Manchikanti Laxmaiah, Manchikanti Kavita N, Manchukonda Rajeev, Pampati Vidyasagar, Cash Kim A
Pain Management Center of Paducah, Kentucky 42003, USA.
Pain Physician. 2006 Apr;9(2):97-105.
The prevalence of persistent upper back and mid back pain due to involvement of thoracic facet joints has been described in controlled studies as varying from 43% to 48% based on IASP criteria. Therapeutic intraventions utilized in managing chronic neck pain and low back pain of facet joint origin include intraarticular injections, medial branch nerve blocks, and neurolysis of medial branch nerves by means of radiofrequency. These interventions have not been evaluated in managing chronic thoracic pain of facet joint origin.
To determine the clinical effectiveness of therapeutic thoracic medial branch blocks in managing chronic upper back and mid back pain of facet joint origin.
A prospective outcome study.
Interventional pain management setting in the United States.
Fifty-five consecutive patients meeting the diagnostic criteria of thoracic facet joint pain by means of comparative, controlled diagnostic blocks were included in this evaluation. All medial branch blocks were performed in a sterile operating room under fluoroscopic visualization with mild sedation with midazolam and/or fentanyl. Statistical methods incorporated intent-to-treat analysis.
Numeric pain scores, significant pain relief > or = 50%), Oswestry Disability Index, work status and Pain Patient Profile (P-3). Significant pain relief was defined as an average 50% or greater reduction of numeric pain rating scores.
The results showed significant differences in numeric pain scores and significant pain relief (50% or greater) in 71% of the patients at three months and six months, 76% at 12 months, 71% at 24 months, and 69% at 36 months, compared to baseline measurements. Functional improvement was demonstrated at one year, two years, and three years from baseline. There was significant improvement with increase in employment among the patients eligible for employment (employed and unemployed) from baseline to one year, two years, and three years (61% vs 96% to 100%) and improved psychological functioning.
Therapeutic thoracic medial branch blocks were an effective modality of treatment in managing chronic thoracic pain secondary to facet joint involvement confirmed by controlled, comparative local anesthetic blocks.
根据国际疼痛研究协会（IASP）标准，对照研究表明，因胸段小关节受累导致的持续性上背部和中背部疼痛患病率在43%至48%之间。用于治疗小关节源性慢性颈痛和腰背痛的治疗干预措施包括关节内注射、内侧支神经阻滞以及通过射频对内侧支神经进行神经溶解。这些干预措施在治疗小关节源性慢性胸段疼痛方面尚未得到评估。
确定治疗性胸段内侧支阻滞在治疗小关节源性慢性上背部和中背部疼痛中的临床疗效。
一项前瞻性结果研究。
美国的介入性疼痛管理机构。
本评估纳入了55例通过对比、对照诊断性阻滞符合胸段小关节疼痛诊断标准的连续患者。所有内侧支阻滞均在无菌手术室中，在透视引导下进行，并用咪达唑仑和/或芬太尼进行轻度镇静。统计方法采用意向性分析。
数字疼痛评分、显著疼痛缓解（≥50%）、Oswestry功能障碍指数、工作状态和疼痛患者概况（P-3）。显著疼痛缓解定义为数字疼痛评分平均降低50%或更多。
结果显示，与基线测量相比，在3个月和6个月时，71%的患者数字疼痛评分和显著疼痛缓解（50%或更多）有显著差异；12个月时为76%，24个月时为71%，36个月时为69%。从基线开始，在1年、2年和3年时显示出功能改善。符合就业条件的患者（已就业和未就业）从基线到1年、2年和3年的就业情况有所改善（61%对96%至100%），心理功能也有所改善。
通过对照、比较局部麻醉阻滞证实，治疗性胸段内侧支阻滞是治疗小关节受累继发的慢性胸段疼痛的有效治疗方式。
