Are steroids used in nerve ablation? Unpacking the Pharmacology

Nerve ablation is a minimally invasive procedure used to treat chronic pain, such as that from spinal arthritis [1.10.1]. The critical question for many patients is: Are steroids used in nerve ablation? The answer is nuanced, as steroids are not the ablative agent but play a frequent adjunctive role.

Quick Summary

Steroids are not the primary agent in nerve ablation but are often used adjunctively. They may be included in diagnostic nerve blocks before the procedure or administered after to manage inflammation and post-procedural pain.

Key Points

• Not an Ablative Agent: Steroids are anti-inflammatory drugs, not the primary agent used to destroy nerve tissue in an ablation procedure [1.5.3].

• Diagnostic Tool: Steroids are commonly used with an anesthetic in diagnostic nerve blocks before an ablation to confirm the pain source [1.6.1, 1.6.3].

• Adjunctive Use is Debated: Some clinicians inject steroids during or after radiofrequency ablation (RFA) to reduce inflammation, but recent studies show no significant long-term benefit [1.2.2, 1.2.3, 1.2.5].

• Post-Procedure Treatment: Oral steroids may be prescribed to manage post-ablation neuritis (nerve irritation) after the procedure is complete [1.5.1].

• Ablation vs. Block: A nerve block is a temporary, diagnostic procedure often using steroids, while ablation is a long-term treatment that destroys nerve tissue using heat, chemicals, or cold [1.7.3, 1.11.3].

Understanding Nerve Ablation and its Purpose

Nerve ablation, also known as neurotomy or rhizotomy, is a medical procedure designed to provide long-term pain relief by disrupting nerve function [1.7.3]. It involves applying a physical or chemical agent to a targeted nerve to stop it from sending pain signals to the brain [1.8.1, 1.11.4]. This technique is commonly used for chronic pain conditions that have not responded to more conservative treatments like physical therapy or oral medications [1.6.1, 1.7.4]. The most frequent applications are for pain originating in the facet joints of the spine (spondylosis) and the sacroiliac joints, which can cause chronic neck, back, or buttock pain [1.7.1, 1.10.1, 1.10.3]. The pain relief from a successful ablation can last from several months to over a year [1.7.1, 1.11.2].

Types of Nerve Ablation

There are several methods a physician can use to perform nerve ablation, each using a different modality to disrupt the nerve.

• Radiofrequency Ablation (RFA): This is the most common form, also called radiofrequency neurotomy [1.7.1]. It uses heat generated by radio waves to create a precise burn (lesion) on the target nerve, interrupting its ability to send pain signals [1.7.3]. A special needle delivers an electrical current to the tissue [1.7.1].
• Chemical Neurolysis: This method involves injecting a chemical agent, such as a high concentration of alcohol or phenol, to destroy nerve tissue [1.8.1, 1.8.4]. It's a targeted way to poison the nerve and stop pain transmission [1.8.2].
• Cryoablation (Cryoanalgesia): This technique uses extreme cold to freeze and damage the targeted nerve [1.9.1]. A cryoprobe delivers liquid nitrogen or argon gas, which lowers the temperature of the nerve and damages its protective outer layer, preventing it from sending pain signals [1.9.1].

The Role of Steroids: Before, During, and After Ablation

The central question is whether steroids are used in these procedures. Corticosteroids are powerful anti-inflammatory medications [1.5.3]. They are not the ablative agent itself—they do not destroy the nerve. Instead, their use is adjunctive and controversial, with different applications throughout the treatment process.

Before Ablation: The Diagnostic Nerve Block

Before a patient is approved for nerve ablation, they must undergo one or more diagnostic nerve blocks to confirm the source of their pain [1.6.3, 1.6.4, 1.6.5]. This is a crucial step. A physician injects a local anesthetic (like lidocaine) near the suspected nerve [1.6.2]. Often, a steroid is included in this injection to provide a stronger anti-inflammatory effect [1.4.1]. If the patient experiences significant, temporary pain relief from this block, it confirms that the targeted nerve is the pain generator, making them a good candidate for the longer-lasting ablation procedure [1.6.3]. In this context, steroids are integral to the diagnostic phase that precedes ablation.

During and After Ablation: A Matter of Debate

It has been a common practice for some clinicians to administer steroids, often with a local anesthetic, at the site of a radiofrequency ablation procedure [1.2.2]. The rationale is to reduce local inflammation caused by the procedure and to potentially lessen post-procedural pain, a condition sometimes called post-neurotomy neuritis [1.2.1, 1.2.2, 1.3.4]. This is an uncomfortable, burning pain that can occur after the nerve is treated.

However, the efficacy of this practice is heavily debated in the medical community. Several recent studies have concluded that adding steroids during or after RFA provides no significant additional benefit in terms of pain relief or improved function compared to RFA alone [1.2.2, 1.2.3, 1.2.5, 1.3.1]. One 2024 study found that while both groups (with and without steroids) saw significant pain reduction, there was no statistical difference between them [1.2.2]. Another study suggested that injecting steroids before the radiofrequency energy is applied might even have a negative impact by reducing the size of the lesion created, potentially decreasing the procedure's success rate [1.2.4]. For post-ablation neuritis, a short course of oral corticosteroids may be recommended to calm the nerve inflammation after the fact [1.5.1].

Comparison: Nerve Block vs. Nerve Ablation

To clarify the different roles, it's helpful to compare a diagnostic/therapeutic nerve block with a nerve ablation procedure.

Feature	Diagnostic/Therapeutic Nerve Block	Nerve Ablation (e.g., RFA)
Primary Purpose	Diagnose the source of pain and provide short-term relief [1.6.5].	Provide long-term pain relief [1.7.3].
Mechanism	Anesthetic numbs the nerve; steroid reduces inflammation [1.4.1, 1.11.3].	Heat, chemical, or cold destroys or injures the nerve to stop signals [1.7.3, 1.8.1, 1.9.1].
Key Agents Used	Local Anesthetic (e.g., Lidocaine) and often a Corticosteroid [1.4.1].	Radiofrequency energy, alcohol/phenol, or liquid nitrogen. Local anesthetic is used for numbing the skin [1.4.2, 1.4.5].
Use of Steroids	Commonly included in the injection mixture [1.3.5, 1.4.1].	Not the primary agent. May be injected adjunctively, but efficacy is debated and not standard practice [1.2.2, 1.2.3].
Duration of Relief	Hours to a few weeks [1.4.1, 1.11.3].	6 months to over a year [1.7.1, 1.11.3].

Conclusion

In summary, while steroids are frequently involved in the overall treatment plan for chronic pain that leads to nerve ablation, they are not the agent that performs the ablation itself. Their primary, established role is within the preliminary diagnostic nerve blocks required to identify a patient as a suitable candidate for the procedure [1.6.3]. The practice of injecting steroids during or immediately after the ablation procedure is common but controversial, with growing evidence suggesting it offers little to no additional long-term benefit for pain relief [1.2.3, 1.5.4]. Therefore, the answer to "Are steroids used in nerve ablation?" is yes, but primarily as a diagnostic tool and a disputed add-on, not as the core of the therapy.

For more information on the RFA procedure, consider this resource from a leading medical institution:

• Radiofrequency Ablation for Back and Neck Pain - HSS

Frequently Asked Questions

What is the main purpose of a nerve ablation?

The main purpose of nerve ablation is to provide long-lasting pain relief by disrupting specific nerves from sending pain signals to the brain. It is typically used for chronic pain, such as from spinal arthritis, that hasn't responded to other treatments [1.7.3, 1.10.1].

Is a nerve block the same as nerve ablation?

No. A nerve block is a short-term, diagnostic procedure where an anesthetic (often with a steroid) is injected to numb a nerve and confirm it's the source of pain. Nerve ablation is a longer-term treatment that uses heat, chemicals, or cold to destroy the nerve tissue [1.7.3, 1.11.3].

Why are steroids used before a nerve ablation?

Before an ablation, a diagnostic nerve block is performed. This injection often contains a steroid along with a local anesthetic to reduce inflammation and help confirm if that specific nerve is the source of pain. A successful block indicates the patient is a good candidate for ablation [1.6.1, 1.6.5].

Do steroids improve the results of radiofrequency ablation (RFA)?

Current research suggests that adding steroids during or after a radiofrequency ablation does not significantly improve long-term pain relief or physical function compared to RFA alone. Some studies even caution against it [1.2.2, 1.2.3, 1.2.4, 1.2.5].

What is post-neurotomy neuritis?

Post-neurotomy neuritis is increased pain, sometimes described as a burning sensation, that can occur as a side effect after a nerve ablation procedure. It may be treated with medications like oral corticosteroids or nerve-pain specific drugs [1.2.2, 1.5.1].

How long does the pain relief from nerve ablation last?

The duration of pain relief varies but typically lasts from six months to over a year. Nerves can regenerate, and if the pain returns, the procedure can sometimes be repeated [1.7.1, 1.11.2].

What are the different types of nerve ablation?

The main types are radiofrequency ablation (RFA), which uses heat from radio waves; chemical neurolysis, which uses chemicals like alcohol or phenol; and cryoablation, which uses extreme cold to freeze the nerve [1.7.3, 1.8.1, 1.9.1].