We reported an alternative therapy for 2 cases respectively with acute and old thoracic compression fracture and persistent back pain. A 94-yearold woman who had multiple comorbidities suffered from severe pain that was caused by an acute thoracic spine compression fracture. The other patient was an 89-year-old man with an old thoracic compression fracture for 2 years. Neither of them could have satisfactory pain relief by the conservative treatments. Surgical intervention was also not considered. Cooled radiofrequency ablation was applied to both patients’ thoracic facet joints. The 2 patients’ back pain improved considerably after the ablation. Cooled radiofrequency ablation over thoracic facet joints could be a pain management alternative for relieving thoracic compression fracture-related pain. Key words: Compression fracture, thoracic vertebra, cooled radiofrequency denervation, facet joint, comorbidity