Recovery from cervical radiofrequency ablation is usually quick: most people return to light activity within a day or two. Many have a burning, sunburn-like soreness or patchy numbness on the skin of the neck for 1 to 3 weeks. Relief often takes 2 to 4 weeks to show. When it works, it often lasts 6 to 12 months or longer, because the treated nerves can regrow over months.
These procedures are used for neck pain coming from the facet joints, the small paired joints at the back of each level of the neck. Facet pain usually sits to one side of the neck and can spread to the back of the head, the top of the shoulder or the shoulder blade. It does not usually cause tingling down the arm.
Key takeaways
- Test first: medial branch blocks numb the small nerves to a facet joint for a few hours to check whether that joint is the pain source.
- Then the longer step: radiofrequency ablation uses heat to switch off those same nerves for months.
- Common after ablation: burning, sensitivity or numbness on the neck skin for 1 to 3 weeks.
- Onset: relief from ablation usually builds over 2 to 4 weeks.
- Not permanent: the nerves usually regrow over months, and the procedure can be repeated if it helped.
What the procedures are and why they are used
Medial branch blocks: the test
Each facet joint sends pain signals through small nerves called medial branches. In a medial branch block, a doctor uses X-ray guidance to place a small amount of local anesthetic beside these nerves. If your usual neck pain drops sharply for the hours the anesthetic lasts, those joints are likely part of the problem. Many doctors look for a reduction of at least half, and some repeat the block on a second day to confirm.
Keep a pain diary for the 6 to 8 hours after a block. Do the movements that usually hurt, such as turning to check a blind spot or looking up, and note the score each hour. The decision about ablation rests on this record.
Facet joint injection
Some doctors inject steroid and anesthetic into the facet joint itself instead. Relief, if it comes, typically lasts weeks to a few months. Guidelines increasingly favor medial branch blocks followed by ablation for longer-lasting facet pain.
Radiofrequency ablation: the longer-acting step
If the blocks helped, radiofrequency ablation (also called radiofrequency neurotomy or rhizotomy) uses a heated needle tip to stop the medial branch nerves sending pain signals. The joint itself is left alone, and the muscles that move the neck keep working. It usually takes 30 to 90 minutes under local anesthetic, sometimes with light sedation.
Day by day: the first week after ablation
- Day 0: someone needs to drive you home. Rest for the day. The neck is often sore where the needles went in.
- Days 1 to 3: soreness, muscle spasm or a flare of your usual pain is common. A cold pack for 10 to 15 minutes at a time helps many people. Light activity and desk work are usually fine from day 1 or 2.
- Days 3 to 7: a burning or sunburn-like feeling, or a patch of numb or oversensitive skin on the back of the neck, often appears. It is caused by irritation of the treated nerves and usually fades over 1 to 3 weeks.
Weeks 2 to 6
- Weeks 2 to 4: pain relief usually becomes clearer. Some people feel a little worse before they feel better.
- Weeks 2 to 6: a useful time to start or restart physical therapy: neck movement, deep neck flexor and shoulder blade strength, and endurance for sitting and screen work.
- Around week 6: most doctors judge the result by now.
The block asks a question. The ablation acts on the answer.
How long the effect usually lasts, and how to use the window
For people who respond, relief from cervical ablation often lasts around 6 to 12 months, sometimes longer, sometimes less. Medial branch nerves regrow over months, and pain can return when they do. The months of lower pain are a chance to build neck and upper back strength and endurance, so the neck copes better if the pain comes back.
How many procedures are usually considered
Ablation is commonly repeated if the first one gave good relief for a meaningful period, usually no sooner than about 6 months apart. Many people have it repeated more than once over the years. If the first ablation gave little relief, repeating it is less likely to help, and the pain source is usually reconsidered.
Is this normal?
- Burning skin on the back of the neck: common in the first few weeks and usually fades.
- Numb patch of skin: common, and usually temporary.
- Pain worse in week 1: common, often from muscle soreness and nerve irritation.
- Feeling slightly off balance: can happen briefly after upper neck procedures and usually settles. Tell your doctor if it lasts beyond a few days.
- Pain coming back after many months: expected as the nerves regrow, and does not mean anything went wrong.
Call your local emergency number or go to the emergency department if
- New weakness: new weakness in an arm or leg, or unsteady walking that is getting worse.
- Breathing or swallowing trouble: difficulty breathing, swallowing or speaking.
- Stroke signs: face drooping, slurred speech, sudden vision loss or confusion.
See a doctor today if
- Signs of infection: spreading redness, heat, swelling or drainage at the needle sites.
- Fever: 100.4°F (38°C) or higher, especially with neck stiffness.
- Severe headache or new severe pain: far beyond expected soreness and not settling with rest and pain relief.
Get it checked soon if
- Burning lasting past 4 weeks: skin pain that has not started to ease by then.
- Numbness or tingling down the arm: new symptoms past the elbow point to a nerve root, not a facet joint.
- Dizziness that persists: balance problems lasting more than a few days.
More on this area: injections for neck and shoulder pain.
Expect a sore few weeks, judge the result at about six weeks, and use the quieter months to build strength.
Written by Louise Yow, Neck & Shoulder Physio.