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Do Diagnostic Genicular Nerve Blocks Predict Treatment Outcomes for Cooled Radiofrequency Ablation in Patients with Chronic Knee Pain from Osteoarthritis: A Prospective Randomized Trial
Session: MP-02b
Thurs, Nov. 16, 10 am-12 pm
Saybrook Room

Please note, medically challenging cases are removed three months after the meeting and scientific abstracts after three years.

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Do Diagnostic Genicular Nerve Blocks Predict Treatment Outcomes for Cooled Radiofrequency Ablation in Patients with Chronic Knee Pain from Osteoarthritis: A Prospective Randomized Trial

Introduction

Genicular nerve radiofrequency ablation (RFA) is a promising treatment for patients with chronic pain from knee osteoarthritis (OA). Little is known about factors that predict treatment success or the prognostic utility genicular nerve blocks prior to genicular nerve RFA. In the case of zygaphophyseal and sacroiliac joint-mediated pain, multiple studies have confirmed the ability of diagnostic nerve blocks to predict short and long-term outcomes of RFA. The current study evaluated the utility of diagnostic genicular nerve blocks to predict clinical outcomes of genicular nerve cooled radiofrequency ablation (cRFA) in patients with OA.

Materials & Methods

This was a randomized, prospective trial of patients with chronic knee pain due to OA. Patients were randomized to receive a diagnostic genicular nerve block or no diagnostic block prior to cRFA. Subjects given a diagnostic block and reporting ≥50% pain relief with 2% lidocaine received cRFA. The primary outcome measure was the proportion of participants with ≥50% reduction in knee pain at 6-months following cRFA. Outcomes measures collected: NRS pain score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short-Form McGill Pain Questionnaire (SF-MPQ), Hospital Anxiety and Depression Index (HADI), Medication Quantification Scale (MQS III) score, Patient’s Global Impression of Change (PGIC), and daily opioid use in morphine equivalents. 

Results & Discussion

Twenty-nine participants (36 knees) had cRFA following a diagnostic block with ≥50% pain reduction and 25 participants (35 knees) had cRFA without a preceding diagnostic block. At least 50% pain relief at 6 months was reported following cRFA of 15 knees (41.7%) in the diagnostic block group and 15 (42.9%) in the no diagnostic block group (P=0.92). In both groups there was significant improvement in pain scores, SF-MPQ, HADS and WOMAC assessments at the follow-up assessments compared with baseline. PGIC rating of “improved” or “very much improved” was reported by 38.6% of participants at 6 months. Exploratory analysis revealed that successful response to cRFA improved as the pain relief from diagnostic nerve block increased from ≥ 50% to ≥ 90%.

Conclusions

This study demonstrated clinically meaningful improvements in pain, physical and psychological function up to 6 months following cRFA. A diagnostic genicular nerve block with a threshold of ≥50% pain relief did not improve the rate of treatment success. We suspect that a more stringent diagnostic block response threshold (>80%) may result in a higher rate of treatment success 
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