Modal Pain Management · Dr. Alex Movshis, MD
After Radiofrequency Ablation: Recovery, Worse Pain, and When Relief Starts
Questions or problems, any hour: (646) 290-6660. Emergency: call 911 or go to the nearest emergency room.
Full guide:modalpain.com/aftercare/
radiofrequency-ablation/
At a glance
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The day of the ablation
- If you had sedation, have someone drive you home and do not drive for the rest of the day.
- Rest for the rest of the day, but walk around the house. You do not need to stay in bed.
- Ice the treated area for 15 to 20 minutes at a time. No heating pad on skin that is still numb.
- A shower tonight is fine. Skip baths, hot tubs and pools for 24 hours.
- Restart any blood thinner on the schedule you were given. If you are not sure when, call before you take it.
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Days 1 to 14
- Soreness, aching or a sunburn-like burning over the treated area is common and can last a few days to a few weeks.
- Your usual pain medicines, including ibuprofen, are fine unless we told you otherwise.
- Normal daily activity and desk work from the next day or two. Ease back into exercise as the soreness allows.
- After knee ablation, check the skin around the knee and call us about any blister or open sore.
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Weeks 2 to 6
- By about one month you should have a fair sense of whether the ablation is working.
- Note how much of the familiar pain is gone and what you can do now that you could not before.
- Start or continue physical therapy. The ablation makes rehabilitation easier but does not replace it.
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Months later
- The treated nerves grow back, usually after many months. If the pain returns, the ablation can be repeated.
Call 911 or go to the nearest emergency room for
- New weakness in a leg or arm, or weakness that is getting worse
- New numbness in the groin, genitals or inner thighs, or new loss of bladder or bowel control
- Fever or chills with pain at the treated area that is getting worse instead of better
- After knee ablation, a hot, swollen knee with fever, or a painful, swollen calf
- Sudden numbness or weakness of the face, trouble speaking, loss of vision, a severe headache, or a seizure
- Trouble breathing, swelling of the lips or throat, or hives spreading over the body
Call us at (646) 290-6660, day or night, for
- Burning, sunburn-like pain or skin that hurts to touch, still there after 2 weeks or getting worse
- A patch of numbness that bothers you or is spreading
- Dizziness or unsteadiness after neck ablation that is not settling
- A blister, open sore or spreading redness at a needle site
- Knee swelling that is not going down after a few days
- Any question about when to restart a blood thinner
Four days after a lumbar ablation, the low back aches more than it did before the procedure, and a palm-sized patch beside the spine burns like a sunburn when the shirt brushes it. That is the most common reason for a worried call in the first two weeks after radiofrequency ablation, and in most cases it is the procedure doing what it was supposed to do. The heat that disables the nerve also irritates the tissue around it, and the irritation settles before the relief becomes clear.
These are the instructions Dr. Alex Movshis gives after radiofrequency ablation at Modal Pain Management, for the lumbar and cervical facet joints, the sacroiliac joint and the knee. If you had your ablation elsewhere, the course is the same, but follow your own physician’s discharge instructions where they differ.
What the first two weeks feel like, by area
Lower back. Aching beside the spine, often worse when getting up from bed or a chair, for several days. Some people have a patch of skin that feels sunburned, tingles, or is oddly numb. In the Mayo series, there were no infections and no new weakness or loss of feeling in 116 procedures (Kornick 2004).
Neck. Soreness for about a week is the rule (Barnsley 2005). Numbness over the treated area is common and usually harmless: in the landmark randomized trial of cervical ablation, 5 of the 12 actively treated patients had numbness in the treated nerve territory, and none found it troubling (Lord 1996). Ablation of the third occipital nerve, for headaches that start in the upper neck, usually leaves numbness at the back of the scalp, and nearly everyone has mild unsteadiness for a while. Both settle without treatment (Govind 2003). The cervical guideline lists dizziness and unsteadiness among the effects that can last from a few days to a few weeks (Hurley 2022).
Sacroiliac joint. Expect the buttock to be sore for five to ten days (Cohen 2008).
Knee. In a small randomized trial, 59% of patients already had at least half their pain gone at one week, and no one reported an adverse event (Choi 2011). Swelling is the most common nuisance. In a large matched-cohort study, swelling within 30 days followed 9.4% of knee ablations, compared with 6.4% of knee joint injections (Fuqua 2025). At the knee, some of the treated nerves lie close to the skin, and a skin burn has been reported (McCormick 2018). Check the skin for the first few days and call us about any blister.
Neuritis after radiofrequency ablation
A smaller group of patients develops neuritis: a burning or electric pain, often with skin that hurts to light touch, over and around the treated area. It is thought to be irritation of the treated nerve, and it fades. The Mayo series recorded 3 cases of neuritic pain, all settling within two weeks (Kornick 2004).
What helps: anti-inflammatories, if you can take them. In a double-blind trial, a few days of diclofenac lowered pain on day one and day seven after ablation compared with placebo (Ma 2011). If the burning lasts more than two weeks, or is severe enough to keep you up, call us. It usually responds to treatment, and it nearly always fades with time.
How long to rest, and getting back to activity
Rest the day of the procedure, but stay up and about. From the next day or two, go back to normal daily activity and desk work, and let the soreness set the pace for exercise. No study has compared rest schedules after ablation. The lumbar guideline does note that a physical therapy program afterwards may improve outcomes (Cohen 2020), and the reason is practical: ablation takes the pain signal away from the joint, but the strength and movement that protect the spine come from rehabilitation.
Driving. If you had sedation, have someone drive you home and do not drive for the rest of the day. Without sedation, most people can drive themselves home once the numbing medicine has worn off and they can turn their head and brake without hesitation. After neck ablation, do not drive until any dizziness or unsteadiness has settled.
Sleep, ice, heat and showering
Sleep in whatever position keeps the treated area comfortable. For the lower back, many people do best on their side with a pillow between the knees. After neck ablation, use a pillow that keeps the neck level with the rest of the spine.
Ice is the better choice in the first week: 15 to 20 minutes at a time, with a cloth between the ice and the skin. Heat is fine for sore muscles once normal feeling has returned, but never on skin that is still numb, because you cannot feel it burn. Showering is fine the same evening. Wait 24 hours before a bath, hot tub or pool. No study has tested bathing or heat after ablation, so these instructions follow from first principles: a numb patch cannot sense heat, and a needle track is a path for infection.
Blood thinners. Restart on the schedule you were given at discharge. The multisociety guideline sets restart times by drug and procedure risk (Narouze 2018). If you are not sure, call before you take the next dose.
When it starts working, and how long it lasts
No study has measured the day relief begins. The trial data give the shape: relief often starts within the first week or two, sometimes behind the soreness, and most trials judge the result at one to three months. We check formally at the follow-up visit, about four to six weeks after the ablation.
The nerves regrow, so the relief is not permanent. In a systematic review, a first ablation that worked gave at least 50% relief for an average of 9 months in the lower back and 7 to 9 months in the neck (Smuck 2012). Repeat ablation usually works again when the first one did. In one lumbar series, 17 of 20 patients had a successful second ablation, lasting a mean of 11.6 months (Schofferman 2004). In a cervical series, 20 of 21 had a successful second ablation, lasting a mean of 12.7 months (Husted 2008). Ablation of the third occipital nerve lasted a median of 297 days (Govind 2003), and sacroiliac ablation a mean of about six months (Cohen 2008).
The guidelines recommend repeating an ablation only when the previous one gave at least three months of improvement, and no more than twice a year (Cohen 2020, Hurley 2022). The lumbar guideline prefers six months (Cohen 2020). The Medicare coverage policy that applies in New York requires at least 50% improvement in pain, or in the ability to do the movements that hurt, lasting at least six months, and allows at most two ablation sessions per spinal region in a rolling year (CMS L35936).
When to go to the emergency room
Serious complications are rare, which is why they are worth knowing. New weakness in an arm or leg, new numbness in the groin or loss of bladder or bowel control, or fever with pain that is getting worse instead of better are emergencies. So, after knee ablation, are a hot, swollen knee with fever or a painful, swollen calf. For any of these, call 911 or go to the nearest emergency room, and tell the team you had a radiofrequency ablation and on what date.
The radiofrequency ablation page explains who the procedure is for and how the diagnostic blocks before it work. The medial branch block aftercare page has the pain diary used to decide whether ablation is the right next step.
Frequently asked questions
The rest of the procedure day. Walk around the house that evening, go back to normal daily activity and desk work over the next day or two, and ease back into exercise as the soreness allows. No study has compared rest schedules after ablation. The soreness, not the nerve, sets the pace.
Usually a few weeks, and the first one or two are often the worst. No study has measured onset directly, but the trial data give the shape: in the knee, 59% of patients already had at least half their pain gone at one week (Choi 2011), while after sacroiliac ablation most patients felt worse for five to ten days before improving (Cohen 2008). Most trials judge the result at one to three months, and we check formally at the follow-up visit four to six weeks after the ablation.
In whatever position keeps the treated area comfortable. After lumbar ablation, many people do best on their side with a pillow between the knees. After neck ablation, use a pillow that keeps the neck level, and if the back of the scalp is numb or sore, lie with that side up. After knee ablation, a pillow under the knee or between the knees. Icing for 15 to 20 minutes before bed helps in the first week.
Walking from day one. Gym work, running and sport when the soreness allows, usually within one to two weeks. There is no evidence that exercise harms the result, and the lumbar guideline notes that physical therapy after ablation may improve outcomes (Cohen 2020).
The medial branch nerves supply the back muscles and joints, not the leg, so new leg pain is not an expected effect of lumbar facet ablation. Leg pain that was there before is usually a separate problem, often a pinched nerve root. New leg numbness or weakness that is getting worse is an emergency. New leg pain that is not getting worse needs a call.
Then the question is why. The common answers are that the facet joints were not the source to begin with, which a single diagnostic block cannot rule out (Schwarzer 1994), that a second source such as the sacroiliac joint or a nerve root is driving the pain, or that the lesion did not capture the nerve. The lumbar guideline notes that the large MINT trials, which found little benefit, were widely criticized for their needle technique (Cohen 2020). A careful second look usually finds which it is.
References
Every figure on this page comes from the sources below. Where no study exists, the page says so and explains the reasoning instead.
- Cohen SP, Bhaskar A, Bhatia A, et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Reg Anesth Pain Med. 2020. doi:10.1136/rapm-2019-101243 · PubMed
- Hurley RW, Adams MCB, Barad M, et al. Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group. Reg Anesth Pain Med. 2022. doi:10.1136/rapm-2021-103031 · PubMed
- Kornick C, Kramarich SS, Lamer TJ, et al. Complications of lumbar facet radiofrequency denervation. Spine. 2004. doi:10.1097/01.brs.0000128263.67291.a0 · PubMed
- Lord SM, Barnsley L, Wallis BJ, et al. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med. 1996. doi:10.1056/NEJM199612053352302 · PubMed
- Barnsley L. Percutaneous radiofrequency neurotomy for chronic neck pain: outcomes in a series of consecutive patients. Pain Med. 2005. doi:10.1111/j.1526-4637.2005.00047.x · PubMed
- Govind J, King W, Bailey B, et al. Radiofrequency neurotomy for the treatment of third occipital headache. J Neurol Neurosurg Psychiatry. 2003. doi:10.1136/jnnp.74.1.88 · PubMed
- Ma K, Yiqun M, Wu T, et al. Efficacy of diclofenac sodium in pain relief after conventional radiofrequency denervation for chronic facet joint pain: a double-blind randomized controlled trial. Pain Med. 2011. doi:10.1111/j.1526-4637.2010.00978.x · PubMed
- Cohen SP, Hurley RW, Buckenmaier CC, et al. Randomized placebo-controlled study evaluating lateral branch radiofrequency denervation for sacroiliac joint pain. Anesthesiology. 2008. doi:10.1097/ALN.0b013e31817f4c7c · PubMed
- Choi WJ, Hwang SJ, Song JG, et al. Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial. Pain. 2011. doi:10.1016/j.pain.2010.09.029 · PubMed
- Fuqua A, Premkumar A, Jayaram P, et al. Complications and opioid-prescribing patterns following genicular nerve radiofrequency ablation versus intra-articular injection: a matched cohort study. Reg Anesth Pain Med. 2025. doi:10.1136/rapm-2023-105053 · PubMed
- McCormick ZL, Walega DR. Third-degree skin burn from conventional radiofrequency ablation of the inferiomedial genicular nerve. Pain Med. 2018. doi:10.1093/pm/pnx204 · PubMed
- Smuck M, Crisostomo RA, Trivedi K, et al. Success of initial and repeated medial branch neurotomy for zygapophysial joint pain: a systematic review. PM R. 2012. doi:10.1016/j.pmrj.2012.06.007 · PubMed
- Schofferman J, Kine G. Effectiveness of repeated radiofrequency neurotomy for lumbar facet pain. Spine. 2004. doi:10.1097/01.brs.0000143170.47345.44 · PubMed
- Husted DS, Orton D, Schofferman J, et al. Effectiveness of repeated radiofrequency neurotomy for cervical facet joint pain. J Spinal Disord Tech. 2008. doi:10.1097/BSD.0b013e318158971f · PubMed
- Schwarzer AC, Aprill CN, Derby R, et al. The false-positive rate of uncontrolled diagnostic blocks of the lumbar zygapophysial joints. Pain. 1994. doi:10.1016/0304-3959(94)90199-6 · PubMed
- Narouze S, Benzon HT, Provenzano D, et al. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications (second edition). Reg Anesth Pain Med. 2018. doi:10.1097/AAP.0000000000000700 · PubMed
- Wellpoint Federal (Medicare Administrative Contractor). Local Coverage Determination L35936: Facet Joint Interventions for Pain Management. CMS Medicare Coverage Database. 2026. Source
These are general instructions after a radiofrequency ablation. If the instructions you were given at discharge differ, follow the ones you were given, because they account for your medications and your procedure. For anything you are unsure about, call (646) 290-6660. See the radiofrequency ablation page for how the procedure works and who it helps, or the aftercare instructions for other procedures.