Chronic back pain can drain the joy from simple things. A walk on the Long Beach boardwalk, a day trip with family, kneeling in the garden, or playing with kids or grandkids can start to feel out of reach when every step sends a sharp reminder through your spine. Many people try rest, pills, and basic therapy and still feel stuck.
Radiofrequency ablation for chronic back pain is one option that can help when other treatments have not been enough. It is a minimally invasive procedure that targets the nerves that carry pain from worn or irritated joints in the spine. Relief can last months or even longer, without relying on daily narcotic medication.
At our Long Island pain practice, led by board-certified anesthesiologist and pain medicine specialist Dr. Edward Rubin, we focus on advanced, largely non-narcotic treatments tailored to each person. Here, we will explain what radiofrequency ablation is, who it may help, what to expect before and after the procedure, and how to know if it might be the right next step for your back pain.
How Radiofrequency Ablation Targets Back Pain at Its Source
Radiofrequency ablation, often shortened to RFA, is a procedure that uses carefully controlled heat from radiofrequency energy to interrupt pain signals coming from certain small nerves in the spine. These nerves do not control strength or movement. Their main job is to carry pain messages from joints in the back to the brain.
Most often, RFA is used to treat pain coming from:
- Facet joints, the small joints along the back of the spine that can develop arthritis
- Sacroiliac joints, where the spine connects to the pelvis
When these joints are irritated, they can cause aching or sharp pain in the lower back, buttocks, or even into the upper legs. By treating the tiny branches of nerves that send pain from these joints, RFA aims to reduce the signal at its source while leaving the rest of your back structure alone.
RFA fits into a modern, non-narcotic pain plan. It is usually combined with:
- Targeted physical therapy
- Guided exercise and stretching
- Posture and body mechanics training
- Lifestyle changes like weight management and core strengthening
Many people worry that RFA will burn or damage the spine. That is not what happens. The heat is focused on very small, specific nerve branches. The bone, discs, muscles, and main nerves that control movement are not the targets.
The procedure is done in an outpatient setting. We use imaging, usually fluoroscopy (a type of X-ray), to guide the needle to the exact spot. A local anesthetic numbs the skin, and when appropriate, light sedation can help you relax during the procedure.
Who Is a Good Candidate for Radiofrequency Ablation
RFA is not the first step in treating back pain. It is usually considered for people with pain that has lasted more than three to six months and has not responded well enough to other care.
You may be a possible candidate if:
- You have chronic low back pain, especially made worse by bending or twisting
- Your doctor suspects arthritis of the facet joints or sacroiliac joints
- You have tried medications, physical therapy, or other conservative care without lasting relief
Before RFA, most patients have diagnostic injections called medial branch blocks or sacroiliac joint nerve blocks. In these, a small amount of numbing medicine is placed around the suspected pain nerves. If your pain eases for the short time that the numbing medicine is active, that suggests those nerves are a good target for radiofrequency ablation for chronic back pain.
There are also reasons why RFA may not be right for someone. These can include:
- Uncontrolled bleeding problems or use of certain blood thinners that cannot be safely held
- Some implanted electrical devices that may be affected by radiofrequency energy
- Active infection
- Back pain mainly from a large disc herniation pressing on a major nerve or from clear spinal instability
Dr. Rubin performs a detailed evaluation, including your medical history, a physical exam, and review of any imaging studies, to see if the source of your pain matches what RFA is designed to treat.
Step-by-Step: What to Expect Before, During, and After RFA
Knowing what will happen can make the procedure feel less stressful.
Before the procedure, we:
- Review your medical history, including any heart or lung issues
- Look over your current medications, especially blood thinners and diabetes drugs
- Explain the procedure, possible benefits, and limits
- Give clear instructions on eating, drinking, and whether you will need a driver
During the procedure, you are usually awake but comfortable. Here is how it typically goes:
- You check in and change into a gown, and we connect you to monitors for heart rate, blood pressure, and oxygen
- You lie on an X-ray table, most often face down for lower back treatment
- We clean the skin and numb the area with a local anesthetic, which may sting for a few seconds
- Using X-ray guidance, we place a thin RFA needle near the target nerve
- We may send a small test signal through the needle to confirm location. You might feel a brief tapping or buzzing sensation
- Once the position is confirmed, we numb the deeper tissue, then apply controlled heat for a set time to treat the nerve
Immediately after the procedure, most people:
- Rest in a recovery area for a short time
- May feel temporary soreness, warmth, or bruising at the sites
- Can usually walk out on their own and go home the same day
You can often return to light activities that day or the next, as long as you follow instructions. Heavy lifting and intense exercise are usually delayed for a short period.
In the short-term recovery period, it may take several days to a few weeks to feel the full benefit. Some people notice a brief increase in pain, sometimes called a flare, as the tissues settle and heal. We talk with you about how to manage this and set up follow-up visits to check on your progress and adjust your overall plan.
How Long Relief Lasts and What Results You Can Expect
The nerve branches treated with RFA do not disappear forever. Over time, they can grow back. Because of this slow regrowth, relief can often last from many months up to a year or longer. Some patients experience meaningful improvement for even more extended periods.
Results vary, but many people report:
- Less daily back pain
- Better ability to walk, stand, or sit
- Improved sleep
- Less need for certain pain medicines
No procedure helps every person, and RFA is not a cure for arthritis or other spine changes. It is a way to reduce the pain signals so you can move better and build strength with therapy and exercise.
If your pain returns and your doctor again confirms that the same nerves are the source, RFA can often be repeated. Repeat procedures may give similar relief, and for some, the benefit lasts even longer the next time.
Radiofrequency ablation has been used for spine-related pain for many years and is generally considered a safe procedure when done by an experienced, board-certified pain medicine specialist. Serious complications are rare. As with any procedure, we discuss possible risks, such as infection, bleeding, temporary numbness, or discomfort at the treatment site, so you can make an informed choice.
Take the Next Step Toward Summer Without Constant Back Pain
Chronic back pain does not have to control your plans or keep you off the boardwalk, out of the garden, or away from family activities. For the right person, radiofrequency ablation for chronic back pain can be an important piece of a larger, non-narcotic strategy to restore movement and comfort.
At the Long Island practice of Dr. Edward Rubin, our goal is to understand where your pain is coming from and match you with the safest, most appropriate interventional options. RFA is only one tool, but for many, it offers a chance at longer-lasting relief and a more active life, this summer and beyond.
Take Control of Your Chronic Back Pain
If chronic back pain is limiting your everyday life, a proper evaluation can determine whether radiofrequency ablation for chronic back pain is right for you. Dr. Edward Rubin sees patients from throughout Nassau County, Queens, and Long Island at our Garden City and New Hyde Park offices, taking the time to understand your symptoms, review your history, and tailor a non-narcotic treatment plan to your needs. Call us at 516-492-3100 or text 516-206-0774 to schedule a consultation — same-week appointments are often available for new patients.
Written by Dr. Edward Rubin, MD, board-certified in Pain Medicine and Anesthesiology, with fellowship training at Cornell, Columbia, Hospital for Special Surgery, and Memorial Sloan Kettering. Dr. Rubin has been treating chronic pain patients on Long Island for over 20 years.
