Trigeminal neuralgia is the most common form of neuralgia, with recurrent episodes of transient and severe pain confined to one or several branches of the trigeminal nerve. It occurs mostly in adults and the elderly, with an annual incidence of 3-5/100,000 and a prevalence of 182/100,000, and its exact etiology remains unclear. In the early stage of the disease, the main drug treatment is carbamazepine, and the drug dose should be increased gradually during the treatment. For patients who do not respond to drug therapy or who experience significant adverse drug reactions due to increased drug doses, other treatments such as closure therapy, acupuncture, percutaneous trigeminal ganglion destruction (radiofrequency thermocoagulation, balloon compression or glycerol injection), trigeminal nerve microvascular decompression or partial posterior rhizotomy, and gamma knife therapy may be used instead. Comparative studies on the long-term efficacy of trigeminal neuralgia treatment have shown that microvascular decompression and trigeminal ganglion percutaneous radiofrequency thermocoagulation are the most desirable treatments. Microvascular decompression may provide longer pain-free survival with fewer complications and higher quality of life than other surgical options, whereas percutaneous trigeminal ganglion radiofrequency thermocoagulation is more suitable for elderly patients who are less tolerant of open surgery. Transcutaneous trigeminal ganglion radiofrequency thermocoagulation is an effective and safe treatment method. Qilu Hospital of Shandong University has been carrying out this treatment for more than 20 years, and now it has become a characteristic and advantageous treatment project of our hospital. However, the process of this treatment can cause severe pain similar to trigeminal neuralgia attack, which some patients cannot tolerate; in addition, there is a potential risk of cardiovascular accidents due to increased heart rate and blood pressure during the treatment. In order to reduce patients’ pain during the treatment process and reduce the risk of complications of cardiovascular accidents during the treatment process, our neurosurgery department and anesthesia department jointly conducted a clinical study on painless radiofrequency treatment of trigeminal neuralgia. During the treatment process, the patient was firstly sedated and anesthetized with consciousness, then the affected oval foramen puncture was performed, and the puncture process used X-ray assisted localization, and after the successful puncture, the area of trigeminal ganglion was further localized by nerve electrical stimulation, and then radiofrequency thermocoagulation was implemented after the accurate localization. The patient remained awake during the whole process and was able to cooperate with electrophysiological positioning, and the heart rate and blood pressure were able to maintain relative stability. On the one hand, this method can reduce the pain of patients undergoing radiofrequency treatment; on the other hand, due to the adoption of pain-free technology, it can guarantee adequate thermal coagulation and destruction of the trigeminal ganglion during the treatment process, which reduces the interruption of treatment due to the patient’s inability to tolerate pain, and thus can improve the efficacy of the procedure.