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A new outpatient procedure offers long-lasting pain relief to patients with moderate to severe arthritis in the hip and shoulder joints.
According to a study presented at the annual meeting of the Radiological Society of North America, researchers said the procedure could help reduce dependence on addictive opioids.
People with moderate to severe pain related to osteoarthritis face limited treatment options. Common methods, such as injections of anesthetics and corticosteroids into the affected joints, become less effective as the arthritis progresses and worsens.
“Patients generally become less sensitive to these injections over time,” he said. Felix M. Gonzalez, MD, of the Department of Radiology, Emory University School of Medicine in Atlanta, Georgia. “The first injection of anesthetic-corticosteroid can provide six months of pain relief, the second can last three months and the third can only last one month. Gradually, the degree of pain relief is no longer significant. “
Without pain relief, patients face the possibility of joint replacement surgery. Many patients are ineligible for surgery for health reasons, while many others choose not to undergo such a major operation.
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For those patients, the only other viable option may be opioid pain relievers, which carry the risk of addiction.
Dr. González and his colleagues have been studying the application of a new interventional radiology treatment known as cooled radiofrequency ablation (c-RFA) to achieve pain relief in the setting of advanced degenerative arthritis. The procedure involves the placement of needles where the major sensory nerves exist around the shoulder and hip joints. The nerves are then treated with a low-grade current known as radiofrequency that “stuns” them, slowing the transmission of pain to the brain.
For the new study, 23 people with osteoarthritis underwent treatment, including 12 with shoulder pain and 11 with hip pain that no longer responded to anti-inflammatory pain control or intra-articular injections of lidocaine and steroids.
Treatment occurred two to three weeks after the patients received diagnostic anesthetic nerve blocks. The patients then completed surveys to measure their function, range of motion, and degree of pain before and three months after ablation procedures.
There were no complications related to the procedure, and both the hip and shoulder pain groups reported a statistically significant decrease in the degree of pain with a corresponding increase in dynamic function after treatment.
“In our study, the results were very impressive and promising,” said Dr. González. “Patients with shoulder pain had an 85% decrease in pain and an increase in function of approximately 74%. In patients with hip pain, there was a 70% reduction in pain and a gain in function of approximately 66%. “
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The procedure offers a new alternative for patients facing the prospect of surgery. Plus, it can lower your risk of opiate addiction.
“This procedure is a last resort for patients who are unable to perform physical activity and may develop a narcotic addiction,” said Dr. Gonzalez. “Until recently, there was no alternative for treating end-of-the-line arthritis patients who did not qualify for surgery or were unwilling to undergo a surgical procedure.”
At the RSNA annual meeting last year, Dr. González presented similarly encouraging results from a study of a similar procedure for the treatment of knee arthritis. Together, the knee, shoulder, and hip joints account for approximately 95% of all arthritis cases.
The procedure could have numerous applications in addition to treating arthritic pain, explained Dr. González. Potential uses include treating pain related to diseases such as cancer and sickle cell anemia pain syndrome, for example.
“Here we are just scratching the surface,” said Dr. González. “We would like to explore the efficacy of treatment in patients in other settings such as trauma, amputation, and especially in cancer patients with metastatic disease.”
Source: Radiological Society of North America
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