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Reduction of Opioid Intake After Cooled Radiofrequency Denervation for Sacroiliac Joint Pain: A Case Series Evaluation up to 1 Year
Session: MP-02a
Thurs, Nov. 16, 10 am-12 pm
Hampton Room

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Reduction of Opioid Intake After Cooled Radiofrequency Denervation for Sacroiliac Joint Pain:  A Case Series Evaluation up to 1 Year

Tinnirello A. MD,FIPP1,2,Todeschini M. MD1,2, Ronconi F. MD1. Barbieri S. MD1,2

         1ASST-Franciacorta Chiari (Italy), 2 Young Against Pain Group

Introduction

Recent guidelines recommend careful assessment before starting opioid medications for chronic non cancer pain and using the lowest dosage for the shortest possible treatment duration.Chronic back pain is a common condition for which  patient are taking opioid medications for long periods.Sacroiliac joint (SIJ) pain is a common cause of low back pain (LBP), radiofrequency denervation has been proven as a safe and effective modality of reducing pain and disability in these patients.

Among different RF modalities, Cooled Radiofrequency (CRF) where the probe’s tip is kept cooled at 60°C in order to increase the lesion size, has been reported as superior to conventional RF techniques.

In this retrospective analysis, cooled radiofrequency (CRF) denervation was evaluated to provide pain and disability relief, and reduce opioid use, in patients with SIJ-derived chronic LBP. 

Matherials and Methods

This was a retrospective analysis of 27 consecutive patients treated by CRF denervation for SIJ-derived LBP in an Italian National Health Service Hospital. Patients had been chronically (more than 6 months) taking opioids (tapentadol = 15/27 patients (55.6%), oxycodone/naloxone = 10/27 (37%), codeine = 1/27 (3.7%), and transdermal fentanyl = 1/27 (3.7%). Median Morphine Equivalent Daily Dose (MEDD) was 40±37 mg at baseline. An intra-articular anesthetic test block was performed and if positive (pain relief > 50%) CRF was performed. Following denervation patients were instructed to reduce opioid medication intake according to their perceived health status (dosage reduction was monitored by patients’ general practitioner in order to prevent adverse effects from sudden withdrawal). Opioid use expressed in MEDD(mg) ,pain (NRS scale) and disability (ODI) were measured  at 1-,6- and 12 months follow up.

Results

Patients presented with severe pain (mean baseline NRS score = 7.7±1 and disability (mean ODI score = 50.1±), which was significantly reduced  up to 12 month  following CRF denervation  (p < 0.05 ). CRF procedure was successful (reduction of pain > 50% from baseline) in 92.6%, and 63% and 44.4% of the study group at 1 month,  and 6 and 12 months post-CRF. Median MEDD was decreased significantly (p < 0.05) at each follow-up compared to baseline. At 1 month, and 6 and 12 months following treatment, 29.6%, and 40.7% and 25.9%  of the study group were not taking opioids.  The MEDD was reduced at 1 month, 6  and 12   months post-CRF  not only for patients who had successful CRF  treatments,   but also for those  who had unsuccessful treatments. Moreover, at each follow-up visit, the extent of MEDD declines was similar for patients who had these respective outcomes. 

Conclusions 

Statistically-significant analgesia and disability relief were manifested by CRF denervation in patients afflicted with SIJ-derived LBP for up to 12 months following the intervention. Moreover, opioid use was significantly  reduced at each time-point following denervation for up to 12 months, and patients who reported successful or unsuccessful CRF denervation treatment reduced their use of opioids, and to similar extents

This study provides further evidence that CRF denervation of nociceptive nerves of the SIJ  can safely provide meaningful pain and disability relief  coupled with significantly less dependence on opioids. 

The latter benefit of CRF denervation may facilitate a means for patients who suffer from SIJ-derived LBP  to escape use of opioids  and the side-effects  that can accompany their consumption.

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