Radiofrequency (RF) ablation of painful bone tumours and metastasis has quickly progressed from an experimental procedure to an established minimally invasive method for pain control. This review will describe the physics behind RF ablation technology. Osteoid osteomas were the first primary bone tumours to be treated in this manner, establishing RF ablation as the treatment modality of choice. A more recent development involves the use of RF ablation in painful bone metastases. In this setting, RF ablation complements radiation therapy. Its advantage lies in a more rapid onset of pain reduction (often at least by 2 points on a 10-point scale), and that radiation therapy can be employed concomittantly. It is important to remember that the aim of RF ablation in painful bone metastases is not curative, but palliation.