Radiofrequency denervation
A procedure that uses heat from a fine probe to interrupt the small nerves supplying the facet joints of the spine, aiming to reduce facet-joint pain for several months in people who first had a positive diagnostic nerve block.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Radiofrequency denervation uses heat to interrupt the facet-joint nerves and aims to reduce pain for several months, but it is not a cure and the nerves can regrow.
- It should only be done after a positive diagnostic medial branch block, and NICE limits it to people whose pain is moderate or severe and has not responded to other care.
- The evidence is mixed: it helps some people, but a major set of trials found no added benefit over a good exercise programme, so expectations should be realistic.
- It works best alongside staying active and physiotherapy, and a flare of soreness for a week or two afterwards is common.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
May reduce facet-joint pain for several months in carefully selected people
You have not had a positive diagnostic medial branch block confirming the facet nerves.
The area may feel sore or bruised. Use simple pain relief, keep the sites dry for 24 hours and take it easy. If you had sedation, do not drive or make...
A clear explanation that benefit builds over weeks and that early soreness is normal.
The area may feel sore or bruised. Use simple pain relief, keep the sites dry for 24 hours and take it easy. If...
A flare of soreness or a burning ache is common as the nerves settle. This usually eases. Keep gently active and...
Any benefit usually begins to build over this period. This is a good time to step up physiotherapy and normal...
The fuller effect, if any, is clearer. Note how much relief you have and use it to stay active.
What is radiofrequency denervation?
The facet joints at the back of the spine are supplied by tiny nerves called medial branches. Radiofrequency denervation (also called facet rhizolysis) uses a fine probe, guided by X-ray, to heat and interrupt these nerves so they stop carrying pain signals from the joints. The aim is longer relief than an injection can give, typically several months.
It is only offered to people whose facet joints have first been shown to be the source of pain by a positive diagnostic medial branch block. UK guidance (NICE NG59) is specific: radiofrequency denervation should only be performed in people with chronic low back pain after a positive response to a diagnostic medial branch block, and only when non-surgical treatment has not worked and the pain is at a moderate or severe level.
It is not a cure. The treated nerves can regrow over time, so pain can return, and the procedure may need repeating. It works for some people and not others, and the published evidence is genuinely mixed: some studies and patients report worthwhile relief, while a major set of trials (the Mint trials) found no meaningful added benefit over a good exercise programme. Experts continue to debate this.
For that reason, radiofrequency denervation is best seen as a possible help for carefully selected people, used alongside staying active and physiotherapy, rather than a guaranteed fix.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Radiofrequency denervation vs medial branch block
| Feature | Radiofrequency denervation | Medial branch block |
|---|---|---|
| Main purpose | Treatment to reduce pain for months | A test to confirm the facet nerves |
| What is used | Heat from a fine probe | Local anaesthetic onto the nerves |
| How long it lasts | Often months; nerves can regrow | Only hours, by design |
| When used | After a positive block | First, to select suitable people |
The block comes first. NICE advises radiofrequency denervation only after a positive diagnostic block.
Preparing for your procedure
- Make sure you have had a positive diagnostic medial branch block, as this should come first.
- See a pain specialist who explains the realistic chance of benefit, that effects are temporary, and that the evidence is mixed.
- Tell the team about all your medicines, especially blood thinners such as warfarin, clopidogrel or rivaroxaban, which may need adjusting.
- Mention any allergy to local anaesthetic or X-ray dye, and tell them if you might be pregnant.
- Ask whether you will have local anaesthetic only or light sedation, as sedation means you must not drive and need an escort.
- Arrange for someone to drive you home and, ideally, stay with you for the first evening.
- Plan a few quieter days afterwards and keep up gentle activity and physiotherapy as advised.
What happens
You lie on an X-ray table, usually face down for a lower back procedure. The skin is cleaned and numbed with local anaesthetic. Using X-ray guidance, the specialist positions a fine probe next to each target nerve. Before applying heat, they often pass a tiny test current; you may feel a brief tingle or a small twitch, which confirms the probe is in the right place.
The tip of the probe is then heated for a short time at each nerve to interrupt it. You may feel pressure, warmth or a brief ache; tell the team if anything is sharply painful so they can add more local anaesthetic. Several nerves are usually treated, so the procedure takes longer than an injection, around 30 to 60 minutes.
Afterwards you rest in a recovery area for a short time before going home the same day. The team will explain that benefit, if it comes, builds over a few weeks rather than immediately, and that some soreness in the first week or two is normal.
Is this procedure right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- You have not had a positive diagnostic medial branch block confirming the facet nerves.
- Your pain is non-specific low back pain with no clear facet source.
- You have an active infection or are unwell.
- You take blood thinners that cannot be safely paused.
- You expect a permanent cure rather than temporary relief.
Delay or rearrange if…
- You have a current infection, fever or feel unwell.
- You might be pregnant, as X-ray guidance is usually avoided.
- Your blood thinners have not yet been reviewed and adjusted.
- You have new or worsening nerve symptoms needing urgent assessment first.
- Your diabetes or other conditions are not currently well controlled.
Alternatives to discuss
- Staying active, physiotherapy and a structured self-management plan, which the evidence supports strongly.
- A supervised exercise programme or group rehabilitation.
- Repeat or different injection approaches in selected cases.
- Psychological support, such as cognitive behavioural approaches. NICE no longer recommends this specifically for low back pain or sciatica, but it may still help if you also have a mental-health condition, or as part of care for long-term (chronic primary) pain under separate guidance.
- Reviewing and optimising medicines, and addressing sleep, mood and activity.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- May reduce facet-joint pain for several months in carefully selected people
- Can make it easier to stay active and get the most from physiotherapy
- May reduce the need for painkillers for a time in those who respond
- Done as a day case under local anaesthetic, without major surgery
- Can be repeated if it helped and the pain later returns
Risks & complications
- Soreness or a flare of pain at the treated area for 1 to 2 weeks
- Bruising or tenderness where the probes went in
- A patch of numbness or odd skin sensation over the treated area
- Tiredness for a day or two after the procedure
- Little or no improvement, so the procedure does not help
- A burning or nerve-type pain (neuritis) for a few weeks as the nerve settles
- Temporary weakness or altered sensation near the treated nerves
- Return of pain after some months as the nerves regrow
- Infection that may need antibiotics, very occasionally a deeper infection
- Lasting nerve injury (extremely rare, reported as less than 1 in 10,000)
- A small area of permanent numbness or, rarely, weakness
- A collapsed lung (pneumothorax) with procedures in the chest (thoracic) area
The most important uncertainty is whether it will help you at all: even after a positive block, not everyone benefits, and a major set of trials found no added benefit over a good exercise programme. A flare of pain in the first week or two is common and usually settles. Ask your specialist what realistic chance of benefit they expect for someone like you, how long any relief tends to last, and what the plan is if it does not work.
Published figures to discuss
Serious complications are rare, but how likely the procedure is to help is genuinely uncertain and varies between studies and patients. A major set of trials (the Mint trials) found no meaningful added benefit over exercise, while other studies and experts report worthwhile relief in selected people. Quoted ranges should be treated as cautious estimates, and benefit is never guaranteed.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Lasting nerve injury | Extremely rare; quoted by NHS sources as less than 1 in 10,000 | New or persistent weakness or numbness needs prompt review; ask for clear emergency instructions. | Mint randomized clinical trials of radiofrequency denervation — JAMAjamanetwork.comPublished figure |
| Temporary neuritis (nerve-type burning pain) | Uncommon; a recognised effect for a few weeks after the procedure | Usually settles with time and simple pain relief; tell your specialist if it is severe. | Mint randomized clinical trials of radiofrequency denervation — JAMAjamanetwork.comSource-linked context |
| Duration of pain relief when it works | Often months rather than permanent; commonly around 6 to 12 months in responders | Nerves can regrow, and repeat treatment may be considered only if the first treatment clearly helped. | Mint randomized clinical trials of radiofrequency denervation — JAMAjamanetwork.comSource-linked context |
| False-positive diagnostic block before denervation | Recognised; estimates vary widely | Radiofrequency denervation should follow a convincing diagnostic pathway, not be offered from scan findings alone. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
Recovery is usually short, but it is normal for the treated area to feel sore for a week or two, and any benefit takes several weeks to show rather than appearing straight away.
- Soreness or a burning ache at the treated area for 1 to 2 weeks
- A patch of numbness or altered skin feeling over the treated area
- Mild bruising or tenderness at the probe sites
- Benefit that builds gradually over weeks rather than immediately
- Relief that may last months and can fade as nerves regrow
Aftercare
- Keep the treated sites clean and dry for 24 hours.
- Do not drive on the day if you had sedation; arrange a lift home.
- Use simple pain relief such as paracetamol for the expected soreness, unless told otherwise.
- Ease back into activity over a few days; avoid heavy lifting and strenuous exercise for 1 to 2 weeks.
- Keep up your physiotherapy and stay as active as your pain allows, as this matters for lasting benefit.
- Keep a simple diary of your pain and how it changes over the weeks.
- Contact the clinic or your GP if you notice signs of infection or new nerve symptoms. For urgent advice, use NHS 111 in England, Scotland or Wales; in Northern Ireland, contact your GP out-of-hours or your HSC Trust's Phone First service. If symptoms are severe or life-threatening, call 999 or go to A&E.
- Someone to drive you home, especially if you had sedation
- Simple pain relief at home
- A few quieter days planned
- A pain diary or notes app ready
- Your physiotherapy plan to continue
- The clinic's contact number saved, plus your urgent-advice number (NHS 111 in England, Scotland or Wales; GP out-of-hours or your HSC Trust's Phone First service in Northern Ireland)
⚠ Get urgent help if…
- Spreading redness, heat, swelling or discharge at a probe site
- Fever, chills or feeling generally unwell in the days afterwards
- New or worsening leg or arm weakness or numbness that does not settle
- Loss of control of your bladder or bowels, or numbness around the back passage (seek emergency help)
- Severe or escalating burning pain that is not controlled by simple pain relief
- Chest pain or breathlessness after a chest (thoracic) procedure (seek urgent help)
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good result is a meaningful reduction in your facet-joint pain that builds over a few weeks and lasts several months, making it easier to move and stay active. Because the treated nerves can regrow, relief is usually temporary and the procedure may need repeating if it helped.
It is important to be realistic. Even with a positive diagnostic block beforehand, not everyone benefits, and a major set of trials found no added benefit over a good exercise programme. A poor response does not mean your pain is imaginary; it means this particular treatment did not work for you, and your specialist will look at other options.
When it works, relief commonly lasts several months, sometimes up to a year or more, before the nerves regrow and pain can return. The procedure can often be repeated if it gave worthwhile relief. It is not a permanent cure, and lasting improvement usually depends on combining it with continued activity and rehabilitation.
Related tests, treatments or support
Radiofrequency denervation works best as part of a wider plan that includes staying active, physiotherapy and self-management. It follows a positive diagnostic medial branch block and is not a substitute for rehabilitation. A responsible service will not offer it in isolation or promise it as a cure.
Follow-up & long-term care
You should have a review, usually several weeks later, to judge how much relief you got and how long it lasts. This guides whether to repeat the procedure in future, focus on rehabilitation, or consider other options. Report any signs of infection or new nerve symptoms straight away.
- Keep up physiotherapy and regular activity to support and prolong any benefit
- Track how long relief lasts so any repeat procedure is based on real benefit
- Review the overall pain plan rather than relying on repeated procedures alone
Repeat, follow-on and what comes next
- The treated nerves can regrow, so pain may return after some months and the procedure may need repeating.
- It is reasonable to repeat it if it gave worthwhile relief, but not to keep repeating it if it did not.
- Even after a positive block, a proportion of people get little or no benefit.
- If it repeatedly fails to help, the approach should be reconsidered rather than simply repeated.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear explanation that benefit builds over weeks and that early soreness is normal.
- A named contact route and advice to use urgent-care services (NHS 111 in England, Scotland or Wales, or GP out-of-hours or a Phone First service in Northern Ireland) or emergency care for red-flag symptoms.
- A planned review to judge relief and decide on any repeat procedure.
- Integration with physiotherapy and a self-management plan rather than the procedure alone.
- An honest discussion of alternatives if it does not help or only helps briefly.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The specialist's fee for assessing you and performing the procedure
- The day-case or facility fee, including X-ray guidance
- How many nerve levels and which side(s) are treated
- Whether local anaesthetic only or sedation is used
- Whether the cost of the prior diagnostic block is included or separate
- Follow-up appointments to review the result
- The likely cost of a repeat procedure if pain returns later
- The specialist's fee and who will perform the procedure
- The facility and imaging fee
- How many levels and sides are included
- Whether the prior diagnostic block is part of the price
- Any sedation fee and recovery arrangements
- A follow-up review to assess the result
- What happens, and what it costs, if it does not help or the pain returns
On the NHS? Radiofrequency denervation is available on the NHS only after a positive diagnostic medial branch block and when pain is moderate or severe and has not responded to other care; private access may be used for speed or choice.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being told the evidence is mixed and that a major trial found no added benefit over exercise.
- Being promised a cure or guaranteed long-term relief.
- Proceeding without a genuinely positive diagnostic block, contrary to NICE.
- No discussion of physiotherapy and self-management as the foundation of care.
- No written emergency instructions for new weakness, severe burning pain or signs of infection.
Marketing red flags
- Promising a cure or permanent fix.
- Offering it without first doing a diagnostic block.
- Selling repeated procedures as a package up front.
- Describing it as pain-free, no-risk or guaranteed to work.
- Downplaying the mixed evidence or the chance it will not help you.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Have my facet joints been confirmed with a positive diagnostic block?
- What realistic chance of benefit do you expect for someone like me?
- How long does relief usually last, and how often might I need it repeated?
- Which technique will you use, and why?
- What is the plan if it does not help or only helps briefly?
- How does this fit with my physiotherapy and staying active?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my procedure, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this procedure not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Will radiofrequency denervation cure my pain?
Why do I need a nerve block first?
How long does the relief last?
Is it true the evidence is uncertain?
Can I get it on the NHS?
Will it hurt afterwards?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NICE NG59 — Low back pain and sciatica in over 16s (recommendations) Mint randomized clinical trials of radiofrequency denervation — JAMA Faculty of Pain Medicine — Patient information leaflets RADICAL trial of lumbar facet radiofrequency denervation — guidelines paper Efficacy of radiofrequency denervation for facet-joint low back pain — meta-analysis (PubMed) NICE NG59 — update information (psychological therapy recommendations withdrawn) nidirect — urgent and emergency care services (Northern Ireland) nidirect — GP out-of-hours service (Northern Ireland)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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