Concierge pain medicine · London
Facet joint denervation — radiofrequency for chronic back and neck pain.
Image-guided radiofrequency thermocoagulation of the medial branch nerves that carry pain from arthritic facet joints — done properly, in theatre, and only after a diagnostic block confirms the facets are the source.
Why patients choose us
- 01
A consultant pain physician, in theatre
A named FPM RCA consultant in interventional pain medicine — image-guided, in a proper theatre, not an outpatient chair.
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A diagnostic block first — always
NICE NG59 is clear: no radiofrequency without a medial branch block that gave you ≥50% pain relief. We do it in that order.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private facet joint denervation costs in London.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across two or three options.
In short
A diagnostic block plus lumbar RF in our network: £2,400–£4,700 across two visits, both day-case.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| Diagnostic medial branch block (single level, bilateral) | £600–£1,200 | 20–30 min | Same visit |
| RF facet denervation — lumbar (bilateral, up to 3 levels) | £1,800–£3,500 | 45–75 min | Same visit |
| RF facet denervation — cervical (bilateral) | £2,000–£3,500 | 45–75 min | Same visit |
| RF facet denervation — thoracic | £1,800–£3,200 | 45–75 min | Same visit |
| Cooled RF (larger lesion, selected cases) | £2,400–£4,000 | 60–90 min | Same visit |
| Consultation with pain consultant | £220–£400 | 30–45 min | Same visit |
Prices vary by clinic, by consultant, by how many spinal levels are treated, by cervical versus lumbar work, and by whether conventional or cooled RF is used. We come back with a firm quote within one working day.
The problem
The right diagnosis, the right block, the right lesion.
Facet RF is one of the most misapplied procedures in private pain medicine — done without a proper diagnostic block, on the wrong pain generator, or by clinicians without interventional training. We insist on the pathway that actually works.
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Is it actually the facets?
Discogenic, sacroiliac and radicular pain all mimic facet pain. A diagnostic medial branch block sorts it out before you commit.
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Was the block done properly?
Small volume, correct target, honest pain diary. We use consultants whose block technique is diagnostic — not just therapeutic.
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Will the RF cover every branch?
Each facet has two medial branches, from above and at the level. Both must be lesioned. Half a job means half a result.
The journey
From enquiry to lasting relief — what happens, in order.
One consultant from first message to review — through the diagnostic block, the RF, the flare and the follow-up.
Phase 1 · Before the RF
Assessment and diagnostic block
Phase 2 · On the day
A few hours in theatre
Phase 3 · After
Flare, then relief
- 01
Before
You tell us what is going on
A short, confidential form. Where the pain is, how long, what makes it worse, any imaging you already have.
- 02
Before
We come back with a recommendation
Within one working day: whether a diagnostic medial branch block is the right first step, which consultant, and an indicative price for the pathway.
- 03
Before
Diagnostic medial branch block
A short image-guided injection of local anaesthetic onto the medial branches. You keep a pain diary for a few hours — ≥50% relief is the green light for RF.
- 04
On the day
Arrival at the clinic
Consent with the consultant and anaesthetist, gown and cannula, and a chat about the levels being treated.
- 05
On the day
The radiofrequency procedure
45–75 minutes in a fluoroscopy or CT suite. Local anaesthetic and light sedation, an insulated RF cannula, motor and sensory testing, then the RF lesion.
- 06
On the day
Home the same day
A short recovery, written aftercare, and home within a few hours. With sedation you will need someone to collect you.
- 07
After
Flare, then relief
A brief post-procedural flare for one to two weeks is normal. The lasting benefit typically builds over four to six weeks and lasts six to twenty-four months.
Typical end-to-end: 3–5 weeks from enquiry to RF. Full benefit: 4–6 weeks after the lesion.
When it helps
When facet joint denervation is the right step.
The pain patterns that respond, plus the red flags that mean a different problem — assessed urgently, not booked for RF.
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Chronic mechanical low back pain
Axial, non-radicular back pain lasting more than three months, worse with standing, extension or rotation.
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Facet-mediated neck pain
Chronic cervical axial pain, often with occipital headache, worse with looking up or turning the head.
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Post-whiplash cervical pain
Chronic C2–C6 facet pain after a whiplash injury, confirmed with medial branch blocks.
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Degenerative facet arthropathy
Osteoarthritis of the zygapophysial joints on MRI or CT, with a matching pain pattern.
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Recurrence after prior successful RF
Pain returning six to twenty-four months after a previous denervation that worked well — usually retreatable.
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Thoracic facet pain
Less common, but the same principle: mid-back axial pain, worse with rotation, confirmed with blocks.
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Pain that failed conservative care
Physiotherapy, medication and activity change tried, but axial pain still limiting sleep, work or daily life.
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Red flag: not for radicular leg or arm pain
Sciatica, arm radiculopathy, cauda equina, fever with back pain or unexplained weight loss are different problems — assessed urgently, not booked for RF.
Procedure options
The pathway is a menu, not a single procedure.
The diagnostic blocks, the RF variants, and the alternatives on the same page — what each involves and when it fits.
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Diagnostic medial branch block
Image-guided local anaesthetic onto the medial branches. ≥50% pain relief for the block’s duration is the gate to RF, per NICE NG59.
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Double diagnostic block
Some units use two blocks on separate days to reduce false positives before committing to RF — worth it in complex cases.
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Conventional RF at 80–90°C
An insulated cannula heats the medial branch to 80–90°C for 60–90 seconds. Above and at-level branches are both treated at every joint.
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Cooled radiofrequency (c-RF)
Water-cooled electrode produces a larger, ellipsoid lesion. Useful for the sacroiliac joint and some facet applications where anatomy is variable.
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Pulsed RF (selected cases)
Non-ablative, lower-temperature pulses. Sometimes used near mixed nerves, but the evidence for facet pain is weaker than conventional RF.
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Sacroiliac joint denervation
A separate, related procedure targeting the S1–S3 lateral branches — considered when the pain generator is the SI joint, not the facets.
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Facet joint steroid injection
A therapeutic — not diagnostic — intra-articular injection. Sometimes tried first, but the evidence for durable relief is limited.
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Consultation only
An honest discussion of whether the pain is likely facet-mediated at all — and whether an intervention is the right next step.
Our vetted London network
A small panel of pain consultants, we picked them.
Consultant pain physicians across central, north, west and south London — all on the FPM RCA specialist register. Not listed publicly; introductions are made privately, once we understand your case.
Selection criteria
How we choose every pain consultant in our network.
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Consultant pain physicians on the FPM RCA specialist register
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Fluoroscopy or CT-guided procedures in a licensed theatre
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Motor and sensory stimulation testing on every RF lesion
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Diagnostic medial branch block before every RF, per NICE NG59
Safety and recovery
What to expect afterwards — honestly.
Facet RF is a well-tolerated day-case procedure in trained hands. The things worth planning are the post-procedural flare, the timeline for benefit, and the small list of things that need same-day attention.
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A pain flare for one to two weeks
A short-lived flare after RF is expected — the treated nerves are irritated before they settle. Simple painkillers, heat and gentle movement help.
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The benefit builds over four to six weeks
Do not judge success on day three. The lasting relief develops as inflammation from the lesion resolves.
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Benefit typically lasts 6–24 months
The medial branch nerves regenerate, so pain can return. If the first RF worked well, a repeat procedure is usually just as effective.
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About 60–80% get ≥50% pain relief
In well-selected patients with a positive diagnostic block, most see meaningful, durable relief — not everyone, and we tell you so before you commit.
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Motor testing protects the ventral ramus
Before every lesion the consultant stimulates the nerve. A leg or arm twitch means the cannula is repositioned — that is why weakness is rare with correct technique.
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Transient neuritis or dysaesthesia
A patch of altered sensation over the treated area can last a few weeks. Almost always self-limiting.
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Infection and bleeding are uncommon
Infection risk is under 0.1% with sterile technique. Bruising at the entry point is normal; deep bleeding is rare.
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Rare complications
Superficial burn at the grounding pad, dural puncture, worsening pain, and — very rarely — deep vessel injury. All discussed at consent.
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Red flags after the procedure
New leg or arm weakness, loss of bladder or bowel control, fever, or severe worsening pain are not normal — call the clinic or A&E the same day.
Reading your procedure note
Your procedure note in four parts. Read the last one first.
Whether conventional or cooled RF was used, the note the consultant sends you keeps to the same shape.
A quiet reminder
Interventional pain notes are precise and can read coldly — we translate them for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Levels treated and side
Which facet joints were denervated — for example L3/4, L4/5 and L5/S1 bilaterally — and which medial branches were targeted at each level.
- 02 Technique
Guidance, cannula, lesion parameters
Fluoroscopy or CT, cannula size, motor and sensory stimulation thresholds, local anaesthetic test dose, and RF temperature and duration at each site.
- 03 Findings
Response to the diagnostic block
The percentage relief you reported after the medial branch block, and the pain pattern that justified proceeding to RF.
- 04 Impression
Aftercare, expected timeline, review
Read this first: the flare window, when to expect benefit, what to do if pain returns, and when the follow-up review is scheduled.
Recognised by major UK insurers
Facet RF denervation is usually covered when NICE criteria are met and a positive medial branch block is documented. We confirm cover with your insurer before booking.
Frequently asked
Everything we get asked about facet joint denervation.
Straight answers on the diagnostic block, the odds of relief, how long it lasts, and what the flare actually feels like.
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What is facet joint denervation, and is it the same as radiofrequency thermocoagulation?
They are the same procedure under different names. Radiofrequency (RF) medial branch neurotomy — also called facet joint denervation, RF ablation or RF thermocoagulation — uses a heated cannula to interrupt the tiny medial branch nerves that carry pain from an arthritic facet joint. Every facet joint is supplied by branches from the level above and at the level itself, so both are treated at each joint.
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Why do I need a medial branch block before the RF?
NICE NG59 requires it. Facet pain cannot be diagnosed reliably from MRI or examination alone, so an image-guided local anaesthetic block is done first. If it gives you ≥50% pain relief for the anaesthetic’s duration, the facet joints are confirmed as the pain source and RF is worth doing. Without that confirmation, RF is not appropriate.
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How long does the pain relief last?
Typically six to twenty-four months. The nerves grow back, so pain can return. When the first procedure worked well, a repeat RF is usually just as effective — patients often come back on a rhythm of every 12–18 months.
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What are the chances it will work?
In well-selected patients with a clearly positive diagnostic block, roughly 60–80% report ≥50% pain relief. That is not a guarantee, and we are honest about the odds before booking.
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How much does RF facet denervation cost privately in London?
Roughly £1,800–£3,500 for lumbar or cervical bilateral RF, £600–£1,200 for the diagnostic block, and £2,400–£4,000 for cooled RF. We come back with a firm figure within one working day.
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Is the procedure painful?
You feel the local anaesthetic sting, then pressure rather than pain. Light IV sedation is offered if you would prefer to be drowsy. A brief flare in the treated area for one to two weeks afterwards is normal — worse than you expected on day three, better than baseline by week six.
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When can I go back to work, driving and exercise?
Office work the next day is fine for most people. Driving when you feel comfortable and are off sedation — usually 24 hours. Heavy lifting and high-impact exercise wait a week or two while the flare settles.
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What are the alternatives to facet RF denervation?
Facet joint steroid injection, medial branch blocks used therapeutically, epidural steroid injection (if there is a radicular component), physiotherapy, weight loss, and — for a small minority — spinal surgery. RF is chosen when facets are the confirmed pain source and conservative care has not been enough.
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