Radiofrequency Neurotomy vs Cortisone Injections: Which is right for you?
If you've been dealing with chronic pain—especially in your back, neck, or joints—you've probably heard about different treatment options. Two that come up often are radiofrequency neurotomy (also called radiofrequency ablation or RFA) and cortisone injections.
Both can be incredibly effective at reducing pain. But they work in different ways, last for different lengths of time, and are suited to different types of pain conditions.
So how do you know which one is right for you?
Let's break it down in plain language, so you can have a more informed conversation with your doctor about what might work best for your situation.
What Are Cortisone Injections?
Cortisone injections are one of the most commonly used treatments for pain caused by inflammation. Cortisone is a type of corticosteroid—a powerful anti-inflammatory medication that's injected directly into or near the area that's causing you pain.
How they work: The injection reduces swelling and inflammation around joints, nerves, or soft tissues. When inflammation goes down, pain often goes down with it.
What they're used for:
Arthritis in the knee, hip, shoulder, or spine
Sciatica and nerve root irritation
Tendonitis or bursitis
Facet joint pain in the spine
Flare-ups of inflammatory conditions
How long they last: Results vary from person to person. Some people get relief for a few weeks, others for several months. The effect isn't permanent, and repeat injections may be needed over time.
What to expect: The procedure is quick—usually done in a clinic or day procedure setting. You might feel some soreness for a day or two afterward, but most people can return to normal activities fairly quickly.
What Is Radiofrequency Neurotomy?
Radiofrequency neurotomy (RFN) is a more advanced procedure that uses heat to interrupt pain signals from specific nerves. It's sometimes called radiofrequency ablation, or RFA for short.
How it works: A thin needle is guided to the nerve that's sending pain signals to your brain. A small amount of radiofrequency energy (think controlled heat) is applied to the nerve, which temporarily stops it from transmitting pain. The nerve isn't cut or removed—it's just "turned off" for a period of time.
What it's used for:
Chronic facet joint pain in the neck or lower back
Pain that hasn't responded well to other treatments
Sacroiliac joint pain
Certain types of knee or hip arthritis pain
Occipital neuralgia (a specific type of headache)
How long it lasts: This is where RFN really stands out. Pain relief can last anywhere from six months to two years—sometimes even longer. Because the nerve eventually regenerates, the procedure can be repeated if needed.
What to expect: RFN is usually done as an outpatient procedure. You'll be given local anaesthetic to numb the area, and the procedure itself takes about 30 to 60 minutes. Some people feel sore or have temporary increased pain for a few days afterward, but most notice improvement within one to three weeks.
So What's the Main Difference?
Here's the simplest way to think about it:
Cortisone injections calm down inflammation. They're great for conditions where swelling is the main driver of pain. They work relatively quickly, but the relief is temporary.
Radiofrequency neurotomy targets the nerve itself. It's designed for pain that comes from a specific nerve or joint, and it offers longer-lasting relief—but it takes a bit longer to work.
Which One Is Right for You?
The honest answer? It depends on your specific condition, your pain history, and what's actually causing your pain.
Here are some general guidelines:
You Might Be a Good Candidate for Cortisone Injections If:
Your pain is caused by inflammation (like arthritis or tendonitis)
You're having a flare-up and need faster relief
You haven't tried injections before and want to see if they help
Your pain is in a joint, bursa, or around an inflamed nerve root
You're not quite ready for a more involved procedure
You Might Be a Good Candidate for Radiofrequency Neurotomy If:
You have chronic facet joint pain in your spine
Cortisone injections helped, but the relief didn't last long enough
Diagnostic nerve blocks confirmed that a specific nerve is the source of your pain
You want longer-lasting relief without ongoing injections
You've already tried conservative treatments like physiotherapy or medication
It's also worth knowing that these treatments aren't mutually exclusive. Some patients start with cortisone injections to see if reducing inflammation helps. If it does but doesn't last, that can actually be a sign that radiofrequency neurotomy might offer more durable relief.
How Do You Know Which Nerve Is Causing the Pain?
Great question. Before performing radiofrequency neurotomy, your pain specialist will usually do what's called a diagnostic nerve block. This is a test injection that temporarily numbs a specific nerve to see if your pain improves.
If the nerve block gives you significant relief—even if it's just for a few hours—that's a strong indicator that RFN could work well for you. Think of it as a trial run.
Are There Risks or Side Effects?
Both procedures are generally safe when performed by experienced pain specialists, but it's important to know what to expect.
Cortisone injection side effects:
Temporary soreness or swelling at the injection site
A small risk of infection (very rare)
Temporary increase in blood sugar levels (important for people with diabetes)
Possible thinning of soft tissues or skin discolouration with repeated injections in the same spot
Radiofrequency neurotomy side effects:
Soreness or bruising at the needle site
Temporary increase in pain (usually improves within a week or two)
Numbness or tingling in the area (usually temporary)
Very rare risk of nerve damage or infection
Your pain specialist will walk you through the risks and benefits based on your individual health and pain condition.
What Happens If One Doesn't Work?
If you try cortisone injections and they don't help, that doesn't mean you're out of options. It just means inflammation might not be the main driver of your pain—or that a different approach, like radiofrequency neurotomy, might be more effective.
Similarly, if RFN doesn't provide the relief you were hoping for, your pain specialist can explore other treatments, such as different types of nerve blocks, regenerative therapies like PRP, or even spinal cord stimulation for more complex pain.
Pain management is rarely one-size-fits-all. The goal is to find the right combination of treatments that works for your body and your pain.
Can You Have Both?
Yes, and in some cases, combining treatments makes sense. For example, cortisone injections might be used to manage pain while you're waiting for radiofrequency neurotomy to take full effect. Or you might have RFN for one type of pain and injections for another area.
Your pain specialist will help you map out the best strategy based on your diagnosis and treatment goals.
The Bottom Line
Both radiofrequency neurotomy and cortisone injections are proven, effective treatments—but they're designed for different situations.
Cortisone injections are often the first step for inflammatory pain. They work quickly and can provide meaningful short- to medium-term relief.
Radiofrequency neurotomy is a longer-term solution for nerve-related pain, especially when other treatments haven't lasted as long as you'd hoped.
The best way to know which one is right for you is to have an honest conversation with a pain specialist who can assess your condition, review your treatment history, and recommend a plan that's tailored to your needs.
We're Here to Help You Find the Right Treatment
At Metro Pain Group, we've spent over 30 years helping people across Melbourne manage chronic pain—and we know that no two patients are the same. That's why we take the time to really understand your pain, explore all your options, and create a treatment plan that's built around your goals.
Whether cortisone injections, radiofrequency neurotomy, or another approach is the right fit for you, we'll walk you through every step of the process with clarity, compassion, and clinical expertise.
If you're tired of living with pain and you're ready to explore what's possible, we're here to help.
Call us at (03) 7049 4468 or book online to schedule a consultation with one of our experienced pain specialists. We're located at Monash House Private Hospital in Clayton, and we're ready to partner with you on your journey toward lasting relief.
You don't have to figure this out alone. Let's find the right solution together.
Metro Pain Group
Experts in interventional pain management
Monash House Private Hospital, Clayton