Cooled radiofrequency ablation (RFA) is very similar to thermal RFA, except that the nerves remain cool while radiofrequency is applied to the region. This treatment is used to alleviate symptoms of chronic pain in various regions of the body, arthritis of the spine (spondylosis), and inflammation of the sacroiliac joint. During this procedure, needles are inserted into the affected area under fluoroscopic guidance.

Once in place, water will begin running through the tips of the needles, keeping the region cool, as radiofrequency currents are applied to the affected nerve. These currents affect the diseased nerve, disrupting its ability to send pain signals to the brain. Since the area remains cool, this procedure is able to affect a larger area than is possible through thermal RFA. This treatment is only considered following a successful, diagnostic nerve block in the affected area.