By Dr. Boris Nektalov, DNM, DC, Chiropractor & Enzyme Nutrition Specialist · Nektalov Chiropractic & Wellness, Forest Hills, Queens NY
Published: September 26, 2026 · Last reviewed: September 26, 2026
The short answer: Radiofrequency ablation (RFA) burns nerve fibers that carry pain signals from spinal facet joints — sometimes helping for months, sometimes not at all. A high-profile JAMA trial (Juch et al., 2017) found RFA no better than sham for many chronic low back pain patients — which is why Queens patients should understand conservative chiropractic and rehab pathways before committing to repeated procedures.
How RFA Works
After localized anesthetic blocks suggest a facet joint is involved, a pain physician guides a needle to the medial branch nerve and applies radiofrequency energy. The goal is to reduce pain signaling from that joint. Success depends on accurate diagnosis — chronic back pain is often multifactorial (disc, muscle, mood, sleep, central sensitization).
RFA vs. Conservative Chiropractic Care
| Factor | Radiofrequency ablation | Conservative chiropractic / rehab |
|---|---|---|
| Mechanism | Nerve heat lesion; interrupts peripheral signal | Restore joint motion, muscle balance, load tolerance |
| Setting | Pain clinic, fluoroscopy-guided procedure | Outpatient clinic; hands-on and exercise-based |
| Duration of effect | Months for responders; nerves may regrow | Cumulative with adherence; no single procedure endpoint |
| Risks | Infection, bleeding, neuritis, procedural pain | Usually soreness; rare serious events with screening |
| Evidence snapshot | Juch JAMA 2017: no benefit vs. sham in trial cohort | Guidelines support manipulation, exercise, multimodal care first |
| Repeat use | Procedures may be repeated when pain returns | Maintenance visits and home program as needed |
What Juch et al. Changed in the Conversation
Before 2017, RFA was widely marketed for facet-related chronic low back pain. The multicenter randomized trial published in JAMA compared RFA to a sham procedure and found no clinically important difference in pain intensity and function over the follow-up period for the studied population.
That doesn't mean zero patients ever benefit — real-world responders exist — but it demands honesty: invasive options with hardware-level cost and risk should not skip adequate trials of movement-based care, education, and non-interventional manual therapy when guidelines recommend them first.
Building a Conservative Path in Forest Hills
Compare broader surgical and non-surgical decision trees in conservative care vs. surgery and review medical guidelines on trying chiropractic before spine surgery. Many disc and facet pain patterns also respond to advanced spinal decompression combined with adjustment and strengthening — especially when leg symptoms trace to compressive loading rather than isolated facet arthropathy alone.
Questions to Ask a Pain Specialist About RFA
- What percentage improvement did I get from diagnostic blocks, and for how long?
- Have I completed a structured course of exercise and manual therapy?
- What were the sham-controlled trial results for patients like me?
- If RFA fails, what is the next step — repeat, fusion, or rehab intensification?
Our Role as Your Chiropractor
We are not anti-interventional care — we are pro-sequence. When manipulation, decompression, and rehab are appropriate, we document response so you and your physicians make ablation or surgery decisions with clearer data. When RFA or surgery is clearly indicated, we support referral without territorial nonsense.
Schedule an evaluation or book online. 108-50 71st Ave, Lower Level, Forest Hills, NY 11375 · (718) 275-9000
Frequently asked questions
What is radiofrequency ablation (RFA) for back pain?
RFA uses heat generated by radio waves to interrupt pain signals from specific nerves — often facet joints in the spine. It is typically offered after diagnostic nerve blocks suggest those joints are a pain source. Relief can last months for some patients but is not permanent; nerves may regenerate over time.
How does RFA compare to chiropractic care?
They address different layers of the problem. RFA targets nerve conduction from presumed joint pain generators; chiropractic care emphasizes joint function, mobility, muscle balance, and exercise. Many patients try structured conservative care first because it carries different risks, costs, and repeat-procedure patterns than ablation.
What did the JAMA trial on RFA show?
Juch et al. (JAMA, 2017) found radiofrequency denervation did not provide meaningful improvement over a sham procedure for chronic low back pain originating from facet joints in that trial design — a result that surprised many interventional pain physicians and reinforced the need for careful patient selection and non-interventional options.
When might RFA still be considered?
Some patients with well-documented facet-mediated pain report temporary relief after RFA, especially after positive medial branch blocks. Shared decision-making with a pain specialist should weigh trial evidence, functional goals, cost, and whether rehabilitation has been adequately tried.
Should I try conservative care before RFA or surgery?
Yes — major guidelines recommend non-drug, non-invasive care including manual therapy and exercise before interventional and surgical escalation for most uncomplicated chronic back pain, unless red flags require urgent workup.
Can Nektalov Chiropractic help before I consider ablation?
We provide evaluation, spinal adjustment, decompression, rehab, and integrative support for many mechanical back pain patterns in Forest Hills, Queens. Call (718) 275-9000 to schedule; we refer to pain management or surgery when appropriate.
This article is intended for informational purposes and does not constitute medical advice. Always consult a licensed healthcare provider regarding your specific condition.