Intercostal neuralgia is a complex and difficult-to-treat condition. We present 2 cases that demonstrate the safe and effective use of thermal radiofrequency ablation (RFA) to achieve significant pain relief.Our first patient was a 62-year-old female who developed chronic chest pain following lumpectomy for breast cancer and failed conservative management. Two intercostal diagnostic nerve blocks were performed with good results. One block provided pain relief for 3 weeks, and the other provided pain relief for 5 weeks. These blocks were followed by RFA that provided excellent improvement in her pain for >1 year. Our second patient was a 67-year-old female with a history of esophageal carcinoma and non-small cell lung cancer. She developed chronic chest pain following surgery and treatment. Conservative management was implemented at first without significant improvement in pain. The patient received intercostal diagnostic blocks that significantly improved her pain. She then underwent RFA for the same nerves and had resolution of her pain at 2-month follow-up.Our cases suggest that thermal RFA can be safely used to treat patients suffering from intercostal neuralgia. This unique treatment has significant implications for chronic pain physicians and warrants additional studies to elucidate its effectiveness, safety profile, and scope of use.