Reduction of opioid intake after cooled radiofrequency denervation for sacroiliac joint pain: a retrospective evaluation up to 1 year

Abstract

Background: Opioids can present intolerable adverse side-effects to patients who use these analgesics to mitigate chronic pain. In this retrospective analysis, cooled radiofrequency (CRF) denervation was evaluated to provide pain and disability relief and reduce opioid use in patients with sacroiliac joint (SIJ) derived low back pain (LBP). Methods: Twenty-seven patients with pain from SIJ refractory to conservative treatments, and taking opioids chronically (> 3 mo), were included. Numeric rating scale (NRS) and Oswestry disability index (ODI) scores were collected at 1, 6, and 12 months post-procedure. Opioid use between baseline and each follow-up visit was compared for the entire group and for those who experienced successful (pain reduction ≥ 50% of baseline value) or unsuccessful CRF denervation. Results: Severe initial mean pain (NRS score: 7.7 ± 1.0) and disability (ODI score: 50.1 ± 9.0), and median opioid use (morphine equivalent daily dose: 40 ± 37 mg) were significantly reduced up to 12 months post-intervention. CRF denervation was successful in 44.4% of the patients at 12 months. Regardless of procedure success, patients demonstrated similar opioid reductions and changes in opioid use at 12 months. Two patients (7.4%) experienced neuritis following CRF denervation. Conclusions: CRF denervation of the SIJ can safely elicit pain and disability relief, and reduce opioid use, regardless of intervention success. Future studies may support CRF denervation as a dependable therapy to alleviate opioid use in patients with SIJ-derived LBP and show that opioid use measurements can be a surrogate indicator of pain.

Retrospective Study of the Analgesic Effect of Sacroiliac Joint Radiofrequency Denervation

“…In the classic RF probe, the posterior curvature is not suitable for all sacral bone conformations, making positioning and ablation difficult. In addition, the probe cannot reach the L5 dorsal ramus from a single insertion point (9). Pulsed RF is the least frequently indicated approach for the SIJ because it does not create a nerve lesion; however, in both the present study and a previous study (10), a good result was obtained.…”

“…No complications were reported in this study and the adverse effects were mild. The possible complications reported in the literature are infection, hematoma, nerve injury, thromboembolism, secondary weakness, neuritis during the first week, dysesthesia and hypoesthesia in the buttocks, and temporary worsening of pain 5 to 10 days after the procedure (3,9) Cooled RF has a lower risk of tissue necrosis than conventional RF because it uses a lower temperature than the conventional technique (2).…”

Practical Advices for Treating Chronic Pain in the Time of COVID-19: A Narrative Review Focusing on Interventional Techniques

“…Interventional pain procedures reduced opioid consumption [ 52 ], which is a cause of immune-suppression, which predisposes individuals to develop COVID-19 disease. Furthermore, interventional procedures can improve the quality of analgesia, provided that they are provided judiciously through evaluation on a case-by-case basis, ideally involving interdisciplinary team discussion [ 53 , 54 ].…”

Comparative Randomized Study between Pulsed Radiofrequency and Suprascapular Nerve Block for the Treatment of Chronic Shoulder Pain

“…These complications have been reported after RF in the sacroiliac joint using the conventional 5,6 and cooled technique. 6 Complications such as nerve damage, muscle weakness, neuritis, dysesthesia, and hypoesthesia are seen after conventional and cooled RF, which causes damage, while pulsed RF is associated with less nerve damage. Pulsed RF presents minimal risks when compared to neurolytic techniques, and is considered a safe procedure for these patients.…”

“…Possible complications of RF injury reported in the literature are infection, hematoma, thromboembolism, and temporary worsening of pain after 5 to 10 days. These complications have been reported after RF in the sacroiliac joint using the conventional 5,6 and cooled technique 6 . Complications such as nerve damage, muscle weakness, neuritis, dysesthesia, and hypoesthesia are seen after conventional and cooled RF, which causes damage, while pulsed RF is associated with less nerve damage.…”