What medical specialty performs radiofrequency (RF) treatments?

Radiofrequency Treatments: Medical Specialties

Radiofrequency (RF) treatments are primarily performed by interventional pain management physicians, which includes anesthesiologists with pain fellowship training, physiatrists (Physical Medicine and Rehabilitation specialists), and interventional radiologists. 1, 2, 3

Primary Specialties Performing RF Procedures

Pain Medicine/Anesthesiology

• Anesthesiologists with subspecialty training in pain management are the most common practitioners performing RF ablation for chronic pain conditions. 1, 4
• The American Society of Anesthesiologists (ASA) provides specific guidelines for RF procedures, particularly for facet-mediated spine pain and medial branch blocks. 2, 3
• These specialists typically complete fellowship training in pain medicine after anesthesiology residency and may achieve board certification in Clinical Cardiac Electrophysiology (CCEP) or pain medicine through the American Board of Internal Medicine (ABIM). 1

Physical Medicine and Rehabilitation (PM&R)

• Physiatrists perform RF ablation as part of interventional spine and pain management, particularly for mechanical low back pain and facet joint pain. 1
• PM&R specialists often work in multidisciplinary settings and emphasize rehabilitation during the pain relief period following RF procedures. 1

Interventional Radiology

• Interventional radiologists perform RF ablation procedures, particularly for bone metastases and tumor-related pain. 1
• These specialists use image guidance (fluoroscopy, CT, ultrasound) to perform ablative procedures for pain control and prevention of skeletal-related events. 1

Other Specialties Performing Specific RF Applications

Cardiology/Cardiac Electrophysiology

• Cardiologists with electrophysiology training perform RF catheter ablation for cardiac arrhythmias, which is a distinct application from pain management. 1
• This requires specialized training through ACGME-approved programs with minimum case requirements (>100 diagnostic electrophysiology studies per year for maintenance of competence). 1

Otolaryngology (ENT)

• ENT surgeons may perform RF procedures for obstructive sleep apnea, including tongue base RF ablation and soft palate treatments. 1, 5
• These procedures are typically temperature-controlled and performed transorally for airway obstruction. 1

Surgical Oncology

• Oncologic surgeons may utilize RF ablation for bone lesions and metastases as part of cancer pain management. 1

Training and Competency Requirements

Pain Medicine Specialists

• Training must be performed under supervision of board-certified experts in pain medicine or cardiac electrophysiology (for cardiac applications). 1
• Maintenance of competence requires participation in >100 diagnostic procedures per year and ≥30 hours of formal continuing medical education every 2 years. 1
• Procedures should be performed under fluoroscopic (X-ray) guidance following good practice guidelines from specialty societies. 1

Key Procedural Considerations

• RF procedures for spine pain require proper patient selection, including positive response to diagnostic medial branch blocks (80% improvement) before proceeding to ablation. 2, 3
• The American Society of Anesthesiologists recommends blocking no more than three facet joint levels bilaterally in a single session. 3
• Specialists must understand management of patients with implanted devices (cardiac devices, spinal cord stimulators, intrathecal pumps) due to electromagnetic interference risks. 4

Common Clinical Applications by Specialty

Pain Medicine Applications

• Facet-mediated low back pain, cervical pain, and thoracic pain 1, 2
• Sacroiliac joint pain 1
• Discogenic pain (limited evidence) 1
• Major joint pain (knee, hip, shoulder) 6
• Chronic headaches and facial pain 6

Oncology Applications

• Bone metastases pain control 1
• Prevention of skeletal-related events 1

Cardiac Applications

• Supraventricular and ventricular arrhythmias 1
• Accessory pathway ablation 1

Important caveat: While multiple specialties may perform RF procedures, the specific anatomical target and clinical indication determine which specialist is most appropriate. For spine and musculoskeletal pain, interventional pain specialists (anesthesiology or PM&R) are preferred; for cardiac arrhythmias, cardiac electrophysiologists are required; for sleep apnea, ENT surgeons are appropriate. 1