Is The Coolief Procedure Painful?

When nothing else calms down the pain in osteoarthritis, we start thinking about more invasive methods. Do we need surgery? Should I try with injections in the articulation? These procedures often cause severe anxiety because they can be painful or have a troubling recovery period. But have you heard about the Coolief procedure? In this article, we’re introducing you to this innovative procedure for osteoarthritis, letting you know the pros and cons of using this alternative.

What is Coolief, and is it painful?

The Coolief procedure is the short name for Cooled Radiofrequency Neurotomy. We can also call it Cooled Radiofrequency Ablation. It is a way to silence or deactivate the nerves that cause osteoarthritis pain. According to studies, this procedure is an effective way to relieve pain in these patients and improve the range of motion and life quality. It is not an invasive therapy but a minimally invasive procedure instead. In other words, it does not involve any cutting or incisions, but it does involve inserting a small needle.

Before performing the Coolief procedure, your doctor will locate the source of pain precisely and then insert a radiofrequency generator in the form of a small needle. Once inside the skin and precisely located in the trouble nerve, it will start heating the area. The nerve will be blocked entirely, and you will significantly reduce your osteoarthritis pain. This procedure does not take or damage motor nerves, which are required to move the articulation. So, you will have a significant improvement in pain sensation without any loss of function.

This procedure does not need general anesthesia, but your doctor may decide to go with local anesthesia in some cases. It usually takes less than an hour, and then you will be able to resume your day-to-day activities one day after, with no downtime. After the procedure, the trouble nerve may still trigger pain signals for a while. Pain can linger for one or two weeks, but it usually goes away after that time.

The benefits of Cooled Radiofrequency Treatment

As a minimally-invasive option, cooled radiofrequency treatment has many benefits for osteoarthritis patients. It is especially useful in knee pain and appropriate for those who are not candidates for knee replacement surgery. In their case, steroid injections are sometimes their only choice, but these have a risk of making everything worse in the long run, and their benefits are only for the short-term.

Cooled Radiofrequency Treatment (Coolief) is FDA cleared for knee osteoarthritis patients with moderate to severe symptoms. Studies show that it provides more significant and long-lasting pain relief than steroid injections.

We can summarize the benefits as follows:

  • Significant pain reduction: Patients experience up to 93% reduction of pain symptoms. Even patients with severe symptoms have such a remarkable recovery after 6 months.
  • Long-lasting pain reduction: Unlike intra-articular steroid injection, the Coolief alternative gives you a long-term solution to articular pain. In most cases, pain is still controlled after 12 months. That means that you will probably forget about knee pain for one year.
  • Better mobility: Your motor nerves will be spared during the procedure, and your movement function will be preserved. Moreover, you will notice a significant improvement in mobility when pain is not obstructing your range of motion. This improves the patient’s quality of life and the ability to get back to their day-to-day activities.
  • Not invasive: This procedure does not involve any type of incision or cut in your skin. That’s why it is a minimally-invasive procedure. It is an appropriate pain solution for patients who can’t undergo surgery.
  • Fast recovery: This is a minimally-invasive procedure. It does not require downtime, and you will only be recommended to stay at home on the day of the procedure. You can get back to your work the day after without any problem. However, you will feel the pain lingering for a few weeks, and that’s completely normal.
  • Outpatient treatment: You can return home immediately after treatment because it is an outpatient procedure. You won’t be under general anesthesia, and your family does not have to worry about post-operative complications.
  • It does not require opioids: You won’t require opioids or intra-articular steroid injections during those 12 months. Sure, you can use them if the pain still lingers during weeks 1 and 2. But if you ever feel pain once again during those 12 months, it will be easier to manage with over-the-counter medications.
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Are there any side effects?

Coolief is a safe and convenient therapy for knee pain in osteoarthritis patients. However, similar to any other medical procedure, it does have potential side effects. They are very uncommon, but we should be aware of them before deciding to use this method.

The most common side effect is the least serious. Since Coolief uses heat to ablate the nerve, you may have a transient sensation of burning pain at the treatment site. It is somewhat similar to a sunburn, and it is not even common, only reported in 3-5% of cases. It can be a troublesome pain but not severe.

Other temporary side effects include:

  • Swelling or bruising
  • Numbness or muscle spasm
  • Soreness where the needle was inserted

As mentioned, all of these side effects are temporary and not very common. Complications such as bleeding, nerve damage, allergic reactions, and increased pain are even rarer.

Coolief is probably one of the best alternatives if you can’t undergo surgery and are currently experiencing moderate to severe symptoms. Talk to your doctor if this is your case and ask him if you’re a candidate for Coolief treatment.


Ho, K. Y., Hadi, M. A., Pasutharnchat, K., & Tan, K. H. (2013). Cooled radiofrequency denervation for treatment of sacroiliac joint pain: two-year results from 20 cases. Journal of Pain Research6, 505.

Stelzer, W., Aiglesberger, M., Stelzer, D., & Stelzer, V. (2013). Use of cooled radiofrequency lateral branch neurotomy for the treatment of sacroiliac joint-mediated low back pain: a large case series. Pain Medicine14(1), 29-35.

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