In the United States, it is estimated that between 6000 and 18,000 individuals each year present with disabling pain after inguinal hernia repair. Although surgical treatment with mesh removal is one of few options available, effective alternatives to nonsurgical management are needed. The use of pulsed radiofrequency (PFR), leading to nondestructive lesions of nerve structures, has been proposed as a treatment option. To examine the evidence of treatment efficacy, a systematic literature search was made. From the databases PubMed, Embase, and CINAHL, 4 case reports were retrieved and 8 patients were included for analysis. The PFR treatment was peripheral (n = 4) and central (n = 4). Pain relief varied between 63% and 100%, the follow-up period was 3 to 9 months, and no adverse effects or complications were reported. In conclusion, the evidence base of PRF in persistent pain after inguinal herniotomy is fairly limited. Suggestions for improved research strategies are presented.