Objective Facet joint injections (FJIs) and medial branch blocks (MBBs) are commonly used interventions for chronic spinal pain, but their comparative effectiveness remains unclear. This meta-analysis aimed to compare the pain relief, functional improvement, complications, and patient satisfaction associated with FJI and MBB.
Methods A systematic review and meta-analysis of randomized controlled trials and observational studies were conducted. Primary outcomes included pain relief (numerical rating scale) and functional improvement (Oswestry Disability Index [ODI]/Neck Disability Index). Secondary outcomes assessed adverse effects and patient satisfaction. The differences in characteristics between patients who were readmitted and those who were not were identified and analyzed using the Review Manager software.
Results FJI resulted in lower pain and ODI scores compared to MBB, but the differences were not statistically significant. However, patient satisfaction was significantly higher in the FJI group (odds ratio, 1.81; 95% confidence interval, 1.02–3.24; p=0.04). Additionally, FJI had fewer adverse effects than MBB.
Conclusion Both FJI and MBB are effective for chronic spinal pain, but FJI may be preferred for patients seeking immediate pain relief with fewer complications. Further high-quality studies are needed to refine treatment guidelines.
Objective The aim of the study was to compare trends and differences in preoperative and prolonged postoperative opioid use following spinal cord stimulator (SCS) implantation and to determine factors associated with prolonged postoperative opioid use.
Methods A database of private-payer insurance records was queried to identify patients who underwent a primary paddle lead SCS placement via a laminectomy (CPT-C3655) from 2008–2015. Our resulting cohort was stratified into those with prolonged postoperative opioid use, opioid use between 3- and 6-month postoperation, and those without. Multivariate logistic regression was used to determine the effect preoperative opioid use and other factors of interest had on prolonged postoperative opioid use. Subgroup analysis was performed on preoperative opioid users to further quantify the effect of differing magnitudes of preoperative opioid use.
Results A total of 2,374 patients who underwent SCS placement were identified. Of all patients, 1,890 patients (79.6%) were identified as having prolonged narcotic use. Annual rates of preoperative (p = 0.023) and prolonged postoperative narcotic use (p < 0.001) decreased over the study period. Significant independent predictors of prolonged postoperative opioid use were age < 65 years (odds ratio [OR], 1.52; p = 0.004), male sex (OR, 1.33; p = 0.037), preoperative anxiolytic (OR, 1.55; p = 0.004) and muscle relaxant (OR, 1.42; p = 0.033), and narcotic use (OR, 15.04; p < 0.001). Increased number of preoperative narcotic prescriptions correlated with increased odds of prolonged postoperative use.
Conclusion Patients with greater number of preoperative opioid prescriptions may not attain the same benefit from SCSs as patients with less opioid use. The most significant predictor of prolonged narcotic use was preoperative opioid use.
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