Radiofrequency Ablation

RFA is used mainly for chronic arthritis pain in the spine’s facet joints, and also for pain from the sacroiliac joint and knee^[2][1]; hip and shoulder RFA are newer, with much less evidence^[6]. It suits people whose pain has lasted months despite physical therapy and medication and whose test block gave clear relief. It is not a treatment for sciatica or arm pain from a pinched nerve, and it does not repair damaged joints.

Relief commonly lasts about 6 to 12 months, and for some people a few years; others get only limited relief^[1]. StatPearls notes that relief after spinal RFA lasts up to a year or longer in many patients^[2]. Pain may return as the treated nerves regrow, and repeat treatment usually works about as well as the first when the first one helped^[3]. Results vary by joint, and the evidence is strongest for the spine.

Yes. A test block that temporarily numbs the target nerves is the standard way to find out whether RFA is likely to help^[3][1]. If your usual pain drops clearly while the numbing medicine works, you may be a candidate. Medicare in New York requires two medial branch blocks with at least 80% relief before spinal RFA^[7], and a genicular nerve block with at least 50% relief before knee RFA^[8].

Both use radiofrequency energy to heat a nerve; the difference is lesion size. Conventional RFA heats tissue to about 80°C. Cooled RFA circulates water through the probe so the tip stays near 60°C while creating a larger lesion^[8]. Larger lesions appear helpful where nerves are small and variable, such as the SI joint^[4], but are not proven better everywhere — a 2026 meta-analysis of knee trials favored conventional RFA^[5].

Most people find RFA uncomfortable rather than very painful, and most stay awake. The skin is numbed, each nerve is numbed again before heating, and a light relaxing medicine may be offered^[1]. Staying awake lets you respond during nerve testing, which helps keep the probe away from nerves that control movement^[3]. Afterward, soreness or a burning feeling at the site can last a week or two^[1].

Serious complications are uncommon. The most frequent side effects are soreness, bruising and a temporary burning or numb feeling near the treated area^[1]. Less often, the treated nerve becomes irritated (neuritis), and rarely a nearby nerve is injured or pain worsens^[3][1]. Infection and bleeding are uncommon. Pacemakers, defibrillators and stimulators need special planning before any RFA^[3].

It depends on the body area. Medicare in New York covers spinal facet RFA when strict criteria are met^[7] and, from October 25, 2026, genicular (knee) RFA for selected arthritis patients; it considers suprascapular nerve RFA investigational and does not list hip RFA as covered^[8]. It does not cover SI joint RFA^[9]. Commercial plans often require prior authorization, and workers’ compensation and no-fault follow their own rules. We verify your benefits before scheduling.

Yes. Because nerves regrow, pain can return, and RFA can be repeated when the first treatment worked^[1]. For spinal RFA, guideline authors found success in at least 80% of repeat procedures among people who had at least three months of good relief the first time^[3]. Medicare in New York limits spinal RFA to two sessions per spinal region, and knee RFA to two sessions per knee, in a rolling 12 months^[7][8].