PONOS • INTERVENTIONAL PAIN MEDICINE
Radiofrequency for chronic pain
The right target.
The appropriate technique.
Pulsed or thermal? The choice starts with the diagnosis, the nerve involved and the treatment goals. A specialist pathway to understand when radiofrequency may help.
The specialist pathwayCompare the techniques
What is radiofrequency in pain medicine?
Radiofrequency uses a high-frequency electrical current delivered through an electrode placed close to a nerve target. It can modulate nerve activity or produce a controlled thermal lesion, depending on the technique selected.
It is not a single treatment for every type of pain. Assessment must identify the structure contributing to the symptoms and establish whether treating that target offers a favourable balance of benefits and risks.
Diagnosis before treatment
Your history, examination and relevant investigations help distinguish the components of your pain.
A defined target
Peripheral nerves, articular branches and craniofacial structures require different approaches.
Shared goals
Reducing pain and improving daily activities, with realistic expectations.
Pulsed and thermal radiofrequency: the differences
PRF · NEUROMODULATION
Pulsed radiofrequency
Energy is delivered in short bursts separated by pauses. The tip temperature is generally limited to around 42 °C to restrict the thermal effect.
The aim is to modulate pain transmission without intentionally creating a thermal nerve lesion. It may be considered for some neuropathic pain conditions and other selected indications.
The quality of evidence varies by target and condition. “Pulsed” does not mean risk-free or effective in every situation.
THERMAL RF · NEUROABLATION
Thermal radiofrequency
The current produces controlled heating in the tissue close to the electrode tip. The aim is to interrupt pain transmission by creating a targeted lesion.
Temperature, duration and electrode geometry are selected for the target: there is no single setting suitable for every procedure.
One example is medial branch denervation for facet joint pain, following appropriate diagnostic selection.
Why technical details matter
With thermal RF, lesion size depends on temperature, duration, electrode diameter, active tip length and tissue characteristics. Pulse settings also matter in PRF. Positioning and checks during treatment form part of the safety strategy.
PONOS uses the Cosman G4 generator (Boston Scientific). The equipment allows treatment parameters to be controlled; outcomes also depend on the indication, technique and individual patient factors.
When may radiofrequency be considered?
Radiofrequency may form part of treatment for certain persistent pain conditions, particularly when conservative care has not provided adequate control. The following pages explain targets and procedures: a diagnosis does not automatically mean that RF is appropriate.
SPINE
Low back, neck and sacroiliac pain
Assessment of possible joint-related pain and the nerves involved.
HEAD AND FACE
Neuralgias and craniofacial pain
Different targets require a specific diagnosis and a tailored choice of technique.
PERIPHERAL NERVES
Shoulder and foot
Targeted procedures when an identifiable nerve contributes to the pain.
The PONOS specialist pathway
Understand the pain
We review symptoms, limitations, previous treatments and their results. Investigations are interpreted alongside the clinical examination, not in isolation.
Assess the target
When indicated, a local anaesthetic diagnostic block helps assess the contribution of the suspected structure. For lumbar medial branch denervation, NICE requires a positive response to a diagnostic block. A positive test supports the indication but does not guarantee success.
Select and perform the procedure
The approach, expected benefits, alternatives and risks are discussed. Positioning is guided by ultrasound or radiological imaging, depending on the target; stimulation tests and parameter monitoring may provide additional checks.
Measure the outcome
Follow-up considers pain, function and everyday activities. Rehabilitation and medication are adjusted when needed; an insufficient response calls for reassessment.
Find out whether radiofrequency suits your case
Bring available reports and a list of treatments you have tried. The consultation helps define the problem, the options and a practical goal.
Request an assessmentCall PONOSOutcomes, limitations and safety
What to expect
Benefit may be partial, take time to develop or not occur. Its duration varies with the procedure, condition and individual response; pain can return.
The aim is a meaningful improvement in daily life. RF can complement medication, rehabilitation and other treatments; it does not replace surgery needed for a different structural problem.
Risks to discuss
Possible effects include local soreness, bruising and a temporary increase in symptoms. Bleeding, infection, burns and nerve injury, including persistent injury, are also possible, depending on the site and technique.
Tell the team about anticoagulants or antiplatelet medicines, infections, allergies, pregnancy and implanted devices. Do not stop medication yourself: you will receive individual instructions.
Frequently asked questions about radiofrequency
Does radiofrequency always burn the nerve?
No. Thermal RF intentionally creates a controlled lesion; PRF delivers pulses at a limited temperature for neuromodulation. PRF also carries procedural risks.
Is PRF always preferable because it is less destructive?
No. The choice depends on the diagnosis, target and available evidence. A technique with a different biological effect does not necessarily provide the same benefit.
Is a diagnostic block always needed?
This depends on the procedure. It is a central step for some indications, such as lumbar medial branch denervation. For other targets, the pathway is determined by the specific clinical picture.
How long does the benefit last?
No duration can be guaranteed. It may vary considerably, and pain can recur. Any repeat procedure requires reassessment, including consideration of the previous benefit.
Is the procedure painful?
Local anaesthetic is usually used; any sedation depends on the procedure and the patient. Discomfort during treatment and temporary pain afterwards are possible.
Does radiofrequency treat all tinnitus?
No. ENT and audiological assessment comes first. Procedures targeting somatic contributors are considered only in selected cases, have limited supporting evidence and cannot guarantee that tinnitus will resolve.
References and further reading
General information to support your medical consultation. The indication, specific risks and alternatives must be discussed during specialist assessment.