- The procedure is performed in a treatment room, under fluoroscopic guidance, with local anesthesia. The patient remains conscious, allowing real-time assessment of responses during the procedure.
- A thin needle is guided to the location of the nerve. Its tip is connected to a high-frequency current generator.
- Unlike conventional thermoablation, where high temperatures (around 80°C) destroy pain-conducting nerve fibers, pulsed radiofrequency uses short current pulses at a lower temperature (42–45°C).
- As a result, the nerve is not damaged but rather "calmed" — the way it conducts pain signals is altered, leading to reduction or complete resolution of pain.
The effect can be compared to "quieting" the nerve so it stops sending erroneous pain signals to the brain.
Advantages of Pulsed Radiofrequency
- Safer than conventional thermoablation — the nerve is not permanently destroyed, reducing the risk of neurological complications (e.g., muscle weakness, sensory disturbances).
- Effectiveness reaches approximately 70% in patients with trigeminal neuralgia.
- The procedure is minimally invasive — no general anesthesia or prolonged hospitalization required.
- It can be repeated multiple times.
- Duration: approximately 20–30 minutes; the patient typically goes home the same day.
- Well tolerated — post-procedure pain is mild and short-lived.
Indications for Pulsed Radiofrequency
The procedure is considered particularly when:
- pharmacotherapy (e.g., carbamazepine, oxcarbazepine, pregabalin) does not provide relief or causes too many side effects,
- the patient does not qualify for conventional thermoablation due to risk of nerve damage,
- trigeminal neuralgia is present — paroxysmal, piercing pain triggered by touch, brushing teeth, or speaking,
- trigeminal neuropathy is present — chronic burning, tingling, or numbness, often following trauma, surgery, or shingles.
Qualification for the Procedure
- Clinical history and neurological examination — the physician carefully analyzes the character of the pain.
- Diagnostic nerve block — before radiofrequency treatment, a trial injection of local anesthetic is administered near the nerve. If pain resolves, it confirms that this nerve is responsible for the symptoms.
- Decision to proceed — if the block was effective, the patient may be qualified for pulsed radiofrequency treatment.
Natalia — since 2014 I've been living with trigeminal nerve pain. I write in plain language, based on reliable sources and personal experience. Read my story →
Frequently Asked Questions
What is trigeminal neuralgia?
Trigeminal neuralgia is a chronic facial pain condition. It manifests as sudden, severe, usually one-sided pain attacks — often described as an electric shock. A single attack typically lasts from a few seconds to about two minutes.
What is the difference between neuralgia and neuropathy?
In simple terms: neuralgia primarily involves paroxysmal pain along a nerve, usually without loss of sensation. Neuropathy involves nerve damage that more often causes constant pain along with numbness and sensory loss.
How does carbamazepine work for trigeminal neuralgia?
Carbamazepine is the first-line medication for trigeminal neuralgia. In a large proportion of patients, it provides effective pain control. It requires gradual dose adjustment and medical supervision.
What is the difference between gabapentin and pregabalin?
Both are anticonvulsant medications used for neuropathic pain. They differ in absorption and dosing characteristics. The choice and dosage should be determined by a physician.
What is postherpetic neuralgia?
This is chronic nerve pain following shingles (herpes zoster), resulting from nerve damage caused by the virus. It is a distinct condition and can be challenging to treat.
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