Date of Award:

12-2010

Document Type:

Dissertation

Degree Name:

Doctor of Philosophy (PhD)

Department:

Psychology

Committee Chair(s)

M. Scott DeBerard

Committee

M. Scott DeBerard

Committee

Susan L. Crowley

Committee

David M. Stein

Committee

JoAnn T. Tschanz

Committee

Edward M. Heath

Abstract

Radiofrequency neurotomy is a pain intervention procedure designed to coagulate nerves that innervate a specific area of spinal vertebrae known as the facet joint. Despite moderate to strong research support for the efficacy of radiofrequency neurotomy to improve short-term subjective pain levels, much of the literature to date has used strict selection criteria and has not focused on functional and quality of life outcomes. Moreover, few studies have examined outcomes in worker's compensation patients or considered biopsychosocial predictive variables for the procedure. The current study aimed to characterize injured workers who have undergone radiofrequency neurotomy across a number of pre and post-procedural variables, evaluate multidimensional functional and quality of life outcomes, and examine biopsychosocial variables predictive of success and failure in this sample.

The current study comprised 101 injured workers who had undergone at least one radiofrequency neurotomy of the spine (cervical, thoracic, or lumbar) in the past 11 years. Participants were solicited through the Worker's Compensation Fund of Utah computerized database. Employing a retrospective cohort design, patients' medical charts were reviewed and various preprocedural variables were coded for analysis including age at the time of the first neurotomy, history of depression, lawyer involvement in the claim, prior back and neck surgical history, and quantity of other compensation claims. Of the total sample, 56 patients (55.4%) were contacted and completed outcome surveys that assessed patient satisfaction, functional impairment, disability status, pain catastrophization, and general physical and mental health functioning.

Findings revealed a moderate proportion of patients with total disability (40%), poor back/neck specific functioning (63%), and dissatisfaction with their current back/neck condition (75%). A multivariate regression model was consistently predictive of patient outcomes. Specifically, litigation status was a robust predictor of multidimensional outcomes, while depression and age retained slightly less predictive power. Results of descriptive, correlational, and regression analyses are compared to existing data for radiofrequency neurotomy and other spine procedures with similar populations. Limitations of the study are discussed, such as the retrospective design, lack of matched controls, and small sample size.

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This work made publicly available electronically on October 1, 2010.

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