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Retrospective cohort study of healthcare utilization and opioid use following radiofrequency ablation for chronic axial spine pain in Ontario, Canada
  1. Eldon Loh1,2,
  2. Jennifer N Reid3,
  3. Fatimah Alibrahim4 and
  4. Blayne Welk2,3,5
  1. 1 Department of Physical Medicine and Rehabilitation, Western University, London, Ontario, Canada
  2. 2 Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, Canada
  3. 3 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  4. 4 Department of Physical Medicine and Rehabilitation, King Saud University, Riyadh, Saudi Arabia
  5. 5 Department of Surgery, Western University, London, Ontario, Canada
  1. Correspondence to Dr Eldon Loh, Department of Physical Medicine and Rehabilitation, Western University, London, ON, Canada; eldon.loh{at}sjhc.london.on.ca

Abstract

Background and objectives Radiofrequency ablation (RFA) is a common treatment modality for chronic axial spine pain. Controversy exists over its effectiveness, and outcomes in a real-world setting have not been evaluated despite increasing use of RFA. This study examined changes in healthcare utilization and opioid use after RFA in Ontario, Canada.

Methods This retrospective cohort study was conducted in Ontario using administrative data. Ontario residents receiving their initial RFA between 1 January 2009 and 31 March 2015 were included. Physician visits, spinal injections, and opioid dosing/prescriptions in the 12-month periods before and after RFA were compared.

Results The study included 4653 patients. The number of RFA procedures significantly increased from 2009 to 2014 (22.5 cases/1 000 000 person-years to 82.5 cases/1 000 000 person-years). 4465 patients had at least one physician visit pre-RFA; there was a significant 23.89% reduction in physician visits post-RFA (pre-RFA: 29 616 visits; post-RFA: 22 542 visits). All reviewed specialties demonstrated a decrease in physician visits post-RF except neurosurgery. 3445 (85.70%) fewer spinal interventions for axial pain (medial/lateral branch blocks, facet/sacroiliac injections) were performed post-RFA. Significantly fewer epidurals were also performed post-RFA. 198 of 1007 patients (19.66%) on the Ontario Drug Benefit who received opioids pre-RFA did not require a postprocedure opioid prescription. Mean opioid dosing was unchanged post-RFA.

Conclusions Healthcare utilization was significantly reduced in the 12 months following RFA, and some patients eliminated opioid use. Selection criteria for RFA are not standardized in Ontario, and appropriate use guidelines for spine interventions may improve outcomes and reduce unnecessary procedures.

  • interventional pain management
  • outcomes
  • radiofrequency ablation
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Footnotes

  • Presented at Preliminary data from this study were presented at the Spine Intervention Society Meeting in Chicago, IL, on 18 August 2018, and will be published as an abstract in Pain Medicine.

  • Funding This study was funded by an Earl Russell Trainee Grant awarded to FA and supported by the Institute for Clinical Evaluative Sciences (ICES) Western site. ICES is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Core funding for ICES Western is provided by the Academic Medical Organization of Southwestern Ontario (AMOSO), the Schulich School of Medicine and Dentistry (SSMD), Western University, and the Lawson Health Research Institute (LHRI).

  • Disclaimer The analyses, conclusions, opinions, results and statements expressed in the material are those of the author(s) and not necessarily those of CIHI, and are independent of the funding sources. No endorsement by ICES, AMOSO, SSMD, LHRI, or the MOHLTC is intended or should be inferred.

  • Competing interests EL has received in-kind research support from Nimbus Concepts and Diros Technologies for other projects.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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