Beyond painkillers: image-guided radiofrequency ablation for chronic back and neck pain

Chronic low-back and neck pain is one of the leading causes of disability worldwide, and modern life is not helping. Long hours at a desk, extended screen time, heavy lifting, past injuries and the natural wear of aging all contribute to persistent spine pain that can interfere with work, sleep and daily life.

For many people, first-line treatments—such as activity modification, physical therapy, and pain medication—provide sufficient relief.

However, a significant number continue to experience persistent pain despite these measures and are understandably reluctant to undergo spinal surgery because of the potential risks and lengthy recovery.

Increasingly, physicians are highlighting a middle-ground option: image-guided interventional pain procedures performed through a needle rather than with a scalpel.

According to Dr. Noppachai Siranart, Postdoctoral Research Fellow at Brigham and Women’s Hospital / Harvard Medical School and founder of YOUNIFY Clinic, a healthy aging and wellness center with a focus on joint and pain medicine, these procedures aim to identify and treat the specific structures generating pain — most often the small facet joints of the spine and the tiny nerves that supply them.

“A large share of chronic back and neck pain comes from the facet joints,” Dr. Noppachai explained. “When we can confirm that with a diagnostic block, we have image-guided options such as radiofrequency ablation that can provide meaningful, longer-lasting relief for carefully selected patients — as an alternative to relying on painkillers indefinitely or moving straight to surgery.”

Finding the Source Before Treating It

A key principle of interventional pain medicine is diagnosis before treatment. The facet joints are small, paired joints at the back of the spine that can become a source of pain with age, arthritis or strain. Because they are supplied by small nerves called the medial branches, physicians can perform a diagnostic medial branch block — a precise, image-guided injection of local anaesthetic near these nerves — to confirm whether the facet joints are indeed the pain generator.

If the diagnostic block confirms the source, longer-lasting treatment options can be considered. This diagnostic step is important: it helps ensure that any subsequent procedure is directed at the true source of pain.

Radiofrequency Ablation and Facet Joint Injection

Medial branch radiofrequency ablation (RFA) uses heat energy delivered through a fine needle, guided by imaging, to interrupt the small nerves carrying pain signals from the facet joints. By quieting these nerves, the procedure can reduce pain for an extended period in appropriately selected patients. Previous studies have reported meaningful relief in patients who were carefully selected using diagnostic blocks, although results vary between individuals and the procedure is not effective for everyone.

Facet joint injection — using steroid or other agents — and other targeted injections such as epidural steroid injection, selective nerve root injection and trigger point injection are further image-guided options within interventional pain medicine, each suited to specific pain patterns and diagnoses.

How the Procedures Work

These are needle-based, image-guided procedures. Using real-time imaging for accuracy, the physician positions a fine needle near the targeted nerve or joint under local anaesthesia. There are no large incisions and no stitches. The procedures are typically performed on a same-day basis, and most patients are able to return home the same day and resume light activities shortly afterward, with any soreness usually settling within a few days.

At YOUNIFY Clinic, these interventional pain procedures are performed under the care of the medical team, following image-guided, needle-only techniques with same-day discharge.

Who Might Be Suitable

Image-guided pain procedures are generally considered for adults with chronic back or neck pain who have not responded adequately to conservative care, and in whom the source of pain can be identified. They are part of a broader, step-by-step approach that still includes physical therapy, exercise, posture and lifestyle changes, and appropriate medication.

They are not suitable for everyone, and individual assessment by a physician is essential to confirm the diagnosis and choose the right procedure. Results depend on the individual, and these treatments are best viewed as one part of a comprehensive plan rather than a standalone cure.

A More Precise Approach to Chronic Pain

As pain medicine advances, the emphasis is moving toward precise diagnosis and targeted, minimally invasive treatment — addressing the specific nerves and joints responsible for pain rather than relying solely on medication. For many people living with persistent back and neck pain, image-guided procedures such as radiofrequency ablation represent an increasingly important option between conservative care and surgery.

Results depend on each individual. Please consult a physician before undergoing any treatment.

 

Noppachai Siranart, M.D. 

Founder at YOUNIFY Clinic 

https://www.younifyclinic.com/

Reference: 

1. YOUNIFY Clinic. Chronic neck pain treatment [Internet]. Bangkok: YOUNIFY Clinic; 2026 [cited 2026 Jul 27]. Available from: https://younifyclinic.com/en/services/chronic-pain/neck-pain

2. YOUNIFY Clinic. Chronic back pain treatment [Internet]. Bangkok: YOUNIFY Clinic; 2026 [cited 2026 Jul 27]. Available from: https://younifyclinic.com/en/services/chronic-pain/back-pain