Cooled radiofrequency ablation of the genicular nerves for chronic pain due to knee osteoarthritis

Six-month outcomes

Zachary L. McCormick*, Marc Korn, Rajiv Reddy, Austin Marcolina, David Dayanim, Ryan Mattie, Daniel Cushman, Meghan Bhave, Robert J McCarthy, Dost Mohammad Khan, Geeta Nagpal, David R Walega

*Corresponding author for this work

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Objective. Determine outcomes of cooled radiofrequency ablation (C-RFA) of the genicular nerves for treatment of chronic knee pain due to osteoarthritis (OA). Design. Cross-sectional survey. Setting. Academic pain medicine center. Subjects. Consecutive patients with knee OA and 50% or greater pain relief following genicular nerve blocks who underwent genicular nerve C-RFA. Methods. Survey administration six or more months after C-RFA. Pain numeric rating scale (NRS), Medication Quantification Scale III (MQSIII), Patient Global Impression of Change (PGIC), and total knee arthroplasty (TKA) data were collected. Logistic regression was used to identify factors that predicted treatment success. Results. Thirty-three patients (52 discrete knees) met inclusion criteria. Thirty-five percent (95% confidence interval [CI] 5 22-48) of procedures resulted in the combined outcome of 50% or greater reduction in NRS score, reduction of 3.4 or more points in MQSIII score, and PGIC score consistent with "very much improved/improved." Nineteen percent (95% CI510-33) of procedures resulted in complete pain relief. Greater duration of pain and greater than 80% pain relief from diagnostic blocks were identified as predictors of treatment success. The accuracy of the model was 0.88 (95% CI50.78-0.97, P < 0.001). Conclusions. Genicular C-RFA demonstrated a success rate of 35% based on a robust combination of outcome measures, and 19% of procedures resulted in complete relief of pain at a minimum of six months of follow-up. Report of 80% or greater relief from diagnostic blocks and duration of pain of less than five years are associated with high accuracy in predicting treatment success. Further prospective study is needed to optimize the patient selection protocol and success rate of this procedure.

Original languageEnglish (US)
Pages (from-to)1631-1641
Number of pages11
JournalPain Medicine (United States)
Volume18
Issue number9
DOIs
StatePublished - Sep 1 2017

Fingerprint

Knee Osteoarthritis
Neuralgia
Chronic Pain
Knee
Pain
Pain Clinics
Knee Replacement Arthroplasties
Nerve Block
Therapeutics
Osteoarthritis
Patient Selection
Cross-Sectional Studies
Logistic Models
Medicine
Outcome Assessment (Health Care)
Prospective Studies
Confidence Intervals

Keywords

  • Chronic pain
  • Knee
  • Osteoarthritis
  • Outcome assessment (health care)
  • Radiofrequency catheter ablation

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

McCormick, Zachary L. ; Korn, Marc ; Reddy, Rajiv ; Marcolina, Austin ; Dayanim, David ; Mattie, Ryan ; Cushman, Daniel ; Bhave, Meghan ; McCarthy, Robert J ; Khan, Dost Mohammad ; Nagpal, Geeta ; Walega, David R. / Cooled radiofrequency ablation of the genicular nerves for chronic pain due to knee osteoarthritis : Six-month outcomes. In: Pain Medicine (United States). 2017 ; Vol. 18, No. 9. pp. 1631-1641.
@article{783e22aa355e4f619e08fd68c842fd33,
title = "Cooled radiofrequency ablation of the genicular nerves for chronic pain due to knee osteoarthritis: Six-month outcomes",
abstract = "Objective. Determine outcomes of cooled radiofrequency ablation (C-RFA) of the genicular nerves for treatment of chronic knee pain due to osteoarthritis (OA). Design. Cross-sectional survey. Setting. Academic pain medicine center. Subjects. Consecutive patients with knee OA and 50{\%} or greater pain relief following genicular nerve blocks who underwent genicular nerve C-RFA. Methods. Survey administration six or more months after C-RFA. Pain numeric rating scale (NRS), Medication Quantification Scale III (MQSIII), Patient Global Impression of Change (PGIC), and total knee arthroplasty (TKA) data were collected. Logistic regression was used to identify factors that predicted treatment success. Results. Thirty-three patients (52 discrete knees) met inclusion criteria. Thirty-five percent (95{\%} confidence interval [CI] 5 22-48) of procedures resulted in the combined outcome of 50{\%} or greater reduction in NRS score, reduction of 3.4 or more points in MQSIII score, and PGIC score consistent with {"}very much improved/improved.{"} Nineteen percent (95{\%} CI510-33) of procedures resulted in complete pain relief. Greater duration of pain and greater than 80{\%} pain relief from diagnostic blocks were identified as predictors of treatment success. The accuracy of the model was 0.88 (95{\%} CI50.78-0.97, P < 0.001). Conclusions. Genicular C-RFA demonstrated a success rate of 35{\%} based on a robust combination of outcome measures, and 19{\%} of procedures resulted in complete relief of pain at a minimum of six months of follow-up. Report of 80{\%} or greater relief from diagnostic blocks and duration of pain of less than five years are associated with high accuracy in predicting treatment success. Further prospective study is needed to optimize the patient selection protocol and success rate of this procedure.",
keywords = "Chronic pain, Knee, Osteoarthritis, Outcome assessment (health care), Radiofrequency catheter ablation",
author = "McCormick, {Zachary L.} and Marc Korn and Rajiv Reddy and Austin Marcolina and David Dayanim and Ryan Mattie and Daniel Cushman and Meghan Bhave and McCarthy, {Robert J} and Khan, {Dost Mohammad} and Geeta Nagpal and Walega, {David R}",
year = "2017",
month = "9",
day = "1",
doi = "10.1093/pm/pnx069",
language = "English (US)",
volume = "18",
pages = "1631--1641",
journal = "Pain Medicine",
issn = "1526-2375",
publisher = "Wiley-Blackwell",
number = "9",

}

McCormick, ZL, Korn, M, Reddy, R, Marcolina, A, Dayanim, D, Mattie, R, Cushman, D, Bhave, M, McCarthy, RJ, Khan, DM, Nagpal, G & Walega, DR 2017, 'Cooled radiofrequency ablation of the genicular nerves for chronic pain due to knee osteoarthritis: Six-month outcomes', Pain Medicine (United States), vol. 18, no. 9, pp. 1631-1641. https://doi.org/10.1093/pm/pnx069

Cooled radiofrequency ablation of the genicular nerves for chronic pain due to knee osteoarthritis : Six-month outcomes. / McCormick, Zachary L.; Korn, Marc; Reddy, Rajiv; Marcolina, Austin; Dayanim, David; Mattie, Ryan; Cushman, Daniel; Bhave, Meghan; McCarthy, Robert J; Khan, Dost Mohammad; Nagpal, Geeta; Walega, David R.

In: Pain Medicine (United States), Vol. 18, No. 9, 01.09.2017, p. 1631-1641.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cooled radiofrequency ablation of the genicular nerves for chronic pain due to knee osteoarthritis

T2 - Six-month outcomes

AU - McCormick, Zachary L.

AU - Korn, Marc

AU - Reddy, Rajiv

AU - Marcolina, Austin

AU - Dayanim, David

AU - Mattie, Ryan

AU - Cushman, Daniel

AU - Bhave, Meghan

AU - McCarthy, Robert J

AU - Khan, Dost Mohammad

AU - Nagpal, Geeta

AU - Walega, David R

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Objective. Determine outcomes of cooled radiofrequency ablation (C-RFA) of the genicular nerves for treatment of chronic knee pain due to osteoarthritis (OA). Design. Cross-sectional survey. Setting. Academic pain medicine center. Subjects. Consecutive patients with knee OA and 50% or greater pain relief following genicular nerve blocks who underwent genicular nerve C-RFA. Methods. Survey administration six or more months after C-RFA. Pain numeric rating scale (NRS), Medication Quantification Scale III (MQSIII), Patient Global Impression of Change (PGIC), and total knee arthroplasty (TKA) data were collected. Logistic regression was used to identify factors that predicted treatment success. Results. Thirty-three patients (52 discrete knees) met inclusion criteria. Thirty-five percent (95% confidence interval [CI] 5 22-48) of procedures resulted in the combined outcome of 50% or greater reduction in NRS score, reduction of 3.4 or more points in MQSIII score, and PGIC score consistent with "very much improved/improved." Nineteen percent (95% CI510-33) of procedures resulted in complete pain relief. Greater duration of pain and greater than 80% pain relief from diagnostic blocks were identified as predictors of treatment success. The accuracy of the model was 0.88 (95% CI50.78-0.97, P < 0.001). Conclusions. Genicular C-RFA demonstrated a success rate of 35% based on a robust combination of outcome measures, and 19% of procedures resulted in complete relief of pain at a minimum of six months of follow-up. Report of 80% or greater relief from diagnostic blocks and duration of pain of less than five years are associated with high accuracy in predicting treatment success. Further prospective study is needed to optimize the patient selection protocol and success rate of this procedure.

AB - Objective. Determine outcomes of cooled radiofrequency ablation (C-RFA) of the genicular nerves for treatment of chronic knee pain due to osteoarthritis (OA). Design. Cross-sectional survey. Setting. Academic pain medicine center. Subjects. Consecutive patients with knee OA and 50% or greater pain relief following genicular nerve blocks who underwent genicular nerve C-RFA. Methods. Survey administration six or more months after C-RFA. Pain numeric rating scale (NRS), Medication Quantification Scale III (MQSIII), Patient Global Impression of Change (PGIC), and total knee arthroplasty (TKA) data were collected. Logistic regression was used to identify factors that predicted treatment success. Results. Thirty-three patients (52 discrete knees) met inclusion criteria. Thirty-five percent (95% confidence interval [CI] 5 22-48) of procedures resulted in the combined outcome of 50% or greater reduction in NRS score, reduction of 3.4 or more points in MQSIII score, and PGIC score consistent with "very much improved/improved." Nineteen percent (95% CI510-33) of procedures resulted in complete pain relief. Greater duration of pain and greater than 80% pain relief from diagnostic blocks were identified as predictors of treatment success. The accuracy of the model was 0.88 (95% CI50.78-0.97, P < 0.001). Conclusions. Genicular C-RFA demonstrated a success rate of 35% based on a robust combination of outcome measures, and 19% of procedures resulted in complete relief of pain at a minimum of six months of follow-up. Report of 80% or greater relief from diagnostic blocks and duration of pain of less than five years are associated with high accuracy in predicting treatment success. Further prospective study is needed to optimize the patient selection protocol and success rate of this procedure.

KW - Chronic pain

KW - Knee

KW - Osteoarthritis

KW - Outcome assessment (health care)

KW - Radiofrequency catheter ablation

UR - http://www.scopus.com/inward/record.url?scp=85037837475&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85037837475&partnerID=8YFLogxK

U2 - 10.1093/pm/pnx069

DO - 10.1093/pm/pnx069

M3 - Article

VL - 18

SP - 1631

EP - 1641

JO - Pain Medicine

JF - Pain Medicine

SN - 1526-2375

IS - 9

ER -