The Doctor does it under a scope. The nerve blocks are done to find the exact nerve that is causing the pain. He injects pain medicine into the area to get the right nerve. If it stops the pain he knows exactly which nerve he will destroy. The pain free can last 2 years. And if it grows back and causes pain he will then repeat the ablation ( Burn the Nerve) I just had the 2nd one done 2 day;s ago. Doing good until the ablation procedure.