Korean J Pain.  2020 Apr;33(2):183-191. 10.3344/kjp.2020.33.2.183.

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

• Tinnirello A

• KMID: 2502642
• DOI: http://doi.org/10.3344/kjp.2020.33.2.183

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.

Keyword

Analgesics, Opioid; Chronic Pain; Conservative Treatment; Denervation; Low Back Pain; Opioid-Related Disorders; Retrospective Studies; Rhizotomy; Sacroiliac Joint

Figure

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  Fig. 1 Mean pain scores (NRS) experienced by the study group over time. Exact mean and standard deviation values are indicated within each bar and adjacent to each whisker, respectively. NRS: numeric rating scale. *Significantly different (P < 0.05) mean value compared to that at baseline.

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  Fig. 2 Mean disability scores (ODI) experienced by the study group over time. Exact mean and standard deviation values are indicated within each bar and adjacent to each whisker, respectively. ODI: Oswestry disability index. *Significantly different (P < 0.05) mean value compared to that at baseline.

• 

  Fig. 3 Mean MEDD used by the study group over time. Exact mean and standard deviation values are indicated within each bar and adjacent to each whisker, respectively. MEDD: morphine equivalent daily dose. *Significantly different (P < 0.05) median value compared to that at baseline.

• 

  Fig. 4 Median MEDD of patients (n) who had successful or unsuccessful treatments at each follow-up visit. Exact median and standard deviation values are indicated without and within parentheses, respectively. MEDD: morphine equivalent daily dose.

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  Fig. 5 Changes at 12 months from baseline in MEDD for patients (n) who had successful or unsuccessful CRF denervation treatments. Exact percentage values are indicated within each bar. MEDD: morphine equivalent daily dose, CRF: cooled radiofrequency.

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