Anesthesiology | Interventional Pain Medicine
Assistant Professor — University of Toronto
Interventional Pain Physician — Afiya Spine & Pain Institute
Staff Anesthesiologist — Scarborough Health Network
Peripheral nerves are the nerves outside the brain and spinal cord. They carry signals such as touch, temperature, movement, and pain from different parts of the body.
Pulsed radiofrequency neuromodulation uses brief pulses of radiofrequency energy near a painful or irritated nerve. Unlike traditional radiofrequency ablation, it is not meant to burn the nerve. The goal is to calm or modulate the pain signal.
This is different from dorsal root ganglion pulsed radiofrequency neuromodulation, which targets a small nerve structure near the spine. This page is about treating a named nerve farther out in the body.
This procedure may be considered when your pain pattern suggests that a specific nerve is carrying a meaningful part of your pain.
Nerve pain often feels burning, electric, shooting, tingling, numb, hypersensitive, or painful to light touch. It may follow a recognizable path rather than staying in one small sore spot.
It is usually considered after simpler treatments have not provided enough relief. These may include medication, time, activity modification, physiotherapy, bracing, desensitization therapy, or previous injections.
This procedure is less predictable when pain is widespread, when the pain pattern does not match a specific nerve, or when several different pain sources are active at the same time.
The most important step is matching the painful area to the nerve that normally supplies feeling to that area.
For example, pain over the outer thigh may point toward the lateral femoral cutaneous nerve. Pain between the big toe and second toe may point toward the deep peroneal nerve. Pain around a surgical scar may point toward one or more small nerves in that area.
We may use your pain drawing, physical exam, tenderness over the nerve, altered sensation, previous imaging, surgical history, and response to a diagnostic nerve block to decide whether a nerve is a reasonable target.
A diagnostic nerve block may be performed before pulsed radiofrequency neuromodulation or at a separate visit. A strong temporary response to numbing medication supports the idea that the target nerve is contributing to your pain.
Examples include, but are not limited to:
The exact target depends on your symptoms and examination. The goal is not to treat every possible nerve. The goal is to identify the most likely pain-carrying nerve and treat that nerve carefully.
Pulsed radiofrequency neuromodulation has been studied for a variety of nerve pain conditions. The evidence is mixed because different studies treat different nerves, use different techniques, and include small numbers of patients.
For some conditions, such as occipital nerve pain and outer thigh nerve pain, there are published studies and case series suggesting that pulsed radiofrequency can reduce pain for selected patients.
For less common targets, such as small nerves in the foot, ankle, groin, or around scars, the evidence is often limited to small studies, case series, and specialist experience. In these situations, the decision depends heavily on whether your pain clearly maps to that nerve and whether a diagnostic block supports the target.
When the procedure works, relief may last weeks to months. Some patients have substantial relief, some have partial relief, and some do not improve. This is not a cure for neuropathy, nerve injury, or the underlying reason the nerve became irritated.
Tell us exactly where your pain is located and where it travels. A pain drawing, notes, or photos marking the painful area can be helpful.
Tell us if you have new or worsening weakness, rapidly worsening numbness, fever, unexplained weight loss, cancer history, recent trauma, or a major recent change in your health. These may need separate assessment before a nerve procedure.
Tell us if you have a pacemaker, defibrillator, spinal cord stimulator, deep brain stimulator, peripheral nerve stimulator, or any other implanted electrical device.
Tell us if you take blood thinners, have an active infection, are taking antibiotics, have diabetes, are pregnant or may be pregnant, or have had a previous serious reaction to local anesthetic, contrast dye, antiseptic solution, or steroid medication.
You usually do not need to fast for this procedure unless you are specifically told otherwise.
The procedure itself is usually quick, but the full visit includes check-in, assessment, preparation, and recovery.
Most patients should expect the full appointment to take approximately 60 to 90 minutes, although this can vary depending on clinic flow that day and the complexity of the procedure.
The needle is placed near the nerve, not intentionally through the nerve. If you feel a strong electric shock, new weakness, or severe pain during needle placement, tell us immediately.
Most patients describe:
Local anesthetic is used to reduce discomfort. We generally want you awake enough to report what you are feeling, because your feedback helps with safety and accuracy.
You may do normal light activity after the procedure. Avoid unusually strenuous activity for the rest of the day.
Do not drive until any numbness, weakness, heaviness, lightheadedness, or altered sensation has fully resolved.
Do not judge the procedure only by the first few hours afterward. The effect can take time to develop.
If the procedure helps, use the improved pain window to gradually increase the activities, rehabilitation, desensitization work, or strengthening plan recommended for your condition.
Some patients notice improvement within days. For others, improvement may take 1 to 3 weeks.
It is common to have temporary soreness or a pain flare before the benefit becomes clear.
The amount and duration of relief varies. A reasonable expectation is weeks to months of benefit when the procedure works, but individual results vary widely.
The next step depends on how much relief you have, how long it lasts, and whether your function improves.
If your pain improves significantly, we may monitor your response and focus on rehabilitation, gradual return to activity, or other treatment directed at the underlying cause of the nerve irritation.
If your pain returns after a period of meaningful relief, repeat treatment may be considered depending on the nerve, your response, and your overall treatment plan.
If your pain does not improve, we would usually reassess the diagnosis. The pain may be coming from a different nerve, a joint, a tendon, the spine, or a more complex pain process.
Keep the needle site dry for 24 hours. Remove bandages after 24 hours.
Pulsed radiofrequency neuromodulation for peripheral nerve pain is generally a low-risk procedure when performed with image guidance and sterile technique, but the risks depend on which nerve is being treated.
The most common issues are temporary soreness, bruising, lightheadedness, temporary increase in pain, temporary numbness, or temporary irritated-nerve discomfort.
Uncommon risks include bleeding, infection, allergic reaction, medication entering a blood vessel, temporary weakness, persistent numbness, persistent worsened nerve pain, or nerve injury.
Some nerve targets are close to important structures such as blood vessels, tendons, joints, the lung, bowel, bladder, or other nerves. Location-specific risks will be reviewed with you when they apply.
Seek medical attention if you develop fever, worsening redness or swelling at the needle site, drainage from the needle site, severe worsening pain, new weakness that does not settle, chest pain, shortness of breath, or any symptom that feels concerning.
The procedure itself, including the clinic visit and image guidance when used, is covered by OHIP.
OHIP does not cover the cost of medications used or prescribed, such as local anesthetic, steroid medication, contrast dye, or other medications. These costs may be covered by private insurance.
The medication cost is usually in the range of $25 to $100, depending on the extensiveness of the procedure, but this may vary.
Unless you are told otherwise, you may usually take your regular medications. Blood thinners require separate review.
Tell us before the procedure if you take blood thinners or antiplatelet medications. Do not stop them on your own. We will give you specific instructions based on the medication, the nerve being treated, and your medical history.
Tell us before the procedure if you have ever had an allergy or serious reaction to contrast dye, local anesthetic, steroid medication, or antiseptic skin-cleaning solution.
Tell us if you have diabetes, an active infection, are taking antibiotics, are pregnant or may be pregnant, have an implanted electrical device, or have had a recent major change in your health.
Afiya Spine & Pain Institute
301 - 15 Wellesley St W, Toronto, ON M4Y 1G1
Phone: 416-413-7999 | E-Fax: 416-641-4520
For questions or concerns after your procedure, contact the clinic.