Understanding one of the most effective treatments for carefully selected patients with chronic low back pain.

Low back pain is one of the commonest reasons people seek medical help.

For some, the pain settles within a few weeks.

For others, it lingers for months or even years, affecting work, sleep, exercise and everyday life.

One of the questions I am often asked is:

“Is there anything that can actually be done?”

The answer depends on one important thing.

First, we need to understand where your pain is coming from.

Not all back pain is the same

The lower back is made up of many different structures.

Muscles.

Ligaments.

Discs.

Nerves.

Sacroiliac joints.

And the small joints at the back of the spine called facet joints.

These joints help guide movement and keep the spine stable. Like any joint in the body, they can become painful through arthritis, wear and tear, injury or following previous spinal surgery.

When the facet joints are the source of pain, the treatment is often very different from treatments used for slipped discs or trapped nerves.

That is why making the right diagnosis matters.

How do facet joint pains feel?

Although everyone experiences pain differently, people with facet joint pain often describe:

• Pain across the lower back rather than below the knee.

• Stiffness first thing in the morning or after sitting for long periods.

• Pain when standing for prolonged periods.

• Discomfort when leaning backwards or twisting.

• Relief when sitting down or bending slightly forwards.

These symptoms can provide clues, but they do not give us the whole answer.

Why scans don’t always tell the full story

Many people are surprised when their MRI scan shows arthritis but their doctor says it may not explain their pain.

Others have very little visible change on imaging yet experience significant symptoms.

This is because scans show structure, not necessarily pain.

The best diagnosis comes from putting together your story, your examination and, when appropriate, a carefully performed diagnostic injection.

The importance of diagnostic injections

Before considering radiofrequency treatment, we first need to ask an important question.

“Are the facet joints really causing your pain?”

The most reliable way of answering that is by temporarily numbing the tiny nerves that carry pain signals from those joints.

If your usual pain improves significantly while the local anaesthetic is working, we have valuable information.

It tells us we are treating the right target.

This careful selection process is one of the reasons radiofrequency denervation can work so well for the right patients.

What is radiofrequency denervation?

Despite the complicated name, the principle is surprisingly simple.

The painful facet joints are supplied by tiny nerves called the medial branch nerves.

These nerves do not control movement or strength.

They simply carry pain signals from the joints.

Using X-ray guidance, a very fine needle is placed alongside these nerves.

A controlled pulse of heat is then used to interrupt their ability to transmit pain.

The joints themselves are not removed or damaged.

The aim is simply to reduce the pain messages travelling from them.

Does it work?

For carefully selected patients, the answer is often yes.

Radiofrequency denervation is one of the best-supported interventional treatments for facet joint pain.

When the diagnosis is correct, many people experience meaningful reductions in pain, improved mobility and a better quality of life.

Some return to activities they had gradually stopped doing.

Others find they can exercise more comfortably or rely less on pain medication.

Like all treatments, it is not successful for everyone.

But careful patient selection significantly improves the likelihood of a good outcome.

How long does it last?

The treated nerves gradually regenerate over time.

For many people, pain relief lasts somewhere between 9 and 18 months, although this varies considerably from person to person.

If the pain returns in the same pattern and the first treatment worked well, the procedure can often be repeated.

It is part of a bigger picture

I often tell patients that successful pain management is rarely about one treatment.

Radiofrequency denervation can reduce pain and create a valuable window of opportunity.

That window can then be used to become more active, strengthen the muscles supporting the spine, improve confidence in movement and rebuild the activities that matter most.

The goal is not simply to reduce pain.

The goal is to help you get back to living your life.

Could it be right for you?

Not every person with back pain is suitable for radiofrequency denervation.

The treatment works best for people whose pain is genuinely coming from the facet joints, which is why a thorough assessment is so important.

At Wye Sanctuary, every consultation begins by understanding your story.

Only then can we decide together whether radiofrequency denervation, another procedure, rehabilitation, medication optimisation or a different approach altogether is most likely to help.

Because the right treatment begins with the right diagnosis.