Radiofrequency denervation for facet joint pain: how it works and what to expect

Facet joints are small paired joints along the back of the spine, and when they become arthritic or inflamed they can cause pain in the neck or back. Each joint has tiny nerves, called medial branch nerves, that carry pain signals. Radiofrequency denervation aims to interrupt those nerves. The Milton Keynes leaflet describes the goal as interrupting the nerve supply to the affected joints and blocking pain signals.

The guidance from the Academy of Medical Royal Colleges Evidence-Based Interventions programme is clear that it should be offered only when non-operative treatment has failed and when one or more degenerate facet joints are thought to be the main source of pain. It gives the age of adults as 19 years and over and says it should be done in line with NICE guidance, with preceding diagnostic blocks.

If your pain is more diffuse, if it has not been through proper rehabilitation, or if the diagnostic block gave no clear benefit, denervation is unlikely to be offered. That is a deliberate safeguard rather than a refusal of care.

Before this procedure, the usual route is physiotherapy, exercise and manual therapy with psychological support where needed, and medicines for pain control. The Evidence-Based Interventions guidance describes failure of these non-operative approaches as a precondition.

The same guidance notes that facet joint injections themselves are no longer recommended by NICE or by the Getting It Right First Time programme, and that medial branch blocks are used instead as a diagnostic test. If you have been offered a facet joint injection as a treatment, ask the clinician how it fits current guidance.

Other options for chronic back pain include longer-term pain management programmes. Your pain team can explain the choices that apply to your pattern of symptoms.

You will first have a diagnostic medial branch block, in which local anaesthetic is placed near the nerves to see whether your pain improves. The Evidence-Based Interventions page describes a significant but short-term improvement as a positive response, and it is that response which makes denervation worth considering.

Preparation for the procedure itself is similar to other pain-clinic procedures: you will be told about fasting if sedation is planned, asked about blood-thinning medicines, allergies and pregnancy, and advised to arrange transport home. The Milton Keynes leaflet says local anaesthetic numbs the skin and that sedation or pain relief may be offered depending on the complexity and your preference.

• Keep a pain diary around the diagnostic block so you can describe the response accurately.

• Tell the team about blood thinners and diabetes medicines before the appointment.

• Ask whether sedation will be used, because that affects who must accompany you.

You lie on an X-ray table, the skin is cleaned and numbed, and a needle is guided by X-ray to lie next to the medial branch nerve. The Milton Keynes leaflet says electrical tests are used to confirm the position, with radiofrequency energy then applied for 90 seconds. The nerve is heated and that segment stops carrying pain signals.

The same leaflet says local anaesthetic and a steroid are then injected at the site. The needle is moved to each nerve that needs treating, so the number of needle positions depends on how many joints were identified as painful. It gives no overall duration, so ask your own unit how long to allow.

The leaflet describes the procedure as using local anaesthetic to the skin, with sedation available if needed. Ask your unit how long you will be observed afterwards and whether you go home the same day.

The Milton Keynes leaflet lists bruising, temporary numbness lasting typically two to three hours, infection and bleeding, with nerve damage causing tingling or weakness described as possible. Spinal cord damage and stroke are described as rare complications. It says pain may increase for days or weeks because of muscle spasm, and mentions that the steroid can affect menstrual cycles or blood sugar control in people with diabetes.

The Evidence-Based Interventions guidance sets realistic expectations: it describes only a small number of people who have not benefited from other treatments as experiencing reduced pain, and says pain may recur because nerve regeneration can occur over time. The retrieved pages give no percentages for success, so none are quoted.

Expect some soreness around the needle sites. The Milton Keynes leaflet says pain can increase for days or weeks because of muscle spasm, so a flare in the first weeks does not necessarily mean the treatment has failed. Pain relief may be delayed, so judge the result after the nerves have settled rather than in the first few days.

Driving and activity advice is not given in the retrieved leaflet, so follow your unit's written instructions. As a general rule, if you had sedation, you should not drive until the effects have fully worn off, and your team will say when to resume exercise and physiotherapy.

If the relief is good but fades, ask whether repeat treatment is appropriate. The guidance says the procedure may require repetition because nerves can regrow.

Contact the pain clinic or your GP, or NHS 111 outside hours, if a needle site becomes red, hot, swollen or discharges, if you develop a fever, or if the pain becomes severe and rapidly worse.

Seek emergency help through 999 or A&E for new weakness in the legs or arms, loss of bladder or bowel control, or numbness around the genitals or buttocks, because these can signal a problem affecting the spinal nerves.

• How many diagnostic blocks do I need, and how will we judge them?

• How many nerves will be treated, and in which part of the spine?

• Will I be sedated, and who must accompany me?

• How long might benefit last, and what then?

• What other options exist if it does not help?

Because the evidence for this procedure is modest and it is covered by a national Evidence-Based Interventions programme, NHS access follows set criteria. Private providers may apply their own criteria, so ask whether the diagnostic blocks and preceding rehabilitation have been completed and what happens if the response is poor.