The Effect of Adding Steroids on the Efficacy of Pulsed Radiofrequency Treatment in Pudendal Neuralgia: A Retrospective Comparative Study

Abstract

Pudendal neuralgia is a challenging cause of pelvic neuropathic pain, and pulsed radiofrequency ablation (pRFA) is increasingly used as a minimally invasive treatment. Corticosteroids may improve analgesia by lowering neurogenic inflammation; however, evidence supporting additional benefits with pulsed radiofrequency ablation (pRFA) is limited. We retrospectively compared ultrasound-guided pRFA + local anesthetic (LA) versus pRFA + LA + triamcinolone for pain intensity and depressive symptoms.
Materials and Methods
We retrospectively reviewed patients diagnosed with pudendal nerve neuropathy who were treated at the Canakkale Onsekiz Mart University Hospital pain outpatient clinic between January 2021 and June 2025. Group 1 received pulsed radiofrequency ablation plus a local anesthetic (pRFA+LA), and Group 2 received triamcinolone in addition to that (pRFA+LA+triamcinolone). The Numeric Rating Scale (NRS) was used to measure pain pre- procedure,1-hour post-procedure, and at 1 and 3 months. The Beck Depression Inventory (BDI) was used to measure depressive symptoms pre-procedure and at 3 months.
Results
The demographic characteristics were similar across groups. After 3 months, BDI scores decreased significantly in both groups, with the triamcinolone group having lower scores (Group 1: 14.5 [IQR 11-16.5] vs. Group 2: 8 [IQR 7-8.5], p < 0.001). The baseline NRS scores were similar (Group 1: 6.0 [5.0-6.5] vs. Group 2: 6.0 [6.0-7.0], p=0.612). Although the NRS scores were similar following the procedure (p=0.602), Group 2 had lower pain scores at 1 month (4.0 [3.0-4.5] vs 3.0 [2.0-4.0], p<0.001) and 3 months (5.0 [4.0-6.0] vs 3.0 [2.0-3.0], p<0.001).
Conclusion
Adding triamcinolone to transgluteal pulsed radiofrequency ablation with local anesthetic may offer a minimally invasive alternative for patients with pudendal neuralgia experiencing refractory symptoms despite conservative therapy. However, randomized controlled trials are required to confirm effectiveness and safety and to define which patient subgroups may benefit most, including those who are poor candidates for surgery due to comorbidities.