RIP Radiofrequency Ablation Treatment for Low Back Pain

By Chris Centeno, MD /

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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!

Category: Back/lumbar

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38 thoughts on “RIP Radiofrequency Ablation Treatment for Low Back Pain

  1. deb

    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. Regenexx Team Post author

      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. Bob D

    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. Chris Centeno Post author

      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.

    2. Kate

      I am scheduled for this procedure but am hearing negative vibes from some people. Like I will have to get these for life because the nerves grow back and they are not happy thus more pain…I have tried everything.

      1. Regenexx Team Post author

        Kate,
        All medical treatment is risk vs benefit. If the goal is to treat back pain the difference between regenerative procedures and RFA is regenerative procedures like platelet or stem cell procedures treat the nerve, whereas RFA is designed to kill the nerve carrying the pain signal. The problem with that is that nerve also supplies the stabilizing muscle to the area. Please see: https://regenexx.com/blog/radiofrequency-back-pain-treatment-reviews/

  3. Brenda Freeman

    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

    1. Regenexx Team Post author

      Brenda,

      Just walking without pain is not a lot to ask, and it sounds like you and your back have been through an awful lot! That said, treating the nerves rather than killing the nerves is always a better plan. This explains the things that are likely going on. https://regenexx.com/blog/pain-after-back-fusion-adjacent-segment-disease/ Please let us know if you’d like us to take a look to see if we can help.

  4. Kat

    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. Regenexx Team Post author

      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: https://regenexx.com/find-a-physician/

  5. Jon Rob

    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
    John

  6. Exan

    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. Regenexx Team Post author

      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.

  7. Deb

    I hope no one is discouraged from considering RFA because of this opinion. Sure, with everything there is risk vs benefit decision. It was definitely the answer for my constant lower back pain due to arthritis. Now I DO exercise daily because I am feeling pain relief!

    1. Chris Centeno Post author

      Deb, glad this worked for you. We have been unimpressed with the results of RFA in the low back and when you add in the predictable muscle damage, we’re concerned about the long-term impacts on the spine.

      1. Mrs P

        I just had an RFA the end of Jul. After years and years of successful procedures this one was a disaster. My psoas muscle was burned causing an abscess or hematoma which they are trying to figure out that had to be asperated. I am in excruciating pain to say the least. RFAs can help however, after a while they stop working and relief time lessens to 5 or 6 months. I would much rather explore other options because when you’re sitting in the ER twice in two weeks getting several ct scans with contrast to figure things out and fentinyl gives you little to no relief, you’ll rethink RFAs.

        1. Regenexx Team Post author

          Mrs P,
          Very sorry to hear what happened! Unfortunately, that type of result is not uncommon. Treating the issues rather than nuking them, or removing them, is always a better plan which is why we’re working so hard on getting these procedures covered. Please see: https://regenexx.com/blog/connect-healthcare-collaboration-picks-regenexx-reduce-orthopedic-surgery-costs/ and https://regenexx.com/blog/regenexx-acap-fixing-broken-medical-care-system/ and and https://regenexx.com/blog/regenexx-pulse-healthcare-announce-partnership-reduce-orthopedic-surgery-rates/ and https://regenexx.com/blog/regenexx-edison-health-mean/ and https://regenexx.com/blog/regenexx-partners-with-access-healthnet/ and https://regenexx.com/blog/regenexx-makes-sense-company/

  8. Glenn Henney

    I had a RFA on my neck little over 2 years ago. That didn’t help enough so I had surgery to relive the pain last year. Had the surgery cause the odds was in my favor to help. But surgery on the lower back are not good enough for me to chance it. My surgeon agreed use surgery as the last resort. The nerve blocks that was done earlier this year worked So I’m going to try the lower back RFA next week on one side then 2 weeks later the other side. Being 59 years old and being disabled over 1/3 of my life because I worked it to hard doing the same job that men 60-100 lbs on me struggled to do. Being on Medicare I have found out that a lot of different treatment are not covered. Almost everything that is newer isn’t. But older treatments that work but not might be the best is. So I guess I’m asking is your treatment covered under Medicare cause I’m not crazy about killing nerves But pain meds just deaden my brain and is hard on my body too. the large doses I have to take now isn’t good on my body either pain is still there

    1. Regenexx Team Post author

      Glenn,

      Medical decisions are always risk vs benefit and the choices available to you through medicare as you’ve said, unfortunately do not include the recent advances in regenerative Spine care. If regenerative treatment is out of the question, speaking to your primary care Doctor about what direction has the least risk to your overall health would likely be a good place to start.

  9. Amanda Lynn Byard

    I have RFA on both sides. I didn’t do enough research on it beforehand tho. I’ve been diagnosed with facet arthritis,degenerative disc disease,spinal stenosis,my spine is calcifying,pinched nerve in neck,fibromyalgia and Rheumatoid Arthritis and both rotator cuffs are torn. I was seeing a pain specialist that was very big on procedures vs meds and that’s fine but procedures don’t always work. I’ve had injections of every kind n the last was this RFA. When she did the right side she had trouble in 1 area n on the left it really bothered me and I told her but she insisted I was wrong n continued. After having this done i have since moved to another state. About 2mo after it was done I began to have issues with my left leg it gets very fatigued quickly. I can take 10 steps n it feels as if I have run a mile. Could having this RFA done have caused some sort of damage that im feeling in my leg? I didn’t get the relief she spoke of. I have terrible pain n pressure in my hips now and pain in the lower back that runs thru hips n down my legs.

    1. Regenexx Team Post author

      Amanda,
      The problem with RFA is that by design, it kills nerves. We don’t have spare nerves, they all have a function. Yes, the symptoms you mention may be related.

  10. Mike Damn Gillum

    Are you covered by most insurance?

    1. Regenexx Team Post author

      Mike,
      Stem Cell procedures are not covered by Health Insurance in general, yet. But our procedures are covered for many people whose employer’s self insure them and medical cost sharing plans.

  11. ken Laukhuff

    I have had RFA several weeks ago. The procedure in the last minute and one half The DR. started the electric current so high it made me jump on my left side. I just about yelled for him to stop when the current went back down. he then said you have a minute and fifteen seconds to go. Now weeks later I have terrible pain down my left side and my bones just crack and crack on my hip and knee cap its horrible. I now use a cane and walker. I now need a hip and knee replacement. Is this going to last forever? I am on oxy 20 mg a day plus nerve and muscle meds. and no help with pain. I am totally lost in what to do.

  12. jeff galbraith

    I had RFA in jan 2018 and within 2 months most of my back pain was gone i have now started jogging and doing more strenuous work.im 56 with back pain for 40 years. All i can say im dumbfounded how well it worked< its has been a miracle and i pinch myself daily because i cannot believe my pain is gone<<< even if temporally

    1. Regenexx Team Post author

      jeff,
      Always glad to hear something helped! Important though to understand that the nerves ablated (“nuked”) are not functioning and doing their job, which has longterm consequences to structures in the back.

    2. Annette

      Hi Jeff
      Can i ask how your pain is going?

  13. Brittney

    That must be why the VA hospitals use it! Because it’s awful for you! Well now I’m worried they want to start doing this for me in October. Figures, they don’t know what’s wrong with my back, nor have they ever really checked for 8 years. It’s just a bunch of, well let’s see if this helps. And on and on

  14. David

    I went through the burning nerve process and the doctor screwed up instead of burning the nerve if burned a vertebrae which is causing extensive damage and thoroughly destroyed the vertebrae or half of it which now has does neurosurgeon has to dig the damage out and shoes the Ferber write in place so it doesn’t cause more damage in the interim item almost been written because of the pay any thoughts thanks

    1. Regenexx Team

      Hi David,
      Burning nerves is never a good idea, burning vertebrae an even worse idea. Reminds me of a case a few years ago. Please see: https://regenexx.com/blog/back-surgery-concerns-stone-age-spine-care/ We’d need to examine you to advise. Please call 855 622 7838 if you’d like to do that.

  15. Phol Krigel

    For the past 10 years or so I have had RF in my low back
    With very good results. I have been experiencing some balance issues in my lower back but did not make the connection until I read this article. I just had my last RF yesterday. What exactly is regenerative treatments, and does insurance cover those? Do most pain specialists offer such treatment? Any advice would be appreciated

    1. Regenexx Team

      Hi Phol,
      Regenerative treatments use your own stem cells and platelets to treat orthopedic injuries and degenerative conditions like arthritis, in the spine, and other joints, tendons and ligaments. Please see: https://regenexx.com/blog/orthopedic-stem-cell-treatment/ Regenexx procedures are covered by these policies: https://regenexx.com/blog/stem-cell-procedure-insurance-coverage/, but in general, these type of procedures are not yet covered by insurance. No, most pain specialists do not offer these procedures. To find a Physician that does, please call 855 622 7838.

  16. Robert Waichunas

    I had an ablation done on my l4, l5 area on May 16 2019 and it is now June 5th and my back hurts worse now than before the procedure. Now what do I do?

    1. Regenexx Team

      Hi Robert,
      As it says in the blog, “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 nerves by sticking an EMG electrode into the multifidus to make sure it’s dead. ” If you’d like us to weigh in on your case to see if we can help, please submit the Candidate form here: https://regenexx.com/conditions-treated/spine/

  17. Rose Rockel

    Had RFA 4 weeks ago
    Nothing has changed. Same pain. Now what??????? Thought it would be my miracle. So disappointed. I made a mistake. I felt it going in but was hopeful.

    1. Regenexx Team

      Hi Rose,
      Sorry to hear that but given what RFA is, it’s unfortunately not surprising. Let us know if you’d like us to weigh in on your case to see what’s actually going on.

  18. Tamera Lynn Stewart

    While most patients who have had this procedure can tell you the same thing this study shows, it seems even with these fundings and all the anecdotal evidence that this is becoming even more of a popular forced procedure.

    Has their been any updates since this that can be used to publicly denounce this treatment?

    1. Regenexx Team

      Hi Tamera,
      Not that have come to our attention.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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