Continuous radiofrequency (CRF) ablation has been utilized in the treatment of chronic pain since 1974. Pulsed radiofrequency (PRF) emerged as a way to treat pain generators without the destructive effects associated with CRF. While the complete mechanism of action of PRF is not understood, the proposed mechanisms are the induction of long-term depression of synaptic potentials which modulate c-fiber transmission. This in turn decreases/inhibits ERK activation. These signal changes in the spinal/dorsal horn processing of nociceptive signals are noted as well as a decrease in inflammatory mediators. Pulsed RF is technically simpler than thermal RF and potentially has a lower risk profile. Conventional thermal RF and pulsed RF differ in mechanism and effect: thermal RF produces a tissue lesion; pulsed RF does not. Thermal RF ablation has proven efficacy; pulsed RF efficacy is limited based on the neural target and available primary literature.