Jeffrey James Peterson MD, Presenter: Nothing to Disclose

Define expected pain following osteoid osteoma radiofrequency ablation and correlate pain level and duration with lesion location and ablation technique

20 radiofrequency ablations for osteoid osteoma reviewed for degree and duration of post-procedure pain. Location: femur (n=14), tibia (n=5), and scapula (n=1). Lesions: extraarticular (n=13), intraarticular (n=7), cortical (n=10), subperiosteal (n=9), cancellous (n=1). Techniques: single ablation (n=13), 2 ablations (n=5), 3 ablations (n=2). Needle traversed: no muscle (n=4), 1 muscle (n=5), 2 muscles (n=10), 3 muscles (n=1). 8 discharged same day. 12 admitted for pain. Pain classified as severe, moderate, mild, or none. Pain recorded immediately post-procedure, evening/night, day after, and until resolved. Pain medication and length of use at each time frame noted

Pain immediately after procedure: severe (n=15), moderate (n=5). Pain evening/night: severe (n=9), moderate (n=7), mild (n=4). Pain next day: moderate (n=11), mild (n=6), none (3). Pain resolved 6.5 days. Pain medication evening/night: dilaudid (n=12), percocet (n=7), ibuprofen (n=1). Pain medication next day: percocet (n=15), ibuprofen (n=4), none (n=1). All pain medication discontinued at 8.7 days. 71% intraarticular lesions admitted for pain with pain meds discontinued at 9.3 days. 53.8% extraarticular lesions admitted for pain with pain meds discontinued at 8.4 days. 70% cortical lesions admitted for pain with pain meds discontinued at 10.5 days. 44.4% subperiosteal lesions admitted for pain with pain meds discontinued at 7.2 days. Correlation of number of ablations and admission: 1 – 46.1%, 2 – 60%, 3 – 50%. Correlation of number of ablations and discontinuing pain meds: 1 – 8.0 days, 2 – 10.2 days, 3 – 7.0 days. Correlation of number of muscles traversed by needle and admission: 0 – 50%, 1 – 60%, 2 – 60%, 3 – 100%. Correlation of number of muscles traversed by needle and discontinuing pain meds: 0 – 5.3 days, 1 – 7.2 days, 2 – 10.9 days, 3 – 11 days.  

Intraarticular lesions, cortical lesions and lesions with more muscles traversed by needle associated with more pain. Number of ablations not associated with difference in pain.

Post-procedure pain following radiofrequency ablation is common and should be expected. Lesion location and ablation technique can effect the degree and duration of post-procedure pain.

Peterson, J, Osteoid Osteoma Radiofrequency Ablation: Assessment of Typical Post-procedure Pain and Correlation of Pain with Lesion Location and Ablation Technique.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6009195.html