low back pain resulting from lumbar FJ pathology. Experts believe this is the cause of chronic lower back pain for 15% of all adults with low back pain and up to 90% of older adults.
  • Doctors generally use RFA after other methods — such as medication, nerve blocks, and physical therapy — have not been successful. They may sometimes use it as a last resort after failed back surgery.
  • It provides pain relief for 6–12 months and sometimes permanently.
  • It can also help:
    • improve function
    • reduce the need for pain medication
    • avoid or delay surgery

Read more about RFA for back pain.

Most people have limited side effects from the procedure. These might include temporary soreness and minor bruising, weakness, or redness that usually subsides within several days but can last up to 2 weeks.

Doctors recommend that people rest and avoid strenuous activity for the first 24 hours after the procedure.

Rarely, more serious complications can arise, including:

  • infection at the insertion site
  • excessive bleeding
  • nerve damage

If the following symptoms occur after an RFA procedure, a person should consult the medical team that performed the procedure or go to the emergency room. These symptoms could indicate a medical emergency that needs immediate evaluation:

  • severe pain at the injection site
  • increasing swelling and redness
  • continued leg weakness or numbness

A doctor will advise a person on follow-up care. A person will usually need to take the following precautions:

  • Do not drive for 24 hours: Do not drive, operate heavy machinery, or engage in any strenuous activity for at least 24 hours after the procedure.
  • Get assistance walking, if necessary: Some people have leg numbness for several hours after the procedure. Until then, a person should have assistance while walking.
  • Take showers instead of baths: Do not take a bath for 1–2 days after the procedure.
  • Rest and apply ice: A person may have mild back pain for up to several days. Apply ice the first day and moist heat thereafter while the pain lasts. Over-the-counter pain medications, with medical approval, may also help.

Reported success rates of RFA procedures vary widely. Some research reports a success rate of 45–55%, but other research reports minimal pain reduction from RFA.

Given this wide range of reported RFA effectiveness, it is not surprising that lower back pain does not resolve for some people after the procedure. Doctors generally advise waiting several months to judge the full scope of improvement.

After that, if there is little improvement, doctors may recommend the following options:

  • Repeat the procedure: If the pain lessens at first but returns a few months later, repeating the procedure may help.
  • Manage pain: A pain management specialist can design a treatment plan for lingering pain.
  • Treat an underlying injury: If the pain is due to injury, healthcare professionals may be able to treat the underlying cause to give a person lasting pain relief.
  • Consider alternative treatments: Pain management techniques such as percutaneous peripheral nerve stimulation and acupuncture may help with lingering pain.
  • Ask for a surgical evaluation: A orthopedic spine surgeon can evaluate whether surgery may further reduce back pain.

Learn about home remedies for back pain.

Radiofrequency ablation (RFA) is a minimally invasive pain management procedure in which a medical team uses radio waves to destroy targeted nerves. The goal is to prevent the nerves from sending pain signals to the brain.

Results of RFA for low back pain vary widely. Many people experience improvements in pain and function for anywhere from several months to several years or even permanently. However, others experience minimal pain relief. Sometimes, pain may even increase after the procedure.

Side effects and complications — such as serious bleeding, infections, or nerve damage — can occur but are rare. People usually tolerate the procedure well, and the recovery period may last several days to a few weeks.