Steroid Use Significantly Reduces Pain After Radiofrequency Neurotomy

Radiofrequency neurotomy (RFN), the burning of nerve fibers innervating the stabilization joints of the spine, is widely used to provide long-term relief for chronic neck and lower-back pain in well-selected patients. The most common side effect of RFN is post-neurotomy neuropathic pain (PNN), a sensation of burning, numbness, and shooting around the area of the neck or back where the needles were placed. Although many practitioners administer steroids after RFN to prevent PNN symptoms from occurring, no study to date has proven true benefit. A new randomized, placebo-controlled, double-blind study sought to answer whether steroids are effective to prevent PNN. Alexander Shustorovich, Tariq AlFarra, Aaron T. Arel, Jaspal R. Singh, Ryan T. Roemmich, and Akhil Chhatre of Johns Hopkins University School of Medicine, Baltimore, MD received a Resident/Fellow Travel Award from the American Society of Regional Anesthesia and Pain Medicine (ASRA) for its 20th Annual Pain Medicine Meeting, being held November 18-20, 2021. The authors will present Abstract #2299, “Dexamethasone Effectively Reduces the Incidence of Post-Neurotomy Neuropathic Pain: A Randomized Controlled Pilot Study,” on Friday, November 19.

Shustorovich et al. enrolled patients who were to receive RFN on both sides of the neck or back. One side was randomized to receive the steroid dexamethasone after RFN, while the other received salt water as placebo. At 4- and 8-week time points, the steroid group had statistically significant reduction in PNN compared to the placebo group. Although this study provides evidence to support steroid use after RFN, replication is needed in different settings and with other types of steroids.

“This protocol can be feasibly conducted in an effective and resource-efficient manner. However, additional research is needed to increase the power of the study,” Shustorovich et al. said.

ASRA is a professional member organization of more than 5,000 physicians and healthcare providers across the United States and the world. The vision of ASRA is to relieve the global burden of pain. ASRA is dedicated to advancing the science and practice of regional anesthesia and pain medicine to improve patient outcomes through research, education, and advocacy. Learn more at www.asra.com.