Adding Steroids Provides No Extra Pain Relief in Cervical and Lumbar Ablation Procedures, Study Finds

Adding steroids to radiofrequency ablation (RFA) does not provide added benefits for postprocedural pain relief in cervical and lumbar regions, according to study results published in Regional Anesthesia & Pain Medicine.

Researchers performed a single-center, prospective, non-inferiority, observational study to determine whether steroids provide any improvement in postprocedural pain relief following RFA of the dorsal rami medial branches for cervical and lumbar facet-mediated pain. The study included 365 patients aged 18 and older scheduled for cervical or lumbar RFA at the University of Rochester Medical Center Pain Treatment Center in New York. The study’s primary outcome was pain intensity at the RFA site 1-week post-procedure, rated on a numeric rating scale of 0-10. Key secondary outcomes include PROMIS Physical Function, anxiety, and depression scales.

There were 175 study participants who received steroids and 190 did not. The average age was 59 years, and 61.4% of those included were women. The primary linear regression analysis showed a difference in 7-day pain intensity scores between the steroid and non-steroid groups of -0.23 (95% CI, -0.76 to 0.30), indicating non-inferiority of the nonsteroid group, as the upper bound of the CI was within the prespecified non-inferiority margin. Sensitivity analyses, including RFA location and separate analyses of lumbar (n=238) and cervical (n=67) subgroups, supported these findings. At 60 days, no significant differences in pain intensity were observed between the groups (adjusted mean difference, 0.09; 95% CI, -0.48 to 0.65), nor were there significant differences in anxiety, depression, or physical function.

Overall, the RFA procedure significantly reduced pain intensity in the study population by 1.8 points at Day 7 (P <.001) and 1.7 points at Day 60 (P <.001). Additionally, RFA improved physical function at both time points (P <.001) and led to reductions in anxiety (P =.025) and depression.

The authors noted that the study was limited by the fact that the treatment was not assigned at random, missing data could have biased the treatment estimates, and adverse events were not recorded.

The study authors concluded, “A randomized clinical trial with a non-inferiority design would provide the gold standard evidence on this topic; however, in the absence of such a study, these data strongly suggest that the benefits of steroids do not outweigh their risks in this context.”

Some study authors reported affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors disclosures.

This article originally appeared on Clinical Pain Advisor