Newly Published
Pain Medicine  |   January 2020
Opioid Fills for Lumbar Facet Radiofrequency Ablation Associated with New Persistent Opioid Use
Author Notes
  • From the Division of Pain Medicine, Department of Anesthesiology (D.L.S., S.M., A.A.S., C.M.B.), the Sections of Transplant Surgery (V.G.) and Plastic Surgery (J.F.W.), University of Michigan Medical School, Ann Arbor, Michigan; the School of Public Health (H.A-A.) and the Institute for Healthcare Policy and Innovation (P.L.), University of Michigan, Ann Arbor, Michigan.
  • The work presented in this article has been presented at the Anesthesiology Annual Meeting in San Francisco, California, October 13, 2018.
    The work presented in this article has been presented at the Anesthesiology Annual Meeting in San Francisco, California, October 13, 2018.×
  • Submitted for publication April 6, 2019. Accepted for publication December 18, 2019.
    Submitted for publication April 6, 2019. Accepted for publication December 18, 2019.×
  • Correspondence: Address correspondence to Dr. Brummett: Division of Pain Medicine, Department of Anesthesiology, University of Michigan Medical School, 1500 E Medical Center Dr, 1H247 UH, PO Box 5048, Ann Arbor, Michigan 48109. cbrummet@umich.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Pain Medicine / Pain Medicine / Pharmacology / Opioid
Pain Medicine   |   January 2020
Opioid Fills for Lumbar Facet Radiofrequency Ablation Associated with New Persistent Opioid Use
Anesthesiology Newly Published on January 29, 2020. doi:https://doi.org/10.1097/ALN.0000000000003164
Anesthesiology Newly Published on January 29, 2020. doi:https://doi.org/10.1097/ALN.0000000000003164
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Perioperative opioid exposure increases the risk for persistent opioid use; however, the strength of the relationship remains unclear for chronic pain patients

What This Article Tells Us That Is New:

  • More than one in five opioid-naïve patients filled a prescription for opioid after minimally painful procedures

  • Patients who filled opioid prescriptions had more than twice the odds of persistent opioid use

Background: Zygapophyseal (facet) joint interventions are the second most common interventional procedure in pain medicine. Opioid exposure after surgery is a significant risk factor for chronic opioid use. The aim of this study was to determine the incidence of new persistent use of opioids after lumbar facet radiofrequency ablation and to assess the effect of postprocedural opioid prescribing on the development of new persistent opioid use.

Methods: The authors conducted a retrospective cohort study using claims from the Clinformatics Data Mart Database (OptumInsight, USA) to identify opioid-naïve patients between 18 and 64 yr old who had lumbar radiofrequency ablation. Patients who had either subsequent radiofrequency ablation 15 to 180 days or subsequent surgery within 180 days after the primary procedure were excluded from the analysis. The primary outcome was new persistent opioid use, defined as opioid prescription fulfillment within the 8 to 90 and 91 to 180 day periods after radiofrequency ablation. The authors then assessed patient-level risk factors for new persistent opioid use.

Results: A total of 2,887 patients met the inclusion criteria. Of those patients, 2,277 (78.9%) had radiofrequency ablation without a perioperative opioid fill, and 610 (21.1%) patients had the procedure with a perioperative opioid fill. The unadjusted rate of new persistent opioid use was 5.6% (34 patients) in the group with a perioperative opioid fill versus 2.8% (63 patients) for those without an opioid fill. Periprocedural opioid prescription fill was independently associated with increased odds of new persistent use (adjusted odds ratio, 2.35; 95% CI, 1.51 to 3.66; P < 0.001).

Conclusions: Periprocedural opioid use after lumbar radiofrequency ablation was associated with new persistent use in previously opioid-naïve patients, suggesting that new exposure to opioids is an independent risk factor for persistent use in patients having radiofrequency ablation for chronic back pain. Opioid prescribing after radiofrequency ablation should be reevaluated and likely discontinued in this population.