Radiofrequency ablation for chronic low back pain

Jun 8, 2024 Blog
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Table of Contents


Chronic low back pain is a debilitating condition that affects millions of people worldwide. It can significantly reduce one’s quality of life, making everyday activities a challenge. While there are many treatment options available, not all of them provide long-lasting relief. One innovative approach that has gained attention for its effectiveness is radiofrequency ablation (RFA). This minimally invasive procedure offers hope to those suffering from persistent back pain, enabling them to regain their normal lives.

Understanding Chronic Low Back Pain

Causes of Chronic Low Back Pain

Chronic low back pain can arise from various sources, including degenerative disc disease, spinal stenosis, herniated discs, and arthritis. Other contributing factors might include muscle strain, poor posture, and injuries. Understanding the root cause is essential for effective treatment, as it helps in targeting the specific area causing pain.

Chronic low back pain is a prevalent issue affecting millions of individuals globally. Its multifactorial nature makes it a complex condition to diagnose and treat. Understanding the various causes is crucial for developing effective treatment strategies and improving patient outcomes. Here, we delve into the most common causes of chronic low back pain.

Degenerative Disc Disease

One of the primary causes of chronic low back pain is degenerative disc disease (DDD). This condition occurs when the intervertebral discs, which act as cushions between the vertebrae, begin to break down due to aging or wear and tear. Over time, the discs lose their elasticity and ability to absorb shock, leading to pain and discomfort.

Symptoms and Progression
Symptoms of DDD include persistent pain in the lower back, which may radiate to the buttocks and thighs. The pain often worsens with activities like bending, lifting, or twisting. As the disease progresses, the discs can become herniated or develop bone spurs, exacerbating the pain and potentially leading to nerve compression.

Herniated Discs

A herniated disc occurs when the soft inner core of a spinal disc pushes through a crack in the tougher exterior. This can irritate nearby nerves, causing pain, numbness, or weakness in the lower back and legs.

Risk Factors and Symptoms
Risk factors for herniated discs include aging, obesity, and repetitive stress on the spine. Symptoms often include sharp, shooting pain that radiates down the leg (sciatica), as well as numbness and tingling. These symptoms can severely impact daily activities and overall quality of life.

Spinal Stenosis

Spinal stenosis involves the narrowing of the spinal canal, which can compress the spinal cord and nerves. This condition is commonly caused by age-related changes in the spine, such as thickened ligaments, bone spurs, or bulging discs.

Types and Symptoms
There are two main types of spinal stenosis: cervical and lumbar. Lumbar spinal stenosis, affecting the lower back, is more common and can cause pain, numbness, and weakness in the legs. The symptoms often worsen with prolonged standing or walking and may be relieved by sitting or leaning forward.


Osteoarthritis of the spine, also known as spondylosis, is another leading cause of chronic low back pain. This degenerative joint disease occurs when the cartilage that cushions the joints in the spine wears down over time.

Impact on the Spine
As the cartilage deteriorates, the bones may rub against each other, causing pain, swelling, and stiffness. Osteoarthritis can also lead to the formation of bone spurs, which can impinge on nerves and exacerbate the pain. The condition is most common in older adults and can significantly impair mobility and function.

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Muscle Strain and Ligament Sprain

Acute injuries to the muscles and ligaments supporting the spine can also lead to chronic low back pain if not properly treated. These injuries often result from overuse, poor posture, or sudden movements.

Symptoms and Recovery
Symptoms of muscle strain and ligament sprain include localized pain, stiffness, and muscle spasms. While these injuries typically heal with rest and conservative treatments, repeated strains or inadequate healing can lead to chronic pain.

Sacroiliac Joint Dysfunction

The sacroiliac (SI) joints, located at the base of the spine, connect the sacrum to the pelvis. Dysfunction in these joints can cause pain in the lower back and buttocks.

Causes and Symptoms
SI joint dysfunction can result from inflammation, arthritis, or injury. Symptoms include sharp or aching pain that can be aggravated by standing, walking, or climbing stairs. The pain may also radiate to the groin or thighs.

Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a type of inflammatory arthritis that primarily affects the spine. It causes chronic inflammation of the spinal joints, leading to pain and stiffness.

Progression and Symptoms
AS typically begins in early adulthood and can lead to the fusion of the vertebrae over time, resulting in a rigid spine. Symptoms include persistent lower back pain and stiffness that improve with exercise but worsen with rest. AS can also cause pain and inflammation in other joints and tissues.

Psychological Factors

Chronic low back pain is not solely a physical condition; psychological factors such as stress, anxiety, and depression can also play a significant role. These factors can increase the perception of pain and contribute to a cycle of pain and emotional distress.

Impact on Pain Perception
Individuals with chronic low back pain may experience heightened sensitivity to pain due to the interplay between their physical condition and psychological state. Addressing these psychological factors through therapy and stress management techniques can be an important component of comprehensive pain management.

Understanding the diverse causes of chronic low back pain is essential for effective diagnosis and treatment. From degenerative conditions and acute injuries to psychological and lifestyle factors, a comprehensive approach to managing low back pain involves addressing all potential contributors. By identifying the root causes, healthcare providers can develop targeted treatment plans that improve patient outcomes and enhance quality of life.

Symptoms of Chronic Low Back Pain

Symptoms often include a dull, aching pain that persists for weeks or months. Some individuals experience sharp, stabbing pain that radiates down the legs, a condition known as sciatica. Other symptoms can include stiffness, reduced mobility, and muscle spasms. These symptoms can severely impact daily activities and overall well-being.

Chronic low back pain is a persistent and often debilitating condition that affects millions of people globally. Unlike acute pain, which typically results from a specific injury and resolves within a short period, chronic low back pain lasts for more than three months and may have no clear cause. Understanding the symptoms is crucial for proper diagnosis and treatment. Here, we explore the common and specific symptoms associated with chronic low back pain.

Persistent Aching or Stiffness

One of the hallmark symptoms of chronic low back pain is a constant, dull aching or stiffness in the lower back. This pain can vary in intensity and is often described as a deep, persistent ache that doesn’t subside with rest. The stiffness can make it difficult to move, bend, or stand up straight.

Sharp, Stabbing Pain

In some cases, individuals with chronic low back pain experience sharp, stabbing sensations. This type of pain may occur intermittently and can be triggered by certain movements, such as twisting or lifting. The sharp pain is often localized to a specific area in the lower back.

Radiating Pain (Sciatica)

Chronic low back pain can sometimes radiate from the lower back down to the buttocks, thighs, and legs, a condition known as sciatica. This occurs when the sciatic nerve is compressed or irritated. Sciatica is characterized by a sharp, burning pain that follows the path of the sciatic nerve, often affecting only one side of the body.

Associated Symptoms of Sciatica

Numbness and Tingling: In addition to pain, individuals may experience numbness or a tingling sensation in the leg or foot.

Weakness: The affected leg may feel weak or fatigued, making it difficult to stand up from a sitting position or walk.

Worsening Pain with Movement: Activities like standing, sitting for long periods, or sudden movements can exacerbate sciatica symptoms.

Limited Mobility

Chronic low back pain often leads to decreased range of motion and flexibility. Simple movements such as bending forward, twisting, or lifting objects can become challenging and painful. This limitation in mobility can significantly impact daily activities and overall quality of life.

Muscle Spasms

Muscle spasms are involuntary contractions of the muscles in the lower back. These spasms can be painful and may cause the back to feel tight or knotted. Muscle spasms can occur suddenly and last for varying durations, sometimes leading to temporary immobilization.

Pain that Worsens with Prolonged Activity

Individuals with chronic low back pain often report that their pain worsens with prolonged activities, such as standing, walking, or sitting. For instance, sitting for extended periods, especially in a poor posture, can aggravate the pain. Conversely, lying down or changing positions might provide temporary relief.

Pain that Improves with Rest or Change in Position

While chronic low back pain persists over time, certain positions or activities may provide temporary relief. Lying down, reclining, or using supportive pillows can sometimes alleviate pain. Similarly, gentle stretching and certain exercises might help reduce discomfort.

Pain that Fluctuates in Intensity

The intensity of chronic low back pain can vary throughout the day or with different activities. Some individuals may experience flare-ups, where the pain becomes more intense for a period before returning to a more manageable level. These fluctuations can be influenced by factors such as physical activity, stress, and overall health.

Emotional and Psychological Effects

Chronic pain can have significant emotional and psychological impacts. Individuals with chronic low back pain often experience frustration, anxiety, and depression due to the persistent nature of their condition and the limitations it imposes on their lives. These emotional responses can, in turn, exacerbate the perception of pain.

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Common Emotional Symptoms

Depression: Persistent pain can lead to feelings of hopelessness and sadness.

Anxiety: Worry about the pain worsening or its impact on daily life can increase anxiety levels.

Irritability: Chronic pain can lead to increased irritability and mood swings.

Sleep Disturbances

Chronic low back pain often interferes with sleep, making it difficult for individuals to find a comfortable position or stay asleep throughout the night. Poor sleep quality can exacerbate pain and contribute to fatigue, creating a vicious cycle of pain and sleep disruption.

Sleep-related Symptoms

Difficulty Falling Asleep: Pain may make it hard to fall asleep initially.

Frequent Awakenings: Pain flare-ups can cause individuals to wake up multiple times during the night.

Non-restorative Sleep: Even after a full night’s sleep, individuals may feel unrested and tired due to the poor quality of sleep.

Impact on Daily Activities

Chronic low back pain can severely impact an individual’s ability to perform daily activities, such as household chores, work-related tasks, and recreational activities. This limitation can lead to a decreased quality of life and a sense of dependency on others for help.

Examples of Impacted Activities

Household Chores: Tasks such as cleaning, cooking, and gardening may become difficult or impossible.

Work: Jobs that require physical labor or prolonged sitting/standing can be particularly challenging.

Recreational Activities: Hobbies and activities that involve movement, such as sports, can be restricted.

The symptoms of chronic low back pain are varied and can significantly affect an individual’s physical, emotional, and social well-being. From persistent aching and sharp pains to radiating sciatica and emotional distress, understanding these symptoms is crucial for effective diagnosis and treatment. By addressing the wide range of symptoms, healthcare providers can develop comprehensive treatment plans tailored to each individual’s needs, ultimately improving their quality of life.

Traditional Treatments for Low Back Pain

Traditional treatments range from physical therapy, medication, and lifestyle changes to more invasive procedures like surgery. Physical therapy focuses on strengthening the muscles and improving flexibility. Medications, such as NSAIDs and opioids, are often prescribed for pain management. In severe cases, surgical interventions may be considered, but these come with their own set of risks and long recovery times.

What is Radiofrequency Ablation?

The Science Behind Radiofrequency Ablation

Radiofrequency ablation is a procedure that uses heat generated by radio waves to target and destroy nerves responsible for transmitting pain signals. By applying a controlled electrical current to the affected nerves, the procedure disrupts their ability to send pain messages to the brain, providing significant pain relief.

Types of Radiofrequency Ablation

There are two main types of RFA: thermal and pulsed. Thermal RFA uses continuous heat to ablate the nerve, while pulsed RFA delivers short bursts of electrical energy to stun the nerve without causing permanent damage. The choice between the two depends on the specific condition and the physician’s recommendation.

Radiofrequency ablation (RFA) is a minimally invasive procedure used to treat chronic pain, including chronic low back pain. It works by using heat generated from radio waves to target and destroy specific nerves that transmit pain signals to the brain. This procedure can provide significant and long-lasting pain relief. There are different types of RFA, each suited for various conditions and patient needs. Understanding these types helps in selecting the most appropriate treatment method for optimal outcomes.

Conventional Radiofrequency Ablation

Conventional RFA, also known as thermal RFA, is the most common type of radiofrequency ablation. This method uses continuous heat to destroy the targeted nerve tissue. The heat is generated by an electrical current passed through an insulated needle, which is guided to the target nerve using imaging techniques such as fluoroscopy or ultrasound.

Procedure Details

Preparation: The patient is given local anesthesia to numb the area. Sedation may also be used to help the patient relax.

Needle Insertion: Using imaging guidance, the physician inserts a needle to the precise location of the nerve.

Heating: A radiofrequency current is passed through the needle, heating the nerve tissue to a temperature of around 80 degrees Celsius for a few minutes.

Outcome: The heat disrupts the nerve’s ability to transmit pain signals, providing relief.


Facet Joint Pain: Commonly used for chronic pain originating from the facet joints in the spine.

Sacroiliac Joint Pain: Effective for pain in the sacroiliac joints, which connect the lower spine to the pelvis.

Nerve Entrapment Syndromes: Can be used for various nerve entrapment conditions causing chronic pain.

Pulsed Radiofrequency Ablation

Pulsed radiofrequency ablation (PRFA) is a technique that delivers short bursts or pulses of electrical energy rather than continuous heat. This method aims to modulate the nerve function without causing significant tissue destruction, making it a less invasive alternative to conventional RFA.

Procedure Details

Preparation: Similar to conventional RFA, involving local anesthesia and sedation if needed.

Needle Insertion: A needle is inserted using imaging guidance to the target nerve.

Pulsed Energy: Instead of continuous heating, the needle delivers bursts of electrical energy, typically at a lower temperature (around 42 degrees Celsius).

Outcome: The pulsed energy modifies the nerve’s pain transmission without extensive damage to the nerve tissue.


Neuropathic Pain: Particularly useful for neuropathic pain conditions where nerve damage is involved.

Postoperative Pain: Effective in managing pain following surgeries where nerve modulation is needed.

Complex Regional Pain Syndrome (CRPS): Can be used to manage pain in CRPS patients with less tissue damage.

Cool Radiofrequency Ablation

Cool radiofrequency ablation (Cool-RFA) is a specialized form of RFA that uses internally cooled probes to maintain a lower temperature at the tissue interface while delivering high-energy radiofrequency. This technique allows for larger lesion sizes with controlled heat application, reducing the risk of collateral damage.

Procedure Details

Preparation: Similar to other RFA techniques, including local anesthesia and potential sedation.

Needle Insertion: A specialized probe with internal cooling is guided to the target nerve.

Cool Heating: The probe delivers high-energy radiofrequency while maintaining a lower temperature at the tissue surface, creating a larger but controlled lesion.

Outcome: The cooled application allows for more extensive nerve ablation while minimizing damage to surrounding tissues.


Multifocal Pain: Effective for conditions requiring larger ablation zones.

Spinal Pain: Useful for treating pain from multiple spinal levels.

Tumor Ablation: Occasionally used for palliative treatment of certain tumors causing pain.

Water-cooled Radiofrequency Ablation

Water-cooled RFA is similar to cool RFA but uses circulating water within the probe to regulate the temperature more precisely. This method is designed to create larger and more uniform lesions with enhanced safety and efficacy.

Procedure Details

Preparation: Involves local anesthesia and possible sedation.

Needle Insertion: A probe with a water-cooling system is placed near the target nerve.

Water-cooled Heating: The system circulates water to maintain consistent cooling while delivering radiofrequency energy, ensuring a larger and uniform lesion.

Outcome: Effective pain relief with minimized risk of thermal injury to adjacent tissues.


Chronic Spinal Pain: Especially useful for chronic pain in the lumbar and thoracic spine.

Extensive Nerve Pain: Beneficial for conditions involving multiple or extensive nerve involvement.

Facet and Sacroiliac Joint Pain: Highly effective for these specific joint pain sources.

Lesion Size and Shape Considerations

The different types of RFA vary not only in their approach but also in the size and shape of the lesions they create. Understanding these differences is crucial for tailoring the treatment to specific patient needs.

Lesion Characteristics

Conventional RFA: Creates small, precise lesions, ideal for targeting specific nerves.

Pulsed RFA: Produces minimal tissue damage, suitable for sensitive or delicate areas.

Cool and Water-cooled RFA: Generates larger, more uniform lesions, advantageous for extensive pain regions.

Clinical Decision-making
Physicians consider various factors, including the patient’s condition, the location and extent of pain, and prior treatment responses, to select the most appropriate type of RFA. This decision-making process ensures that the chosen technique provides the best possible outcomes with minimal risks.

Radiofrequency ablation offers a versatile and effective option for managing chronic low back pain and other pain conditions. By understanding the different types of RFA—conventional, pulsed, cool, and water-cooled—patients and healthcare providers can make informed decisions about the most suitable treatment approach. Each type of RFA has unique advantages and applications, making it possible to tailor pain management strategies to individual patient needs, ultimately enhancing the quality of life for those suffering from chronic pain.

Radiofrequency Ablation vs. Other Treatments

Compared to other treatments, RFA offers several advantages. It is less invasive than surgery and has a quicker recovery time. Unlike medications, it provides long-lasting relief without the risk of dependency or adverse side effects. Moreover, RFA targets the source of pain more directly than general pain management strategies, making it an effective option for many patients.

Indications for Radiofrequency Ablation

When to Consider Radiofrequency Ablation?

RFA is typically considered when other conservative treatments have failed to provide adequate relief. It is especially beneficial for individuals suffering from facet joint pain, sacroiliac joint pain, and other nerve-related back pain. Candidates for RFA often have undergone diagnostic nerve blocks to confirm the source of their pain.

Conditions Treated by Radiofrequency Ablation

RFA is used to treat a variety of conditions, including chronic back pain caused by facet joint arthritis, sacroiliitis, and nerve entrapment. It is also effective for treating pain from degenerative disc disease and certain types of spinal stenosis. By targeting the specific nerves causing pain, RFA offers a focused and effective treatment option.

Preparing for the Procedure

Pre-procedure Consultations

Before undergoing RFA, patients typically have a consultation with a pain specialist. This involves a thorough review of their medical history, a physical examination, and a discussion about their pain and previous treatments. This step ensures that RFA is an appropriate treatment option and helps plan the procedure.

Necessary Tests and Evaluations

Pre-procedure evaluations often include imaging tests such as X-rays, MRIs, or CT scans to pinpoint the exact location of the pain. Additionally, diagnostic nerve blocks may be performed to ensure that the targeted nerves are indeed the source of pain. These preparatory steps are crucial for the success of the procedure.

The Procedure Itself

How Radiofrequency Ablation is Performed

RFA is performed under local anesthesia and sometimes mild sedation. During the procedure, a needle-like probe is guided to the target nerve using imaging techniques like fluoroscopy. Once the probe is in place, a small electrical current is used to heat the nerve tissue, disrupting its ability to transmit pain signals.

Duration and Anesthesia

The procedure typically lasts between 30 minutes to an hour, depending on the number of nerves being treated. Local anesthesia is used to numb the area, ensuring patient comfort. In some cases, mild sedation is also administered to help patients relax.

Post-procedure Care

Immediate Aftercare

After the procedure, patients are monitored for a short period to ensure there are no immediate complications. Most individuals can go home the same day. It is recommended to rest and avoid strenuous activities for the first 24 hours. Pain at the injection site is common and can be managed with over-the-counter pain relievers.

Long-term Care and Monitoring

Long-term care involves regular follow-up appointments to monitor the effectiveness of the treatment. Patients are advised to engage in physical therapy to strengthen their back muscles and maintain mobility. It is also important to manage any underlying conditions that may contribute to back pain.

Benefits of Radiofrequency Ablation

Pain Relief and Quality of Life

One of the primary benefits of RFA is significant and prolonged pain relief. Many patients report a substantial reduction in pain, allowing them to resume normal activities and improve their overall quality of life. The relief from pain also contributes to better sleep and emotional well-being.

Reduction in Medication Use

RFA can reduce or eliminate the need for pain medications, which is beneficial given the potential side effects and dependency issues associated with long-term use of these drugs. This reduction in medication use can lead to a more active and healthier lifestyle.

Potential Risks and Complications

Common Side Effects

Common side effects of RFA include temporary pain at the injection site, bruising, and swelling. These effects are usually mild and resolve on their own within a few days. Patients may also experience temporary numbness or tingling in the treated area.

Rare but Serious Complications

Serious complications are rare but can include infection, nerve damage, or bleeding. In extremely rare cases, there might be an allergic reaction to the medications used. It is essential to discuss these risks with your doctor before undergoing the procedure.

Recovery and Outcomes

Expected Recovery Timeline

Most patients experience pain relief within a few weeks after the procedure. The full effects of RFA may take up to three weeks to manifest. During this time, it is important to follow post-procedure care instructions and attend follow-up appointments to ensure optimal recovery.

Long-term Outcomes and Success Rates

The success rates of RFA are high, with many patients experiencing pain relief for six months to two years. The duration of relief can vary depending on the individual and the specific condition being treated. Repeat procedures can be performed if the pain returns.

Patient Experiences and Testimonials

Real-life Stories of Pain Relief

Patients who have undergone RFA often share positive experiences, highlighting significant reductions in pain and improvements in their quality of life. These testimonials provide valuable insights into the effectiveness and benefits of the procedure.

Expert Opinions

Medical experts advocate for RFA as a reliable treatment option for chronic low back pain, especially for patients who have not found relief through other means. Their expertise underscores the procedure’s safety and efficacy, making it a viable choice for many individuals.

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What is radiofrequency ablation?
Radiofrequency ablation is a minimally invasive procedure that uses heat generated by radio waves to destroy nerves responsible for transmitting pain signals, providing significant pain relief.

How long does the pain relief from radiofrequency ablation last?
The pain relief from RFA can

last from six months to two years, depending on the individual and the condition being treated. Some patients may require repeat procedures.

Is radiofrequency ablation safe?
Yes, RFA is generally considered safe. However, as with any medical procedure, there are risks and potential complications, which should be discussed with your doctor.

Who is a good candidate for radiofrequency ablation?
Candidates for RFA are typically individuals who have chronic low back pain that has not responded to conservative treatments. A diagnostic nerve block is often used to determine if RFA will be effective.

What can I expect during the recovery period after radiofrequency ablation?
Most patients can resume normal activities within a few days. Some may experience temporary pain or discomfort at the injection site. Full pain relief typically occurs within a few weeks.

Are there alternatives to radiofrequency ablation?
Yes, alternatives include physical therapy, medications, and surgical options. The choice of treatment depends on the specific condition and the patient’s overall health and preferences.


Radiofrequency ablation offers a promising solution for individuals suffering from chronic low back pain. By targeting and disabling specific nerves, this procedure can provide substantial and long-lasting pain relief. For those who have not found success with traditional treatments, RFA represents a beacon of hope, offering a path to a more active and pain-free life. If you are struggling with persistent back pain, consult with a pain specialist to determine if radiofrequency ablation is the right option for you.


Well-known Interventional Radiologist Dr. ALOK KUMAR UDIYA is currently a consultant at The CARE CHL, an Indore hospital with NABH accreditation. He has a distinguished medical career and has studied at numerous top federal, state, and international superspecialty medical institutes.

He earned his M.B.B.S. from M G M Medical College in Indore and then M.D. in radiodiagnosis from Lady Hardinge Medical College at Delhi University.

Following that, he completed a fellowship in neuro- and vascular interventional radiology at the Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS) in Lucknow, where he gained extensive experience in diagnostic imaging along with hepatobiliary, peripheral vascular, and neurovascular interventions.

The prestigious Institute of the liver and biliary sciences Hospital (ILBS), New Delhi, awarded him a P.D.C.C. (Post Doctoral fellowship) in Hepatobiliary intervention, where he also received further in-depth instruction and advanced training in hepatobiliary and transplant imaging and interventions.

Moreover, he completed a six-month Neuro-Interventional Fellowship (FINR) at the famous University of Zurich, where he received specialized training from Professor Anton Valavanis in the endovascular management of stroke and aneurysm.

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