Cervical medial branch radiofrequency ablation and opioid usage: Cross sectional views at six months prior to and six months following procedure

Abstract

Background: Zygapophysial joint pain has a prevalence of up to 55% in patients suffering from neck pain. Interventional pain procedures are commonly used to treat facetogenic neck pain including cervical medial branch radiofrequency ablation (CMBRFA), which has been shown to effectively reduce pain. However, there is little research regarding its impact on opioid medication usage. Objective: We aimed to evaluate changes in opioid medication usage after CMBRFA and impact of comorbid conditions on noted changes. Design: Retrospective observational study. Methods: For patients undergoing CMBRFA between May 01, 2017 and May 31, 2020, the following data were collected: demographics, spinal level of procedure, history of prior neck surgery or pain procedures, presence of comorbid conditions, and opioid medication prescription data at 6 months before and after the procedure. Fisher’s exact tests were used for continuous variables due to inadequate sample for parametric tests. Multivariable analysis was used to assess independent predictive factors. Results: A total of 140 patients underwent RFA during the 3-year study period. Fifteen percent (N = 21) of the cohort were on opioid medication pre-procedurally – of these, 71 % (N = 15) decreased opioid use post-procedurally which includes the 43 % (N = 9) who ceased opioid use completely. However, no statistically significant difference was noted between pre- and post-procedural MME. Of the 119 opioid-naïve patients, 16 % (N = 19) started opioids by 6 months following CMBRFA; this group was noted to have higher prevalence of anxiety and depression. Conclusion: Opioid use, studied in isolation, is not a reliable measure to assess CMBRFA effectiveness. Psychologic considerations such as history of anxiety or depression are significant factors in opioid use and may influence procedure effectiveness. Opioid use patterns are multifaceted. Larger, future studies are needed to analyze post-procedure opioid use in the context of other factors such as pre-procedure opioid use, psychiatric comorbidities, and presence of multiple pain generators.

Keywords

• Ablation
• Medial branch
• Chronic spinal pain
• Interventional techniques
• Therapeutic interventions
• Radiofrequency neurolysis