RIP Radiofrequency Ablation Treatment for Low Back Pain

burn nerves in lower back

When Radiofrequency Ablation (RFA) became popular in the late 90s, it seemed like a miracle for many patients with chronic neck pain. At the same time, while this therapy seemed to work reliably to provide pain relief in the neck, it was always hit or miss as a treatment for low back pain. Perhaps that’s because the nerves treated with this procedure are also the ones that stabilize the spine. The procedure uses heat to destroy nerves, therefore a “Burn Nerves in Low Back” treatment is a more accurate name for the procedure. Now new research hopefully puts the proverbial final nail in the coffin for using RFA to treat back pain.

What Is Radiofrequency Ablation?

While the term “radiofrequency ablation” (aka radiofrequency denervation) sounds like some fancy new high-tech procedure, it has actually been around and used to manage pain for many decades. I’ve mentioned before how innocuous and elegant the phraseology—radiofrequency ablation—sounds, but the truth is, this procedure is more medieval than it is modern. Let’s break it down a bit.

At the basic level, RFA uses radiofrequency, converting electromagnetic signals into heat energy. The heat energy travels into the tissue being treated via a tool such as a probe or needle. “Ablation” means to melt, vaporize, and remove or destroy using a very high temperature or chemicals. What exactly are we “nuking” during an RFA for back pain? Nerves and surrounding tissue—remember an RFA can also be called radiofrequency denervation (de- meaning “to remove,” and nervation meaning “nerves”). Chances are, it would be very difficult to have patients buy into radiofrequency nerve “vaporization” or “melting” or “destruction,” or burn nerves in low back, so the more obtuse “radiofrequency ablation” is used.

It did seem, before our more modern regenerative-medicine options came along, that RFA might have been a great technology for its time. Despite the negative long-term effects of the tissue destruction, a treatment for low back pain having longer periods of short-term pain relief seemed preferable to dangerous painkillers and back fusions for example. However, the results of the new study certainly brings to question whether an RFA was ever a good option for chronic back pain. Let’s review the study.

Study Review: Radiofrequency Ablation Treatment for Low Back Pain vs. Exercise

The new study set out to determine how well radiofrequency for chronic low back pain worked when compared with standard exercise. The three-month study consisted of 681 subjects in three randomized control trials. Subjects were randomized into either a test group (RFA plus exercise) or a control group (exercise only) with 521 completing a one-year follow-up. Subjects had chronic low back pain due to problems in the facet joints, the sacroiliac joints, the discs, or a combination of these and had not responded to other treatments.

The researchers concluded that when compared to the exercise-only control group, the RFA-with-exercise group experienced no clinically significant improvements. So RFA with exercise was no better than exercise alone.

More Issues when We Burn Nerves in Low Back

I’ve shared before that in the long run, destroying nerves in low back discs via RFA for back pain treatment is a really bad idea. Our nerves serve a purpose. In the discs, for example, they help take forces off the disc so it can heal. Destroying the nerves not only disrupts that process but also, based on what we’ve observed in patients, degenerates the disc over time.

The nerves also transmit pain signals from the joint and other tissues. Frying the nerves may mask the pain, but the pain is there for a reason, and if the root cause isn’t addressed (e.g., arthritis in the joint), more damage is likely to be done, especially since the ability to transmit the pain signal has been stifled. In other words, in the case of arthritis, your joint still hurts because the forces on your joint (as these haven’t changed) continue to advance your arthritis. However, since your nerves have been burned away, your body can’t tell you your joint hurts and, therefore, that your arthritis is getting worse.

Additional side effects we see with radiofrequency ablation for chronic low back pain include killing off the multifidus muscle which can cause instability in the low back. This extra movement due to dead multifidus muscles means more wear and tear on the low back discs, joints, and ligaments. In fact, you can tell the level of success of a low back RFA (i.e. did you really kill all of the nnerves by sticking an EMG electrode into the multifidus to make sure it’s dead.

We see the same problem with radiofrequency ablation procedures in the upper back, the neck area. With the advent of interventional orthopedics in recent years, there’s no reason to ablate these nerves when we now have regenerative-medicine options to address the real problem along with the pain.

The upshot? RIP low back RFA. Good-bye to the Burn Nerves in Low Back procedure. Not sure how we ever thought that killing the nerve that goes to the muscle that stabilizes the spine was a good idea as a treatment for low back pain? With newer regenerative medicine techniques, it’s time to hold a big wake and get those RFA probes six feet under, where they belong!



*DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.
Read 11 Comments
  1. I was in a rollover accident years ago. My low back and sacrum are so extremely tight that my hips are not only rotated in opposite directions but are also anterior. I have been working with physio therapist who uses intramuscular stimulation to loosen muscles.. Still we are trying to get my hips to release enough so that I can do a pelvic tilt properly.
    if you think that stem cells prp or whatever you can use to correct this problem I’m in.

    1. deb,
      Egoscue, which is a very specific form of PT might help. We’d be glad to take a look and evaluate you for Candidacy. Do you have a recent MRI of your low back?

  2. I’m 68 and have had back chronic back pain since 1977.
    I’ve tried everything for relief and I mean everything ! Then I was offered RF Ablation.
    I’ve had RF Ablation done on both sides of my lower back. I can’t even describe what a relief
    I’ve experienced after living with pain for 40 yrs.! I’m so glad I had it done !

    1. Bob, glad it helped. When we used to perform this procedure, it also helped some patients. However, it also takes out a critical nerve that supplies the stabilizing muscle. Hence, when the pain returns (which is usually 6-9 months, but perhaps as long as 12), please consider a regenerative treatment that doesn’t damage the nerve.

  3. I’m scheduled for RAF in a week for chronic back and hip pain. It started in 1981 with back pain that increased while walking. Next pulled out back while working. Ten years later car accident that was t-boned on my side. Second car accident hit from behind by drunk at approximately 45mph. Had laminectomy of l4-l5 with fusion because I couldn’t walk or stand due to excruciating pain not controlled by meds. I’ve done everything PT, injections, RAF ten years ago with moderate relief. Traction helps but not enough to be effective. Also complicated b/c osteoarthritis very bad case. I just want to walk with out pain. Now I’m bending over due to scoliosis. I’m 62 years old and 5’4” 160 lbs

  4. I am scheduled for an ablation in January. I had a fusion of my lower back in 2012. 7 weeks after the surgery a screw went through my spinal cord leaking spinal fluid on to my nerves. I was in excruciating pain and finally my surgeon did an MRI and saw the problem. He put a 75 mg fentenyl patch on my arm and asked me to wait 2 months until the fusion could “take” and then he went in removed the hardware and sewed and glued the tear in my spinal cord. 2 months later he had to repair it again and in less than 4 weeks I was again in horrible pain and had another surgery to repair the tear. I’ve had several surgeries since and been on 2400 mg a day of gab ape tin and 20 mg of methodone daily. I have exercised and worked to get down to 21/2 mg twice a day of meth and 18 mg of gab but the pain is so bad. I would love to be able to sit without pain. A doctor promised me an ablation would allow me to sit again and be pain free for 6-9 months. I so want this. What are the possibles side affects?

    1. Kat,
      RFA, or Radio Frequency Ablation, like all medical procedures all medical decisions are a risk vs. benefit decision. The general possible side effects are listed in the blog. While we’d love to help, to determine side effects for which you in particular would be at greater risk would require an exam. These are the Physicians who can do that type of exam:

  5. Interesting comment
    You may have forgotten to mention that RFN should be undertaken for facet joint pain not for disc pain or unspecified ‘back pain’ . It requires 2 double blind diagnostic blocks prior to being undertaken if the correct protocol is followed. If the procedure is undertaken for ‘back pain’ without a correct diagnosis being made, it will obviously not work every time. If the prevalence of facet joint pain in ‘back pain’ is 10–15 percent in younger people, that is how often it will help. This is a small group, bigger in older folks.
    If this procedure is undertaken for the correct indications, it will work. I totally agree that it should not be performed bilaterally at multiple levels due to the effect on multifidus function
    A number of factors including funding, and poor diagnostic testing may contribute to it being undertake for the incorrect indications at times

  6. I had my first RFA for my lower back six months ago and my pain which I ve been struggling to live with for the past 14 years seemed to be improving a lot since then. However, the same procedure I just had on end November last year for my neck facet worked the other way round. Instead of the average 2 weeks healing period, I have been continuing my medical leave for the 6th week now.

    The pain is just horrible to the extend that I regret having it done 🤐 but yeah, touchwood it will get better over time.

    1. Exan,

      Really hoping it will! But the issue is that the whole purpose of RFA is to kill the nerves that as well as carrying pain signals, operate the structures that stabilize the neck. Treating the nerves instead of killing them, solves the problem without creating new ones.

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