Back Pain Treatment Without Surgery: Why I Moved Beyond Routine Nerve Burning
- cassis101
- 28 minutes ago
- 5 min read
By Deborah Westergaard, M.D. Dallas | Regen Experts Dallas & Plano
If you've been told that nerve burning—also known as radiofrequency ablation (RFA) or rhizotomy is your next step for chronic back pain, you may wonder whether it is your only option.
For many years, I performed these procedures myself.
Today, I do not.
That decision was not based on a single study or a single patient. It came from years of experience, an evolving understanding of spinal biomechanics, and a growing desire to focus on treatments that strive to address underlying pathology rather than simply interrupt pain signals.
Back Pain Treatment Without Surgery Should Start With the Right Diagnosis
One of the most important lessons I have learned over more than four decades in medicine is that chronic back pain is rarely caused by a single structure.
Pain may arise from:
- Facet joints
- Intervertebral discs
- Ligaments
- Muscles
- Subchondral bone
- Tendons
- Segmental instability
- Multiple overlapping pain generators
When we understand the true source of symptoms, we can make more informed decisions about back pain treatment without surgery and whether a particular intervention is appropriate.
Why I Moved Beyond Routine Nerve Burning
Radiofrequency ablation works by interrupting pain transmission through small medial branch nerves that supply the facet joints.
Many carefully selected patients experience meaningful pain relief, often lasting several months. However, nerves commonly regenerate, and symptoms may return over time. The procedure also does not repair cartilage, ligaments, bone, or other structural contributors to degeneration.
Another consideration is that the medial branch nerves also provide innervation to the multifidus muscle, an important stabilizer of the lumbar spine.
Emerging imaging research has reported changes in the multifidus after lumbar medial branch ablation, including increased fatty infiltration and reduced functional muscle area on follow-up MRI. While additional research is needed to determine the long-term clinical significance of these findings, they contributed to my decision to re-evaluate routine denervation procedures.
My Philosophy About Back Pain Treatment Without Surgery
My current philosophy centers on understanding why the spine hurts before deciding how to treat it.
Whenever appropriate, I prefer strategies that aim to preserve mobility, support normal biomechanics, and evaluate the structural contributors to pain rather than focusing solely on blocking pain signals.
For appropriately selected patients, this may include advanced image-guided orthobiologic procedures using the patient's own biologic materials, rehabilitation, or other individualized non-operative approaches. These treatments are not suitable for everyone, and results vary based on diagnosis and patient-specific factors.
Do I Believe Nerve Burning Has a Role?
Yes.
I do not believe radiofrequency ablation is inherently inappropriate or ineffective.
There are patients who experience worthwhile symptom relief, and there are circumstances in which it may represent a reasonable option after careful evaluation.
However, I no longer perform routine nerve burning procedures in my own practice. For patients who have exhausted other appropriate options or who may still be candidates for radiofrequency ablation, I am happy to discuss referral to trusted colleagues for further evaluation.
What High-Performing Patients Often Want
Many of the executives, professionals, entrepreneurs, and active adults I see are not simply trying to reduce pain for a few months.
They want to:
- Preserve mobility for decades.
- Continue traveling, golfing, skiing, or playing with grandchildren.
- Make evidence-informed decisions.
- Delay or avoid surgery when medically appropriate.
- Invest in long-term function rather than temporary symptom control whenever possible.
Those goals resonate strongly with my approach to back pain treatment without surgery.
Frequently Asked Questions
Why did you stop performing routine nerve burning procedures?
As my understanding of spinal biomechanics and regenerative medicine evolved, I shifted my practice toward approaches that aim to evaluate and address underlying structural pathology rather than routinely interrupt pain transmission.
Does nerve burning work?
For many carefully selected patients, yes. It can provide meaningful pain relief, often for several months. However, pain may recur as nerves regenerate, and the procedure does not repair underlying degenerative changes.
Is nerve burning dangerous?
Like all medical procedures, it has potential risks and benefits. Emerging studies have examined changes in the multifidus muscle following medial branch denervation, but additional research is needed to clarify the long-term clinical implications.
Do you ever recommend nerve burning?
Yes. Although I no longer perform these procedures myself, I may recommend referral for selected patients who have exhausted other reasonable options and understand the potential benefits, limitations, and alternatives.
What do you offer instead?
Every patient deserves an individualized evaluation. Depending on the diagnosis, options may include rehabilitation, conservative management, image-guided orthobiologic procedures, or referral for surgery or other conventional interventions when appropriate.
About Dr. Deborah Westergaard
Dr. Deborah Westergaard is a double board-certified physician with more than 30 years of experience in advanced image-guided spine and musculoskeletal procedures. She focuses on evidence-informed, precision-guided non-surgical care for patients seeking to preserve mobility and optimize long-term function in the Dallas and Plano area.
What Does the Research Say?
Several studies have influenced my decision to move away from performing routine nerve burning procedures.
A 2024 MRI study found that patients who underwent lumbar radiofrequency ablation developed greater fatty infiltration and shrinkage of the multifidus muscle on the treated side compared with the untreated side. The multifidus is an important stabilizer of the spine, although more research is needed to determine the long-term clinical impact.
A large randomized clinical trial published in 2017 reported that adding radiofrequency denervation to an exercise program did not produce clinically meaningful improvements in pain or function compared with exercise alone for many patients with chronic low back pain.
Earlier imaging studies also demonstrated multifidus muscle changes after medial branch denervation, raising questions about whether interrupting these nerves could have unintended effects on spinal support over time.
No single study proves that nerve burning is harmful for every patient, and some individuals do experience worthwhile pain relief. However, taken together, the available evidence and my own clinical experience led me to shift my practice toward evaluating and treating underlying structural problems whenever appropriate rather than routinely interrupting pain signals.
Final Thoughts
Medicine evolves, and physicians should evolve with it.
My decision to move beyond routine nerve burning was driven by a commitment to continually reassess the evidence and pursue approaches that align with long-term mobility, structural preservation, and individualized patient care.
If you are exploring back pain treatment without surgery, the most important first step is obtaining an accurate diagnosis and understanding all reasonable options before deciding on the path that best fits your goals.
Dallas geographic reference: I regularly evaluate patients from Dallas, Preston Center, North Dallas, Plano, and surrounding communities who are seeking evidence-informed, non-surgical approaches to chronic spine conditions.
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