Introduction: Radiofrequency ablation (RFA) of the genicular nerve is an increasingly common treatment for chronic knee pain, refractory to conservative measures. However, RFA often provides significant but temporary relief, and patients return for repeat RFAs for the treatment of their pain. This study investigates the efficacy of repeat RFAs compared to the initial RFA for patients who receive repeat RFAs for chronic knee pain. Methods: This study is a retrospective chart review and analysis that was conducted between 2015 and 2023. Groups were determined by the number of RFA procedures that patients received, and a one-tailed ANOVA test was performed to assess the statistical significance of the initial RFA and the three repeat RFA groups. A one-way ANOVA was performed to analyze statistical differences between percent improvement, preoperative pain scores, and the duration of improvement using the visual analog scale (VAS). A p-value of statistical significance was set at p < 0.05. A paired two-tailed T-test was carried out, individually comparing the initial RFA to the three repeat groups for percent improvement. A paired t-test was also carried out to compare initial and first repeat RFAs for preoperative pain score and duration of improvement. Results: A total of 42 patients underwent repeat RFA procedures, with 8 receiving bilateral treatments, totaling 50 knees and 116 procedures. The original RFA group demonstrated a mean percent improvement of 75% ± 25% (mean ± SD) and a duration of improvement of 9.46 ± 5.45 months. The first repeat group had a mean percent improvement of 66% ± 29% and a duration of improvement of 8.77 ± 7.32 months. The second repeat group had a mean percent improvement of 67% ± 24% and a duration of improvement of 10.00 ± 2.45 months. The third repeat group had a mean percent improvement of 85% ± 20% and a duration of improvement of 4.00 months. ANOVA revealed no statistically significant differences among the groups in preoperative scores (p = 0.40), percent improvement (p = 0.25), or duration of improvement (p = 0.79). Paired t-tests showed a significant decrease in percent improvement in the first repeat RFA compared to the original RFA (p = 0.04), but no significant differences were observed in preoperative scores (p = 0.057) or duration of improvement (p = 0.175). No significant differences were found in percent improvement via paired T-test between the original RFA and the second (p = 0.75) or third repeats (p = 0.21). Conclusions: The repeat RFA of genicular nerves retains a clinically significant level of pain reduction for chronic knee pain. However, this study demonstrated decreased pain relief following the first repeat RFA compared to the initial RFA when analyzing individual knees sequentially via a paired T-test. An analysis of initial, first, second, and third repeat groups via ANOVA showed no difference in percent improvement, duration of pain relief, or preoperative pain scores.

Introduction Chronic pain poses a significant challenge to quality of life throughout the USA. It is estimated that as much as 21% of the US population experiences chronic pain, and the incidence of new chronic pain cases is shockingly high, at 52.4 cases per 1000 persons per year. An intrathecal pump (ITP) consists of a small pump surgically implanted under the skin, along with a catheter inserted into the intrathecal space in the spine. Medication, usually in the form of opioids, local anesthetics, or muscle relaxants, is then delivered through the catheter into the spinal fluid, where it can act directly on nerves to provide pain relief or reduce spasticity. The use of intrathecal drug delivery has been established for decades and is used for various conditions, including chronic noncancer pain and cancer-related pain. ITPs are also employed for managing severe spasticity in conditions such as multiple sclerosis or spinal cord injury. Over the years, there has been a gradual increase in the use of ITPs, particularly as awareness of their benefits and technological advancements has increased. ITPs have been historically placed in the abdomen. However, more recently, some ITPs have begun to be placed in the lower back. Placing ITPs in the lower back has the potential to lower operative time and complication rates, but more research in this area is warranted. This study analyzes the outcomes of posterior ITP placement to evaluate their suitability and potential benefits. Methods This study consisted of a retrospective review including data from 115 procedures completed between 2015 and 2025. Data collection included patient demographics, preoperative and postoperative pain scores, surgical time, needle and catheter locations, and adverse events. Pain scores were collected using the visual analog scale (VAS), and data were analyzed using SPSS 29. Two-tailed paired t-tests were used to determine the significance of the difference between preoperative and postoperative pain scores. Results A total of 115 procedures from 103 patients were included in the statistical analysis. The average preoperative pain was 6.54 (6.54 ± 2.00, n = 114), and the average postoperative pain score in the first year following the procedure was 4.45 (4.45 ± 2.30, n = 114), with a p value of < 0.001. The average surgical time for the procedure was 49.00 ± 19.53 min (n = 113). Conclusions In this study, ITPs implanted in the lower back were associated with greater pain relief, shorter surgical times, and fewer complications than those placed in the abdomen. These findings, while indirect, provide evidence for promoting ITP placement in the lower back as a safe and effective option for patients experiencing chronic pain.