At Modal Pain Management NYC, Dr. Alex Movshis specializes in radiofrequency ablation (RFA) as a cornerstone of non-surgical interventional pain management. Radiofrequency ablation is an advanced, minimally invasive procedure that uses carefully controlled heat to create a precise lesion on nerve fibers responsible for transmitting chronic pain signals. Unlike oral medications or temporary nerve blocks, RFA can give relief that, in people who respond, usually lasts 7 to 9 months (Smuck 2012) and longer in some series (MacVicar 2013). For patients in the NYC area suffering from chronic back pain, neck pain, or joint pain who have not found adequate relief through conservative treatments, radiofrequency ablation is an established option that can meaningfully improve quality of life while avoiding the risks and recovery period associated with surgery.
How Radiofrequency Ablation Works
Radiofrequency ablation operates on a sophisticated principle of thermal nerve lesioning. During the procedure, a specialized needle electrode is precisely positioned adjacent to the target nerve using real-time fluoroscopic guidance—a form of live X-ray imaging that allows Dr. Movshis to visualize the anatomy in detail. Once the electrode is correctly positioned, radiofrequency energy is delivered through the needle, generating controlled heat. The tip of the probe is heated to about 80 to 90°C for one to three minutes (Cohen 2020). This heat creates a small lesion that disrupts the nerve’s ability to transmit pain signals to the brain. The procedure does not destroy the nerve permanently. Over time the treated nerve can heal, and that is the most likely reason pain sometimes returns. Exactly how long that takes is not known, which is one reason relief varies so much from person to person (Cohen 2020). If pain returns, the procedure can be repeated. Serious complications are uncommon when it is performed under fluoroscopic guidance (Kornick 2004).
Conditions Treated with RFA
Radiofrequency ablation works best when pain travels along a specific, known nerve pathway. Facet joint pain, from the small joints along the spine, is its most studied use, because the pain signals travel through medial branch nerves that can be targeted precisely. Sacroiliac joint pain, another common source of lower back and buttock discomfort, similarly benefits from ablating the nerves that supply this joint — performed as a dedicated SI joint radiofrequency ablation targeting the L5 dorsal ramus and S1–S3 lateral branches. Chronic back pain and neck pain resulting from facet joint osteoarthritis are among the most frequently treated conditions at our NYC practice. Some painful peripheral nerves, such as the occipital nerves in occipital neuralgia, are treated with pulsed radiofrequency (PRF) instead, a related technique that calms the nerve without destroying it. The key to success is good evidence that the pain really comes from the nerve being targeted, which is tested with a diagnostic block before any ablation.
The Diagnostic Process
Before performing radiofrequency ablation, Dr. Movshis uses a carefully structured diagnostic approach to test whether the targeted nerve is likely responsible for the patient’s pain. This begins with a medial branch block—a diagnostic injection of local anesthetic placed directly around the suspected pain-transmitting nerve. If this injection provides significant pain relief, even temporarily, it supports the nerve as the source of the pain. A positive block raises the odds that RFA will help, but it is not a guarantee. How strictly patients are selected changes the odds. In a randomized comparison, ablation succeeded in 64% of patients selected with two blocks and 39% of those selected with one (Cohen et al., 2010). Stricter testing also screens out some people who would have done well, and a 2020 guideline from about a dozen pain societies recommends a single block, with at least 50% relief counted as positive (Cohen 2020). At Modal Pain Management NYC, every patient has two blocks first, lidocaine then bupivacaine, and goes on to facet ablation only if both relieve at least 80% of the usual pain.
What to Expect During the Procedure
The radiofrequency ablation procedure is performed in our fluoroscopy-equipped interventional suite with local anesthetic and usually no sedation, which keeps the patient comfortable while alert enough to communicate with Dr. Movshis about any unusual sensations. After the skin is cleaned and numbed with local anesthetic, the fluoroscope guides the placement of the radiofrequency needle to the precise location of the target nerve. Once proper positioning is confirmed through imaging, sensory and motor stimulation tests may be performed to ensure the needle is at the correct anatomical site. The radiofrequency energy is then applied continuously, typically for one to three minutes per lesion. Patients may feel a mild warming sensation during this time, but the local anesthetic prevents significant discomfort. The entire procedure usually takes 30 to 45 minutes from start to finish. After the procedure, patients are monitored briefly in recovery before being discharged home with post-operative instructions and pain management guidance.
Effectiveness and Duration of Relief
How well radiofrequency ablation works depends on who is selected and how the procedure is done, and the trials do not all agree.
The supportive evidence comes mostly from studies that chose patients carefully. In a double-blind trial of 24 people with neck pain after whiplash, selected with placebo-controlled blocks, pain took a median of 263 days to climb back to half its original level after real RFA, against 8 days after a sham procedure (Lord 1996). Two other small sham-controlled trials in the low back, of 31 and 40 patients, also favored RFA (van Kleef 1999, Nath 2008). In a prospective audit of just 15 patients selected by controlled blocks, about 60% still had at least 90% relief at 12 months (Dreyfuss et al., 2000).
Outside those trials the numbers are more modest. In carefully selected patients, about half to two-thirds report at least 50% less pain six months to two years after lumbar RFA (Conger 2020, Schneider 2020). Looser selection and older techniques give lower rates. In people who respond, relief after a first lumbar treatment lasts about 9 months on average (Smuck 2012). In a New Zealand series of strictly selected patients it lasted a median of 15 months, and patients who had repeat treatments as needed kept relief for a median of 17 to 33 months (MacVicar et al., 2013).
The negative evidence is just as real. In the Dutch MINT trial, adding RFA to an exercise program did no better than exercise alone at 3 months in 251 people with facet-type back pain (Juch et al., 2017). That trial was pragmatic and unblinded, with no sham procedure. In 2025, a BMJ guideline panel reviewed the randomized trials and made a strong recommendation against joint RFA for chronic axial back and neck pain (Busse 2025). A 2026 meta-analysis of 55 randomized trials in chronic low back pain found small improvements in pain and function over sham, none large enough to pass the authors’ preset threshold for a difference patients would notice (Truong 2026). The gap between those reviews and the carefully selected studies above is genuine, and Dr. Movshis will go through it with you before you decide.
That is why we test carefully before offering RFA, and why we tell patients plainly that it does not work for everyone. When it does work and the pain later returns, the procedure can be repeated. If the first RFA helped, a repeat usually helps again and lasts about as long (Smuck 2012, Schofferman 2004).
Recovery and Follow-Up
Most patients go home the same day, rest that evening, and resume normal activities within 24 to 48 hours. Soreness, and sometimes a sunburn-like burning over the treated area, can last from a few days to a few weeks, and the relief usually becomes clear after that. Dr. Movshis assesses the result at a follow-up visit four to six weeks after the procedure. If pain returns as the treated nerves recover, the ablation can be repeated. The full recovery instructions, including neuritis, sleep, exercise, driving and the warning signs that need a call or an emergency room, are on the radiofrequency ablation aftercare page.
References
- Dreyfuss P, Halbrook B, Pauza K, Joshi A, McLarty J, Bogduk N. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Spine (Phila Pa 1976). 2000;25(10):1270–7. doi:10.1097/00007632-200005150-00012 · PubMed
- Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med. 1996;335(23):1721–6. doi:10.1056/NEJM199612053352302 · PubMed
- 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;45(6):424–467. doi:10.1136/rapm-2019-101243 · PubMed
- MacVicar J, Borowczyk JM, MacVicar AM, Loughnan BM, Bogduk N. Lumbar medial branch radiofrequency neurotomy in New Zealand. Pain Med. 2013;14(5):639–45. doi:10.1111/pme.12000 · PubMed
- Juch JNS, Maas ET, Ostelo RWJG, et al. Effect of Radiofrequency Denervation on Pain Intensity Among Patients With Chronic Low Back Pain: The Mint Randomized Clinical Trials. JAMA. 2017;318(1):68–81. doi:10.1001/jama.2017.7918 · PubMed
- Cohen SP, Williams KA, Kurihara C, et al. Multicenter, randomized, comparative cost-effectiveness study comparing 0, 1, and 2 diagnostic medial branch (facet joint nerve) block treatment paradigms before lumbar facet radiofrequency denervation. Anesthesiology. 2010;113(2):395–405. doi:10.1097/ALN.0b013e3181e33ae5 · PubMed
- Kornick C, Kramarich SS, Lamer TJ, Todd Sitzman B. Complications of lumbar facet radiofrequency denervation. Spine (Phila Pa 1976). 2004;29(12):1352–4. doi:10.1097/01.brs.0000128263.67291.a0 · PubMed
- Smuck M, Crisostomo RA, Trivedi K, Agrawal D. Success of initial and repeated medial branch neurotomy for zygapophysial joint pain: a systematic review. PM R. 2012;4(9):686–92. doi:10.1016/j.pmrj.2012.06.007 · PubMed
- Schofferman J, Kine G. Effectiveness of repeated radiofrequency neurotomy for lumbar facet pain. Spine (Phila Pa 1976). 2004;29(21):2471–3. doi:10.1097/01.brs.0000143170.47345.44 · PubMed
- Conger A, Burnham T, Salazar F, et al. The Effectiveness of Radiofrequency Ablation of Medial Branch Nerves for Chronic Lumbar Facet Joint Syndrome in Patients Selected by Guideline-Concordant Dual Comparative Medial Branch Blocks. Pain Med. 2020;21(5):902–909. doi:10.1093/pm/pnz248 · PubMed
- Schneider BJ, Doan L, Maes MK, et al. Systematic Review of the Effectiveness of Lumbar Medial Branch Thermal Radiofrequency Neurotomy, Stratified for Diagnostic Methods and Procedural Technique. Pain Med. 2020;21(6):1122–1141. doi:10.1093/pm/pnz349 · PubMed
- van Kleef M, Barendse GA, Kessels A, Voets HM, Weber WE, de Lange S. Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine (Phila Pa 1976). 1999;24(18):1937–42. doi:10.1097/00007632-199909150-00013 · PubMed
- Nath S, Nath CA, Pettersson K. Percutaneous lumbar zygapophysial (facet) joint neurotomy using radiofrequency current, in the management of chronic low back pain: a randomized double-blind trial. Spine (Phila Pa 1976). 2008;33(12):1291–7. doi:10.1097/BRS.0b013e31817329f0 · PubMed
- Busse JW, Genevay S, Agarwal A, et al. Commonly used interventional procedures for non-cancer chronic spine pain: a clinical practice guideline. BMJ. 2025;388:e079970. doi:10.1136/bmj-2024-079970 · PubMed
- Truong KMTL, Maas E, Rasmussen MM, Ostelo R, Hurri H, van Tulder MW. Current evidence on radiofrequency denervation for chronic low back pain: a systematic review and meta-analysis. BMJ Open. 2026;16(7):e105106. doi:10.1136/bmjopen-2025-105106 · PubMed
- Kanjanapanang N, Madrid R, Lin P, et al. Effectiveness of genicular nerve radiofrequency ablation in osteoarthritis and post-surgical knee pain: systematic review. Pain Med. 2026;27(2):189–208. doi:10.1093/pm/pnaf115 · PubMed
- Chua NH, Vissers KC, Sluijter ME. Pulsed radiofrequency treatment in interventional pain management: mechanisms and potential indications—a review. Acta Neurochir (Wien). 2011;153(4):763–71. doi:10.1007/s00701-010-0881-5 · PubMed
