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Title: | Cooled versus conventional radiofrequency treatment of the genicular nerves for chronic knee pain: 12-month and cost-effectiveness results from the multicenter COCOGEN trial | Authors: | BELBA, Amy Vanneste, Thibaut Kallewaard, Jan Willem van Kuijk, Sander M. J. Gelissen, Marloes Emans, Peter BELLEMANS, Johan Sommer, Micha VAN BOXEM, Koen SMEETS, Kristof Kimman, Merel VAN ZUNDERT, Jan |
Issue Date: | 2024 | Publisher: | BMJ PUBLISHING GROUP | Source: | REGIONAL ANESTHESIA AND PAIN MEDICINE, | Status: | Early view | Abstract: | Background Radiofrequency (RF) treatment of the genicular nerves reduces chronic knee pain in patients with osteoarthritis (OA) or persistent postsurgical pain (PPSP) after total knee arthroplasty (TKA). The objective of this study is to compare long-term outcomes of cooled and conventional RF and perform an economic evaluation. Methods The COCOGEN trial is a double-blinded, non-inferiority, pilot, randomized controlled trial that compared the effects up to 12 months of cooled and conventional RF in patients with chronic knee pain suffering from OA or PPSP after TKA following a 1:1 randomization rate. Outcomes were knee pain, functionality, quality of life, emotional health, medication use, and adverse events. A trial-based economic evaluation was performed with a 12-month societal perspective. Here, the primary outcome was the incremental costs per quality-adjusted life year (QALY). Results 41 of the 49 included patients completed the 12-month follow-up. One patient in the PPSP cooled RF group had substantial missing data at 12-month follow-up. The proportion of patients with >= 50% pain reduction at 12 months was 22.2% (4/18) in patients treated with conventional RF versus 22.7% (5/22) in patients treated with cooled RF (p>0.05). There was a statistically significant difference in the mean absolute numerical rating scale at 12 months after cooled RF and conventional RF in patients with PPSP (p=0.02). Differences between other outcomes were not statistically significant. The health economic analysis indicated that cooled RF resulted in lower costs and improved QALYs compared with conventional RF in PPSP but not in OA. There were no serious adverse events. Conclusions Both RF treatments demonstrated in approximately 22% of patients a >= 50% pain reduction at 12 months. In patients with PPSP, contrary to OA, cooled RF seems to be more effective than conventional RF. Additionally, cooled RF has in patients with PPSP, as opposed to OA, greater effectiveness at lower costs compared with conventional RF. | Notes: | Vanneste, T (corresponding author), Ziekenhuis Oost Limburg, Anesthesiol Intens Care Med Emergency Med & Multid, B-3600 Genk, Belgium. Thibaut.Vanneste@zol.be |
Keywords: | analgesia;Pain;Postoperative;Treatment Outcome;CHRONIC PAIN | Document URI: | http://hdl.handle.net/1942/42653 | ISSN: | 1098-7339 | e-ISSN: | 1532-8651 | DOI: | 10.1136/rapm-2023-105127 | ISI #: | 001174315500001 | Rights: | American Society of Regional Anesthesia & Pain Medicine 2024. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ. Open access This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, an indication of whether changes were made, and the use is noncommercial. See: http://creativecommons.org/licenses/by-nc/4.0/. | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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Cooled versus conventional radiofrequency treatment of the genicular nerves for chronic knee .pdf | Early view | 1.66 MB | Adobe PDF | View/Open |
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