The rami communicantes are small nerve branches that carry pain signals from the disc and front of the spine. When disc-related (discogenic) pain is suspected, targeting these nerves aims to reduce your pain, though individual results vary. There are several treatment options, used only as far as needed:

• Local anaesthetic: numbs the nerve immediately, helping confirm it as a source of your pain.
• Pulsed radiofrequency (pulsed RF): short bursts of energy that calm the nerve without destroying it, aiming for relief lasting weeks to months.
• Thermal radiofrequency (thermal RFA): uses heat to disable the nerve for longer, only considered if pulsed RF relief doesn't last long enough.

This procedure may help if you have:

• Chronic lower back pain believed to be coming from a disc (discogenic pain)
• Pain not explained by facet joint or sacroiliac joint sources
• Not had lasting relief from physiotherapy, medication, or activity modification

It isn't possible to guarantee how any individual will respond. As a general guide:

• Local anaesthetic: works within minutes and wears off after a few hours.
• Pulsed RF: effect usually begins after a couple of weeks and may last for a few months.
• Thermal RFA: full effect typically develops over 6-12 weeks and may last longer, only used if needed.

This procedure is generally considered safe when performed under X-ray guidance, though as with any medical procedure benefit cannot be guaranteed and complications rarely occur. Pulsed RF modulates the nerve rather than destroying it.

Common, minor effects:

• Temporary soreness at the injection site
• Brief flare of your usual back pain before it settles

Rare, more serious risks:

• Infection or bleeding at the injection site
• Nerve injury, which may rarely be permanent
• Allergic reaction to the local anaesthetic or contrast dye
• Small increased lifetime risk from the X-ray exposure used to guide the procedure
• Serious sedation or anaesthetic complications, very rarely including stroke or death
• No improvement in pain, or relief that doesn't last

• Tell us about any blood-thinning medication (e.g. warfarin, Xarelto, Plavix) well in advance — special arrangements may be needed and you may be asked to pause these under guidance
• Tell us if you are, or might be, pregnant — this procedure uses X-ray guidance
• Tell us about any allergies, including to contrast dye, local anaesthetics, or reactions to previous injections or anaesthesia
• You will usually be asked to fast for 6 hours beforehand if sedation is planned
• Bring a list of your current medications
• Arrange for someone to drive you home afterwards

• The skin over the treatment area is cleaned with antiseptic
• Local anaesthetic numbs the skin before the main needle is placed
• Live X-ray (fluoroscopy) guides the needle precisely to each target
• A brief stimulation test checks the needle is correctly positioned
• The procedure usually takes 30-45 minutes

• You will be monitored briefly in recovery before going home
• Some soreness at the injection sites is common for 1-3 days — simple pain relief (e.g. paracetamol) usually helps
• You may remove the small dressing after 24 hours, keeping the area clean and dry
• Avoid strenuous activity or heavy lifting for 24-48 hours
• If you were sedated, avoid driving, operating machinery, or making important legal or financial decisions for 24 hours
• Continue your regular medications unless specifically advised otherwise

Contact your GP, Total Pain Clinic, or your nearest Emergency Department if you notice:

• Increasing redness, swelling, or discharge at the injection site
• Fever or feeling generally unwell
• New weakness, numbness, or loss of bladder/bowel control
• Severe pain not settling with simple pain relief

A review appointment is usually arranged 2-4 weeks after your procedure to discuss how you responded and plan next steps — please call Total Pain Clinic reception to schedule this if it hasn't already been arranged. Please ask your doctor any questions before you proceed; you will be asked to sign a consent form if you agree to go ahead.