Are Steroids Needed After Radiofrequency Ablation? A Summary of a Non-Inferiority Study
Radiofrequency ablation (RFA) uses heat to interrupt pain signals from small nerves that supply the joints of the spine, often in the neck or lower back. Some physicians add a steroid injection at the end of the procedure, hoping to reduce inflammation and soreness afterward. But strong evidence for this practice is lacking, and steroids have risks of their own. A 2025 study in Regional Anesthesia & Pain Medicine asked a simple question: is RFA alone any worse than RFA with steroids?
This summary is based on the published abstract. Read the abstract on PubMed
What the authors did
This was a single-center, prospective, observational study. “Prospective” means patients were enrolled and followed forward in time; “observational” means the researchers did not decide who received steroids.
- Who was included: adults aged 18 or older scheduled for cervical (neck) or lumbar (lower back) RFA.
- Main outcome: average pain on a 0 to 10 scale, 7 days after the procedure.
- Other outcomes: anxiety, depression, and physical function, measured with standard patient-reported questionnaires (PROMIS short forms).
- Timing: questionnaires were completed before the procedure and at 7 and 60 days afterward.
The study used a non-inferiority design, which tests whether one approach is not meaningfully worse than another. The preset margin was 1.5 points on the pain scale.
What they found
- Participants: 365 people completed the baseline assessments; 175 received steroids and 190 did not.
- Pain at 7 days: similar between groups (mean difference, steroid minus no steroid, -0.23 points; 95% confidence interval -0.76 to 0.30). This range fell within the 1.5-point margin, so RFA without steroids was not inferior. A confidence interval is the range in which the true difference likely lies; here, even the edges of that range were well inside the margin.
- Pain at 60 days: also similar (mean difference 0.09; 95% confidence interval -0.48 to 0.65).
- Mood and function: no significant differences in anxiety, depression, or physical function at 7 or 60 days.
The authors conclude that adding steroids to RFA does not appear to provide added benefit and is therefore not worth the additional risks.
Limitations
Patients were not randomly assigned, so other differences between the groups, such as why a physician chose to give a steroid, could affect the results. The study came from a single center, which may limit how widely the findings apply. The abstract does not list the type or dose of steroid used or report specific side effects, so this summary does not cover them. A randomized trial would give stronger evidence.
Safety takeaways
- Routine add-ons deserve a reason. In this study, adding a steroid did not change short-term or 60-day pain, mood, or function.
- Steroids are not risk-free. Using them only when there is a clear benefit is a sound safety principle.
- Evidence can change habits. Common practices are worth re-examining when new data become available.
- Ask before the procedure. Patients can ask whether a steroid will be included, why, and what the alternatives are.
- Share your health history. Tell your care team about diabetes or other conditions that steroids can affect.
Reference
- Williams MR, Philip A, Sheen S, Aujla S, Feng C, Gao S, Kralovic S, Poli J, Ortiz T, Stefanos T, Pennella-Vaughan J, Gewandter JS. Non-inferiority study assessing the utility of postcervical and lumbar radiofrequency ablation steroid use. Reg Anesth Pain Med. 2025 Dec 5;50(12):958-962. DOI: 10.1136/rapm-2024-105501. PMID: 39097327. Abstract: https://pubmed.ncbi.nlm.nih.gov/39097327/
Related: Epidural Steroid Injection Complications
This article is educational information, not legal or medical advice.
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