What to Expect from Testing and Treating Arthritic Spine Joint Pain
The facet joints are small joints at the back of the spine that let you bend and twist. When they become arthritic, they can cause chronic neck or back pain. Each facet joint sends pain signals through tiny nerves called medial branch nerves. Treatment happens in two steps. First, medial branch blocks numb these nerves temporarily to test whether they are the pain source. If the test is positive, radiofrequency ablation (RFA) uses heat to disable the nerves for longer-lasting relief, often 6 to 12 months or more.
Who May Be a Candidate
Chronic neck or low back pain, usually lasting more than three months.
Pain that worsens with bending backward, twisting, or standing, and is often worse in the morning.
Pain without strong shooting arm or leg symptoms.
Pain that hasn't improved enough with physical therapy and medications.
Step 1: Medial Branch Blocks (the Test)
A small amount of numbing medicine is placed next to the medial branch nerves under x-ray guidance.
Afterward, you track your pain in a diary for several hours while doing activities that usually hurt.
If your pain drops substantially while the numbing medicine is active, the facet joints are likely the source.
Many insurers, including Medicare, require two positive blocks before RFA is approved.
Step 2: Radiofrequency Ablation (the Treatment)
Using x-ray guidance, special needles are placed alongside the same nerves.
The nerves are first tested with mild stimulation to confirm a safe position.
After numbing, the needle tip is heated to disable the nerve's ability to send pain signals.
The procedure usually takes 30 to 90 minutes, depending on how many levels are treated.
Before Your Procedure
Blood thinners: Tell us about every blood thinner you take. Any hold is coordinated with your prescribing doctor. Never stop a blood thinner on your own.
Pain medications: On the day of the blocks, avoid taking pain medication beforehand so the test results are accurate, unless we tell you otherwise.
Sedation: If you receive sedation for RFA, you will need a driver.
Pacemakers and stimulators: Tell us if you have any implanted electrical device.
After Your Procedure
After the blocks: Record your pain levels every hour or so for 6 to 8 hours. Return to normal activity the next day.
After RFA: Soreness or a sunburn-like sensation in the area is common for 1 to 3 weeks. Ice and acetaminophen can help.
Full benefit from RFA usually develops over 2 to 4 weeks.
The nerves can slowly regrow. If pain returns, RFA can often be repeated.
Physical therapy and core exercise help make the most of the pain-free window.
Risks and Safety
Common: Temporary soreness, increased pain for a few weeks after RFA, or numbness or tingling in the skin of the area.
Uncommon: Bleeding or infection.
Rare: Nerve injury or a burn at the grounding pad site.
How Strong Is the Evidence?
Lumbar facet RFA: Level II · Multisociety consensus practice guidelines on interventions for lumbar facet joint pain (Cohen et al., Reg Anesth Pain Med 2020); ASIPP facet guidelines (Manchikanti et al., Pain Physician 2020)
Cervical facet RFA: Level II · ASIPP facet guidelines; multisociety cervical facet consensus guidelines
Diagnostic medial branch blocks: Level II · Same guidelines; standard method to confirm facet pain
Lumbar facet PRP (alternative): Level I · Grade B · ASPN 2024 consensus guideline (x-ray guided intra-articular injection)
Evidence levels and guideline citations above are summarized for general clinical reference based on the literature and major society guidelines available at the time of writing. Guidelines are periodically updated; please verify current recommendations before relying on this summary for clinical decision-making.
Alternatives
Alternatives include physical therapy, medications, facet joint steroid or PRP injections, and, for persistent pain, spinal cord stimulation or surgical evaluation. We review the benefits and trade-offs of each with you.
Conditions This May Help
Talk With Us About Your Options
Call 650-507-4113 or send us a message to schedule a consultation at our Daly City, Los Altos, or Stockton office. We will review what may be causing your pain and walk through the risks, benefits, and alternatives of each option with you.
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This information is provided for general patient education and does not replace individualized medical advice. Please discuss your specific symptoms, diagnosis, and treatment options with your pain management physician.
