Jordan B Starr1, Laura S Gold2, Zachary McCormick3, Pradeep Suri4, Janna Friedly5. 1. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA. Electronic address: jordanbstarr@gmail.com. 2. CLEAR Center, University of Washington, Seattle, Washington, USA. 3. Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA. 4. Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA; Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, Washington, USA. 5. Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.
Abstract
PURPOSE: Although the effectiveness of medial branch nerve radiofrequency ablation (RFA) for lumbosacral facet pain has been described, little is known regarding patterns of repeat RFA utilization and prescription opioid use afterward. DESIGN: Retrospective cohort analysis. PATIENT SAMPLE: Patients undergoing lumbosacral RFA in MarketScan from 2007 to 2016. METHODS: The time until and number of staged RFAs (<180 days after initial RFA) and repeat RFAs (≥180 days after initial RFA), as well as opioid use at 90 and 180 days after RFA were assessed. Survival analyses were employed to estimate subsequent RFA rates, whereas subsequent RFA frequencies were estimated with inverse probability weighting. Repeated measures testing was performed comparing opioid use pre- and post-RFA. RESULTS: Initial RFAs were identified in 44,936 patients. Staged RFAs were performed in 33.1% of patients. Repeat RFAs through 1, 3, and 7 years were performed for 14.6%, 33.5%, and 45.7% of patients, respectively. Within 3 years, 12.2% of patients underwent one repeat RFA, whereas 13.2% of patients underwent two or more. Post-RFA opioid use was examined in 128,310 patients, 32.2% of whom used opioids pre-RFA. By 180 days post-RFA, 8.1% of patients discontinued opioids and 6.7% started opioids (p<.001). Exclusively examining pre-RFA opioid users, 24.9% stopped filling opioid prescriptions 180 days after RFA. CONCLUSIONS: This study delineates utilization rates of repeat RFA in the commerciall y insured population, with one-third undergoing repeat RFA within 3 years. Additionally, the present data indicate that lumbosacral RFA is associated with reduced filling of opioid prescriptions through 180 days.
PURPOSE: Although the effectiveness of medial branch nerve radiofrequency ablation (RFA) for lumbosacral facet pain has been described, little is known regarding patterns of repeat RFA utilization and prescription opioid use afterward. DESIGN: Retrospective cohort analysis. PATIENT SAMPLE: Patients undergoing lumbosacral RFA in MarketScan from 2007 to 2016. METHODS: The time until and number of staged RFAs (<180 days after initial RFA) and repeat RFAs (≥180 days after initial RFA), as well as opioid use at 90 and 180 days after RFA were assessed. Survival analyses were employed to estimate subsequent RFA rates, whereas subsequent RFA frequencies were estimated with inverse probability weighting. Repeated measures testing was performed comparing opioid use pre- and post-RFA. RESULTS: Initial RFAs were identified in 44,936 patients. Staged RFAs were performed in 33.1% of patients. Repeat RFAs through 1, 3, and 7 years were performed for 14.6%, 33.5%, and 45.7% of patients, respectively. Within 3 years, 12.2% of patients underwent one repeat RFA, whereas 13.2% of patients underwent two or more. Post-RFA opioid use was examined in 128,310 patients, 32.2% of whom used opioids pre-RFA. By 180 days post-RFA, 8.1% of patients discontinued opioids and 6.7% started opioids (p<.001). Exclusively examining pre-RFA opioid users, 24.9% stopped filling opioid prescriptions 180 days after RFA. CONCLUSIONS: This study delineates utilization rates of repeat RFA in the commerciall y insured population, with one-third undergoing repeat RFA within 3 years. Additionally, the present data indicate that lumbosacral RFA is associated with reduced filling of opioid prescriptions through 180 days.
Authors: E S Fisher; F S Whaley; W M Krushat; D J Malenka; C Fleming; J A Baron; D C Hsia Journal: Am J Public Health Date: 1992-02 Impact factor: 9.308
Authors: Johan N S Juch; Esther T Maas; Raymond W J G Ostelo; J George Groeneweg; Jan-Willem Kallewaard; Bart W Koes; Arianne P Verhagen; Johanna M van Dongen; Frank J P M Huygen; Maurits W van Tulder Journal: JAMA Date: 2017-07-04 Impact factor: 56.272
Authors: Pradeep Suri; Eric N Meier; Laura S Gold; Zachary A Marcum; Sandra K Johnston; Kathryn T James; Brian W Bresnahan; Michael O'Reilly; Judith A Turner; David F Kallmes; Karen J Sherman; Richard A Deyo; Patrick H Luetmer; Andrew L Avins; Brent Griffith; Patrick J Heagerty; Sean D Rundell; Jeffrey G Jarvik; Janna L Friedly Journal: Pain Med Date: 2021-06-04 Impact factor: 3.750