Opioid Dose Reduction Vis-à-Vis Lumbar Medial Branch Intervention

TL;DR

This study shows that lumbar medial branch interventions significantly reduce opioid use in patients with chronic low back pain from facet joint degeneration.

Contribution

Demonstrates that combining medial branch blocks with radiofrequency ablation enhances opioid reduction in lumbar facet arthropathy patients.

Findings

LMBB alone reduced opioid use by 4.06 mg morphine-equivalent dose.

Combining LMBB and RFA reduced opioid use by 6.10 mg, showing added benefit.

Procedures effectively reduced pain and healthcare burden from lumbar facet arthropathy.

Abstract

Introduction

Lumbar facet arthropathy (LFA) is a chronic degenerative condition that evolves over time. Osteoarthritis is defined by bony overgrowth, joint effusions, and synovial cysts. These findings are also seen in LFA, as there is degeneration of the facet joints throughout the spine. It primarily affects individuals >40 years of age and is a leading cause of low back pain. The most affected region of the lumbar spine includes the L4/L5 and L5/sacral ala junctions. We investigated the association between lumbar medial branch blocks (LMBBs) and radiofrequency ablations (RFAs), and the reduction in prescription opioid use in patients with LFA.

Methods

This is a retrospective cohort study of patients presenting to an outpatient pain medicine clinic with documented LFA. A total of 526 patients with LFA who underwent an LMBB, RFA, or a combination of both procedures were evaluated for morphine-equivalent opioid prescriptions in the outpatient clinic before and after the interventions. We used a paired t-test to compare pre- and post-procedure results to assess changes in prescribed morphine equivalent medications.

Results

There were statistically significant reductions in prescription opioid use when standardized to morphine equivalency in patients who underwent an LMBB or a combination of both LMBB and RFA procedures. For patients who underwent an LMBB procedure, the mean reduction in opioid equivalence dose from pre- to post-procedure was 4.06 mg. Among those who received both LMBB and RFA, the reduction was 6.10 mg, suggesting that the addition of RFA may further enhance the decrease in opioid use.

Conclusions

We found that individuals who underwent an LMBB or a combination of LMBB and RFA procedures had a significant reduction in morphine-equivalent drug use within the outpatient pain medicine clinic. These findings support the effectiveness of these procedures in reducing pain from LFA and highlight their potential to lessen the associated healthcare burden.

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