Reduction of opioid intake after cooled radiofrequency denervation for sacroiliac joint pain: a retrospective evaluation up to 1 year
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
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 treat-ments, 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 re-duction ≥ 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 suc-cess, 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 sup-port 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.
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 treat-ments, 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 re-duction ≥ 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 suc-cess, 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 sup-port 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.
참고문헌 (47)
- Cohen SP, "Sacroiliac joint pain : a comprehensive review of anatomy, diagnosis, and treatment", Anesth Analg, 101, pp.1440~1453 (2005)
- Dreyfuss P, "Sacroiliac joint pain", J Am Acad Orthop Surg, 12, pp.255~265 (2004)
- Hansen H, "A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions", Pain Physician, 15, pp.E247~78 (2012)
- Simopoulos TT, "Systematic review of the diagnostic accuracy and therapeutic effectiveness of sacroiliac joint interventions", Pain Physician, 18, pp.E713~56 (2015)
- 이재담, "천장관절 증후군 환자에서 관절강 내 증식치료의 효과", The Korean Journal of Pain, 22(3), pp.229~233 (2009), 대한통증학회
- Kuijpers T, "A systematic review on the effectiveness of pharmacological interventions for chronic nonspecific low-back pain", Eur Spine J, 20, pp.40~50 (2011)
- Garcia AN, "McKenzie method of mechanical diagnosis and therapy was slightly more effective than placebo for pain, but not for disability, in patients with chronic non-specific low back pain : a randomised placebo controlled trial with short and longer term follow-up", Br J Sports Med, 52, pp.594~600 (2018)
- Spiker WR, "Surgical versus injection treatment for injection-confirmed chronic sacroiliac joint pain", Evid Based Spine Care J, 3, pp.41~53 (2012)
- Trang T, "Pain and poppies : the good, the bad, and the ugly of opioid analgesics", J Neurosci, 35, pp.13879~13888 (2015)
- "Opioid overdose crisis" (2019)[URL]
- Morone NE, "Pain as the fifth vital sign : exposing the vital need for pain education", Clin Ther, 35, pp.1728~1732 (2013)
- Van Zee A, "The promotion and marketing of oxycontin : commercial triumph, public health tragedy", Am J Public Health, 99, pp.221~227 (2009)
- Rudd RA, "Increases in drug and opioid-involved overdose deaths-United States, 2010-2015", MMWR Morb Mortal Wkly Rep, 65, pp.1445~1452 (2016)
- Florence CS, "The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013", Med Care, 54, pp.901~906 (2016)
- Vowles KE, "Rates of opioid misuse, abuse, and addiction in chronic pain : a systematic review and data synthesis", Pain, 156, pp.569~576 (2015)
- Muhuri PK, "Associations of nonmedical pain reliever use and initiation of heroin use in the United States", CBHSQ Data Rev, 8, pp.1~17 (2013)
- Cicero TJ, "The changing face of heroin use in the United States : a retrospective analysis of the past 50 years", JAMA Psychiatry, 71, pp.821~826 (2014)
- Carlson RG, "Predictors of transition to heroin use among initially non-opioid dependent illicit pharmaceutical opioid users : a natural history study", Drug Alcohol Depend, 160, pp.127~134 (2016)
- Ramasubba C, "Cooled sacroiliac radiofrequency denervation for the treatment of pain secondary to tumor infiltration : a case-based focused literature review", Pain Physician, 16, pp.1~8 (2013)
- Kapural L, "Cooled radiofrequency system for the treatment of chronic pain from sacroiliitis : the first case-series", Pain Pract, 8, pp.348~354 (2008)
- Cohen SP, "Outcome predictors for sacroiliac joint(lateral branch)radiofrequency denervation", Reg Anesth Pain Med, 34, pp.206~214 (2009)
- Stelzer W, "Use of cooled radiofrequency lateral branch neurotomy for the treatment of sacroiliac joint-mediated low back pain : a large case series", Pain Med, 14, pp.29~35 (2013)
- Stelzer W, "Influence of BMI, gender, and sports on pain decrease and medication usage after facet-medial branch neurotomy or SI joint lateral branch cooled RF-neurotomy in case of low back pain : original research in the Austrian population", J Pain Res, 10, pp.183~190 (2017)
- Tinnirello A, "Conventional(Simplicity III)and cooled(SInergy)radiofrequency for sacroiliac joint denervation : one-year retrospective study comparing two devices", Pain Med, 18, pp.1731~1744 (2017)
- Cohen SP, "Sacroiliac joint pain : a comprehensive review of epidemiology, diagnosis and treatment", Expert Rev Neurother, 13, pp.99~116 (2013)
- Laslett M, "Diagnosis of sacroiliac joint pain : validity of individual provocation tests and composites of tests", Man Ther, 10, pp.207~218 (2005)
- Szadek KM, "Diagnostic validity of criteria for sacroiliac joint pain : a systematic review", J Pain, 10, pp.354~368 (2009)
- Hegarty D, "Clinical outcome following radiofrequency denervation for refractory sacroiliac joint dysfunction using the Simplicity III probe : a 12-month retrospective evaluation", Pain Physician, 19, pp.E129~35 (2016)
- Bellini M, "Single strip lesions radiofrequency denervation for treatment of sacroiliac joint pain : two years’results", Anaesthesiol Intensive Ther, 48, pp.19~22 (2016)
- Ho KY, "Cooled radiofrequency denervation for treatment of sacroiliac joint pain : two-year results from 20 cases", J Pain Res, 6, pp.505~511 (2013)
- Cohen SP, "Randomized placebo-controlled study evaluating lateral branch radiofrequency denervation for sacroiliac joint pain", Anesthesiology, 109, pp.279~288 (2008)
- Franklin G, "A comprehensive approach to address the prescription opioid epidemic in Washington state : milestones and lessons learned", Am J Public Health, 105, pp.463~469 (2015)
- Farrar JT, "Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale", Pain, 94, pp.149~158 (2001)
- Dworkin RH, "Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials : IMMPACT recommendations", J Pain, 9, pp.105~121 (2008)
- Fairbank JC, "The Oswestry disability index", Spine (Phila Pa 1976), 25, pp.2940~2952 (2000)
- Nuttall FQ, "Body mass index : obesity, BMI, and health : a critical review", Nutr Today, 50, pp.117~128 (2015)
- Al-Khayer A, "Percutaneous sacroiliac joint arthrodesis : a novel technique", J Spinal Disord Tech, 21, pp.359~363 (2008)
- Buchowski JM, "Functional and radiographic outcome of sacroiliac arthrodesis for the disorders of the sacroiliac joint", Spine J, 5, pp.520~528 (2005)
- Waisbrod H, "Sacroiliac joint arthrodesis for chronic lower back pain", Arch Orthop Trauma Surg, 106, pp.238~240 (1987)
- Schütz U, "Poor outcome following bilateral sacroiliac joint fusion for degenerative sacroiliac joint syndrome", Acta Orthop Belg, 72, pp.296~308 (2006)
- Wise CL, "Minimally invasive sacroiliac arthrodesis : outcomes of a new technique", J Spinal Disord Tech, 21, pp.579~584 (2008)
- Ashman B, "Chronic sacroiliac joint pain : fusion versus denervation as treatment options", Evid Based Spine Care J, 1, pp.35~44 (2010)
- Watanabe I, "Cooled-tip ablation results in increased radiofrequency power delivery and lesion size in the canine heart : importance of catheter-tip temperature monitoring for prevention of popping and impedance rise", J Interv Card Electrophysiol, 6, pp.9~16 (2002)
- Roberts SL, "Cadaveric study of sacroiliac joint innervation : implications for diagnostic blocks and radiofrequency ablation", Reg Anesth Pain Med, 39, pp.456~464 (2014)
- Cox RC, "The anatomy of the lateral branches of the sacral dorsal rami : implications for radiofrequency ablation", Pain Physician, 17, pp.459~464 (2014)
- Deyo RA, "Opioids for low back pain", BMJ, 350, pp.g6380~ (2015)
- Chaparro LE, "Opioids compared to placebo or other treatments for chronic low-back pain", Cochrane Database Syst Rev, (8), pp.CD004959~ (2013)