A retrospective cohort study compared the efficacy of pulsed radiofrequency combined with selective nerve root block with dexamethasone palmitate (intervention group, 215 patients) versus oral diclofenac sodium (control group, 342 patients) in 557 patients with a mean age of 55.37 ± 13.70 years suffering from neuropathic pain from lumbar disc herniation. There were no statistically significant differences between the groups in gender, age, course of the disease, lesion segment, or preoperative VAS, ODI, and JOA scores (P > 0.05). After treatment, the intervention group had a significantly lower VAS score (1 week: 2.15 ± 0.951; 1 month: 1.80 ± 0.730; 6 months: 2.07 ± 0.979; 12 months: 2.25 ± 0.947) compared to the control group (1 week: 3.07 ± 1.326; 1 month: 3.67 ± 0.947). 0.933; 6 months: 4.18 ± 1.444; 12 months: 4.23 ± 1.407) as well as better ODI and JOA scores (P < 0.05). Excellent and good rates according to the modified MacNab score were significantly higher in the intervention group than in the control group (P < 0.05). No serious complications or side effects were noted in both groups. The combined method more effectively alleviated pain, improved the quality of life and supported the functional restoration of the lumbar spine.