Pulsed radiofrequency (PRF)

Pulsed radiofrequency is a minimally invasive or transcutaneous technique that delivers short bursts of electromagnetic energy without causing thermal destruction.

Unlike continuous radiofrequency ablation, which produces heat to destroy nerve tissue, PRF delivers controlled pulses that generate an electromagnetic field without causing structural damage. This means that the targeted area remain intact, but their abnormal activity is “reset,” leading to pain relief.

At the cellular level, PRF has been shown to reduce oxidative stress — an imbalance between reactive oxygen species (ROS) and the body’s antioxidant defenses. Oxidative stress fuels inflammation and sensitizes pain pathways, making pain persistent even after the original injury has healed. By lowering oxidative stress, PRF decreases the production of pro-inflammatory cytokines, reduces glial cell overactivity and promotes a shift toward anti-inflammatory immune responses. This mechanism interrupts the cycle of oxidative stress and inflammation, which is a cornerstone of many chronic pain conditions.

PRF also stabilizes ion channel activity in neurons, reducing their tendency to fire abnormally, and influences neuroplasticity by calming overexcited circuits in the dorsal root ganglion and spinal cord. Together, these actions modulate both peripheral and central pain processing, creating a more balanced nervous system response to stimuli.

Clinically, PRF can be applied in two main ways:

• Invasive PRF: an needle is placed near a target structure such as a dorsal root ganglion  or peripheral nerve under imaging guidance. This is often used for neuropathic pain, radiculopathy or facet-mediated spinal pain.

• Transcutaneous PRF (TcPRF): electrodes are placed on the skin to deliver PRF fields. This treatment is applied mostly on joints such as knees, shoulders, elbows or hips. TcPRF is non-invasive, repeatable and has shown promise in pain syndromes whereby inflammation plays a pivotal role.

Both approaches are safe, with very low complication rates and are well-tolerated by patients.
Outcomes are typically evaluated with standardized measures such as the Numeric Rating Scale (NRS) or Visual Analog Scale (VAS) for pain intensity, alongside functional and quality-of-life assessments.

Because PRF reduces oxidative stress, decreases inflammation and restores balance in neural signaling without causing tissue destruction, it is increasingly seen as a bridge between conservative care and destructive interventions — making it a valuable tool in modern pain medicine.