Patients who decreased opioid use after undergoing basivertebral nerve (BVN) ablation were found to experience greater relief of chronic low back pain than those who increased opioid use, according to a study published in Neurosurgery.
In this post-hoc analysis of a sham-controlled randomized trial, a total of 224 patients who received BVN ablation (n=146) or sham treatment (n=78) were assessed 12 months later for pain and disability using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores, respectively.
Baseline opioid use rates and pain intensity levels were comparable in patients who received BVN ablation and those who received sham treatment (opioid use: 34% and 35%, respectively; pain scores: 6.97 and 7.03, respectively; P =0.863).
On average, patients who decreased their opioid use in the 12 months following the intervention experienced greater functional improvements than those who increased their use of opioids. In patients treated with BVN ablation, those who decreased opioid use had a mean ODI improvement of 24.9, compared with a mean of 7.3 in those who increased use (P <.001) and a mean VAS improvement of 3.3, compared with a mean of 0.6 in patients who increased opioid use (P <.001). Patients who received a sham intervention and had decreased vs increased their opioid use had greater improvements in disability (ODI scores: 17.4 vs 1.2, respectively; P =.053) and pain (VAS scores: 2.5 vs 1.4, respectively; P =.374).
Study limitations include that patients self-reported their opioid use.
“We did not observe a correlation of improvement in function or pain as a result of increased opioid use. Overall, patients reporting greater functional improvement were more able to reduce or eliminate opioid use over the course of the study,” noted the study authors.
Markman JD, Rhyne AL, Sasso RC, et al. Association between opioid use and patient-reported outcomes in a randomized trial evaluating basivertebral nerve ablation for the relief of chronic low back pain [published online April 29, 2019]. Neurosurgery. doi:10.1093/neuros/nyz093