Cooled RFA for SI Joints
For patients with chronic SI joint pain, radiofrequency ablation is often discussed after more conservative treatments have failed. One of the big questions, though, is how long the relief actually lasts.
A 2026 multicenter study published in Regional Anesthesia and Pain Medicine gives us useful longer-term data. Researchers followed patients with injection-confirmed SI joint pain who had also responded to prognostic lateral branch blocks. After a single cooled radiofrequency ablation treatment, many patients were still experiencing meaningful improvements in pain, disability, and quality of life 12 months later.
🔥 What is cooled radiofrequency ablation?
Cooled radiofrequency ablation, often shortened to cooled RFA or CRFA, uses radiofrequency energy to create controlled lesions around the nerves that carry pain signals from the SI joint region.
In this study, treatment targeted the L5 dorsal ramus and sacral lateral branches at S1 through S3/4. The goal is not to fuse, stabilize, or repair the SI joint itself. Instead, the procedure aims to reduce pain signaling from the region by treating the nerves that transmit those signals.
The “cooled” part refers to the technology used in the probe. Internal cooling allows the system to create a larger lesion than some conventional radiofrequency techniques, which may help account for normal variation in the location of the small lateral branch nerves.
🧪 Who was included in the study?
The original randomized study included 210 patients with chronic SI joint pain. Patients were not selected based on symptoms alone. Their SI joint pain had first been confirmed through an injection, and they also had to respond to prognostic lateral branch nerve blocks before being considered for cooled RFA.
Participants were initially randomized to either cooled RFA or standard medical management, which could include medications, physical therapy, injections, and integrative treatments. Patients who were unhappy with their results from standard medical management were later allowed to cross over and receive cooled RFA.
Researchers followed patients at multiple points through 12 months and looked at pain, disability, quality of life, and adverse events.
📊 What happened after 12 months?
Among patients originally assigned to cooled RFA who were still being followed at 12 months, average pain scores dropped from 6.4 before treatment to 3.5 at one year.
The researchers also reported that 57.4% of those patients met the study’s pain-response threshold at 12 months. That threshold required at least a 30% or 2-point reduction in average daily pain along with the patient reporting that they felt at least moderately better overall.
The group that later crossed over from standard medical management to cooled RFA showed a very similar pattern. Twelve months after their procedure, average pain scores had dropped from 6.1 to 3.4, and 55.6% met the same pain-improvement threshold.
🚶 Pain wasn’t the only thing that improved
Researchers also measured disability and quality of life, which matters because a lower pain score doesn’t necessarily tell us whether someone is actually functioning better.
At 12 months, both groups showed improvements on the Oswestry Disability Index, a commonly used measure of how low-back pain affects daily activities. Quality-of-life scores also showed clinically meaningful improvement.
That makes the results more useful than a simple “Did your pain go down?” measurement. The study suggests that, for some carefully selected patients, the benefits of cooled RFA may extend into daily function and overall quality of life as well.
⚠️ It did not work for everyone
This is one of the most important parts of the study. A response rate of roughly 57% does not mean cooled RFA works for every patient with SIJD, and it certainly does not mean everyone will get a year of pain relief.
The patients in this trial were also highly selected. They had confirmed SI joint-mediated pain and had already demonstrated a response to lateral branch blocks. Those selection steps matter because RFA treats pain carried by specific nerves. If those nerves are not responsible for someone’s pain, ablating them would be much less likely to help. So these results should not be interpreted as a 57% success rate for every person who has pain near an SI joint.
🧩 RFA treats pain signaling, not the underlying mechanics
Another distinction patients deserve to understand is that cooled RFA is primarily a pain-management procedure.
It does not tighten loose ligaments, correct hypermobility, reverse arthritis, fuse an unstable joint, or otherwise mechanically change the SI joint. Instead, it reduces the ability of selected nerves to transmit pain signals from the area.
For some patients, reducing pain may make it easier to move, participate in rehabilitation, work, sleep, or return to activities that had become difficult. For others, pain may eventually return as nerves recover or regenerate, and some patients may receive repeat procedures when medically appropriate.
🛡️ What about safety?
In this study, researchers reported no serious adverse events related to the cooled RFA procedure during follow-up.
That does not mean the procedure is risk-free. Radiofrequency ablation can still involve temporary soreness, numbness, neuritis or nerve irritation, bleeding, infection, or other complications depending on the patient and procedure. Those risks should be discussed with the treating physician.
🔎 How does this fit with the rest of the research?
This study does not stand completely on its own. A separate 2026 systematic review and network meta-analysis evaluated 18 randomized trials involving 1,075 patients and compared several interventional treatments for SI joint pain, including conventional, cooled, and pulsed radiofrequency techniques, steroid injections, PRP, prolotherapy, sham procedures, and conservative care.
Overall, radiofrequency-based treatments performed better than steroid injections, sham procedures, and conservative treatment for pain in that analysis. Cooled RFA ranked highest for pain relief at one month, while conventional RFA ranked highest at three months and pulsed RFA at six months.
There is an important caveat: the authors rated the certainty of much of that evidence as low to very low because of study limitations and imprecision. So the broader evidence is encouraging, but there is still plenty we need to learn about which RFA technique works best, which patients are most likely to respond, and how durable the benefits are.
💵 One disclosure worth knowing
The 12-month cooled RFA study also reported industry relationships that patients should be able to see when evaluating research.
Several investigators served on the study steering committee for Avanos Medical, which manufactures radiofrequency equipment, and two investigators reported consulting relationships with the company. That does not invalidate the results, but financial relationships are relevant context and one reason replication by independent researchers remains valuable.
💚 What should SIJD patients take from this?
The useful takeaway isn’t that cooled RFA “fixes SIJD for a year.” It is that a single cooled RFA treatment produced sustained pain, disability, and quality-of-life improvements through 12 months in a meaningful portion of carefully selected patients with confirmed SI joint pain. About 57% of the originally treated patients still met the study’s pain-response threshold at one year, while a similar response was seen in patients who later crossed over to receive the treatment.
Combined with newer comparative research showing favorable results for radiofrequency treatments overall, this strengthens the evidence that RFA can be a legitimate treatment option for certain patients with SI joint-mediated pain. It also reinforces something we say a lot around here: patient selection matters.
The right question isn’t simply, “Does RFA work?” It’s “Does RFA make sense for this particular patient’s pain source, anatomy, history, and treatment goals?”
Sacroiliacly yours,
SIJD Hub Team
Research
2026 12-Month Cooled RFA Follow-Up
Cohen SP, Kapural L, Kohan L, et al. Cooled radiofrequency ablation provides extended clinical utility in the management of chronic sacroiliac joint pain: 12-month follow-up results from the observational phase of a randomized, multicenter, comparative-effectiveness crossover study. Regional Anesthesia and Pain Medicine. 2026;51(6):660-669.
PubMed: https://pubmed.ncbi.nlm.nih.gov/40089310/
DOI: https://doi.org/10.1136/rapm-2024-106315
2026 Systematic Review & Network Meta-Analysis
Park JH, Jang JN, Park S, et al. Interventional treatments for sacroiliac joint pain: a systematic review and network meta-analysis. Regional Anesthesia and Pain Medicine. 2026.
PubMed: https://pubmed.ncbi.nlm.nih.gov/41912272/
DOI: https://doi.org/10.1136/rapm-2026-107633
