Treating the Joint vs. Treating the Nerve
Cortisone injections and nerve blocks are both used for pain management, but they work in fundamentally different ways. Cortisone goes into the joint to reduce inflammation. Nerve blocks target the nerves carrying pain signals to interrupt the message before it reaches your brain.
Understanding this difference is critical because the right choice depends entirely on what is causing your pain. An inflamed joint and a pinched nerve call for different solutions.
Side-by-Side Comparison
| Factor | Nerve Blocks | Cortisone Injections |
|---|---|---|
| What it targets | Specific pain-carrying nerves | Inflamed joint tissue |
| How it works | Numbs or disrupts nerve signal | Reduces joint inflammation |
| Speed of relief | Often immediate (minutes) | 24-72 hours |
| Duration | Hours to months (varies by type) | 4-12 weeks |
| Best conditions | Nerve pain, spine, diagnostic | OA, bursitis, tendinitis |
| Medicare coverage | Yes | Yes |
| Imaging guidance | Usually required (fluoroscopy/ultrasound) | Often not needed |
| Cost with insurance | $100-$500 copay | $20-$150 copay |
| Procedure setting | Often outpatient surgical center | Doctor’s office |
| Repeat frequency | Varies by type (some repeated regularly) | 3-4 per joint per year max |
Cortisone Injections: Calming Joint Inflammation
What It Is
Cortisone is a corticosteroid injected directly into the joint space or surrounding tissue. It reduces the inflammatory chemicals that cause pain, swelling, and stiffness.
Best Used For
Limitations
Nerve Blocks: Interrupting Pain Signals
What It Is
A nerve block is an injection of local anesthetic (and sometimes a steroid) near specific nerves to block pain signals. Types include diagnostic blocks (short-acting, to identify the pain source), therapeutic blocks (longer-acting, for treatment), and ablation procedures (which use heat or cold to disable nerves for months).
Types of Nerve Blocks
Best Used For
Limitations
The Evidence: Different Tools for Different Problems
When Research Supports Each Option
Cortisone injections have strong evidence for:
- Short-term pain relief in knee, hip, and shoulder OA
- Bursitis and tendinitis management
- Acute inflammatory flare-ups
Nerve blocks have strong evidence for:
- Facet joint pain in the spine (medial branch blocks + RFA)
- Genicular nerve blocks for knee OA (growing evidence)
- Diagnostic confirmation of pain source
- Pain management when joint injections have failed
A Growing Role for Genicular Nerve Blocks: Recent research has shown that blocking or ablating the genicular nerves around the knee can provide significant pain relief for knee OA patients, especially those who have not responded well to cortisone or HA injections. A 2019 study in JAMA found genicular nerve RFA provided meaningful pain reduction lasting 6-12 months.
Cost Comparison
| Scenario | Nerve Block | Cortisone Injection |
|---|---|---|
| With Medicare | $100-$500 copay | $20-$50 copay |
| With private insurance | $150-$500 copay | $30-$150 copay |
| Facility fees | Often additional (surgery center) | Usually none (office-based) |
| Imaging guidance fees | $200-$500 additional | Not typically needed |
Who Should Consider Each Option?
Cortisone Is Right For:
Nerve Blocks May Be Better For:
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How to Choose a ProviderFrequently Asked Questions
Can I get both a nerve block and a cortisone injection?
Yes. They target different things, so they can complement each other. Some patients receive cortisone in the joint for inflammation and a nerve block for persistent nerve-related pain. Your doctor can determine if both are appropriate for your situation.
Is radiofrequency ablation (RFA) permanent?
No. RFA disables nerves using heat, providing relief for 6-12 months. The nerves eventually regenerate, and pain may return. The procedure can be repeated if it was effective the first time.
Why does my doctor want to do a diagnostic nerve block first?
Diagnostic blocks use short-acting anesthetic to determine if a specific nerve is causing your pain. If the block provides temporary relief, it confirms the pain source and helps your doctor recommend a longer-lasting treatment like RFA.
Are nerve blocks safe for older adults?
Yes. Nerve blocks are generally safe for older adults, including those on blood thinners (with appropriate precautions). The main risks are bruising, infection (rare), and temporary numbness. Discuss your medications with your provider beforehand.
References
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Choi WJ, et al. Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial. Pain. 2011;152(3):481-487.
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Davis T, et al. Prospective, multicenter, randomized, crossover clinical trial comparing genicular nerve radiofrequency ablation for chronic knee pain. Regional Anesthesia and Pain Medicine. 2018;43(1):84-91.
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McAlindon TE, et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain. JAMA. 2017;317(19):1967-1975.
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Cohen SP, et al. Consensus practice guidelines on interventions for lumbar facet joint pain. Regional Anesthesia and Pain Medicine. 2020;45(6):424-467.
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