A nerve burn is a medical procedure that uses heat to disable specific nerves so they can no longer send pain signals to your brain. The medical term is radiofrequency ablation (RFA), though doctors also call it radiofrequency neurotomy or nerve denervation. During the procedure, a specialized needle delivers an electrical current that heats the targeted nerve tissue to around 80°C for 60 to 150 seconds, creating a small lesion that interrupts pain transmission. It’s most commonly used for chronic back and neck pain that hasn’t responded to other treatments.
How Heat Disables a Nerve
Nerve tissue begins to break down at temperatures above 45°C. During a standard nerve burn, the tip of a needle-like electrode is positioned next to the problem nerve, and radiofrequency energy heats the surrounding tissue to between 60°C and 90°C. The electrode itself isn’t the heat source. Instead, the electrical current passing through the tissue generates heat, and the electrode is warmed passively by the tissue around it.
The heat destroys all types of nerve fibers in the targeted area. Early research suggested that only certain pain-carrying fibers were affected, but later studies showed the destruction is not selective. Both the electrical current and the thermal energy play a role in disabling the nerve. Doctors keep the temperature below 80 to 90°C to avoid gas formation in the tissue, which could cause complications.
Conditions Treated With a Nerve Burn
The most common reason people get this procedure is chronic pain from the facet joints, the small joints that connect your vertebrae. Facet joints are the leading cause of chronic low back pain, responsible for an estimated 21% to 41% of cases, and they’re an even more frequent source of pain in adults over 65. The procedure targets the medial branch nerves, tiny nerves that carry pain signals from these joints to your spinal cord.
Nerve burns are also used for neck pain originating from the cervical facet joints, sacroiliac joint pain (the joint connecting your lower spine to your pelvis), tailbone pain, and hip joint pain. In some cases, people who’ve had spinal fusion surgery develop new facet pain at levels next to the surgical site, and radiofrequency ablation can help there too. The procedure is typically reserved for people who haven’t gotten adequate relief from more conservative options like physical therapy, anti-inflammatory medications, or weight loss, and who aren’t candidates for surgery.
How You Qualify for the Procedure
Before a nerve burn, you’ll need to pass a diagnostic test. Your doctor will inject a local anesthetic near the suspected nerve to temporarily block it. If that injection reduces your pain by 50% or more, it confirms that the targeted nerve is actually the one causing your problem. Most protocols require at least two successful diagnostic blocks before moving forward with the ablation. This step is important because it significantly improves the odds that the nerve burn will work for you.
Standard vs. Pulsed Nerve Burns
There are two main approaches. Standard (continuous) radiofrequency ablation delivers constant heat, typically at 80°C for 90 seconds in the lower back and 90 to 150 seconds in the neck. This creates a permanent lesion on the nerve. A variation called cooled RFA, sometimes used for hip or sacroiliac joint pain, operates at a slightly lower 60°C for about 120 seconds but creates a larger treatment area.
Pulsed radiofrequency takes a gentler approach. It delivers short bursts of energy with pauses in between, keeping the tissue temperature at or below 42°C. Because the temperature stays well below the point where nerve tissue is destroyed, pulsed RF modifies nerve function rather than destroying it outright. Research comparing the two found that at six months, about 87% of patients treated with pulsed RF still had significant pain relief (defined as 50% or greater improvement), compared to just 20% of patients who received steroid injections alone.
What Pain Relief Looks Like
Pain relief varies. Some people notice improvement immediately after the procedure, while others need up to three weeks before the full effect kicks in. On average, patients experience roughly 48% pain reduction, with relief lasting an average of about 4.5 months. But averages can be misleading because outcomes vary widely from person to person.
The more encouraging numbers come from longer follow-up studies. At 12 months after the procedure, 60% of participants still had at least 90% pain relief, and 87% still had at least 60% relief. The key factor is how well you responded to the diagnostic nerve block. If the block gave you strong, clear relief, you’re more likely to get a good result from the ablation.
Nerves Grow Back
One thing that catches many people off guard is that the treated nerve will regenerate over time. The nerve burn doesn’t permanently eliminate your pain source. As the nerve fiber regrows along its original path, pain can gradually return. When that happens, the procedure can be repeated, often with similar results. Many patients go through multiple rounds of ablation over the years as part of an ongoing pain management strategy rather than a one-time fix.
Side Effects and Recovery
Nerve burns have a low complication rate. The most common side effect is temporary soreness at the treatment site, which can last a few days to a couple of weeks. Some people experience post-procedural neuritis, a brief flare of nerve irritation that can actually increase pain temporarily before things settle down. The reported rate of these minor complications is less than 1%.
Other uncommon side effects include reduced sensation in the skin near the treated area, increased sensitivity to touch over the denervated zone, temporary flushing, or a mild headache. These are almost always transient. Serious complications are rare, particularly when the procedure is performed on the well-studied facet joint nerves of the spine. Most people return to normal activities within a few days, though some doctors recommend avoiding strenuous activity for about a week to let the treatment area heal.
What the Procedure Feels Like
The procedure is done as an outpatient visit, meaning you go home the same day. You’ll lie face down on a procedure table, and the doctor uses real-time X-ray imaging (fluoroscopy) to guide the needle to the correct nerve. Before the nerve burn itself, a small amount of local anesthetic numbs the area. During the actual ablation, you may feel pressure, warmth, or a brief tingling sensation. The entire process typically takes 30 to 60 minutes depending on how many nerves are being treated. You’ll need someone to drive you home, but most people feel well enough to resume light activities the next day.