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
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.
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.
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.