Pain Management Center of Paducah, Paducah, Kentucky, USA.
Pain Physician. 2010 Sep-Oct;13(5):437-50.
Cervical therapeutic intraarticular facet joint injections, therapeutic medial branch blocks, and radiofrequency neurotomy have been applied in managing chronic neck pain of cervical facet joint origin. However, the effectiveness of these modalities continues to be debated. The purpose of this study was to determine the clinical effectiveness of therapeutic cervical medial branch blocks with or without steroids.
A randomized, double-blind, controlled trial.
An interventional pain management practice, a specialty referral center, a private practice setting in the United States.
To evaluate the clinical outcomes of therapeutic cervical medial branch blocks with local anesthetic with or without steroids in managing chronic neck pain of facet joint origin.
A total of 120 patients meeting inclusion criteria were included. All of the patients met the diagnostic criteria of cervical facet joint pain by means of comparative, controlled diagnostic blocks, with at least 80% relief. Group I consisted of cervical medial branch blocks with bupivacaine only and Group II consisted of cervical medial branch blocks with bupivacaine and steroid. Therapeutic cervical medial branch blocks with local anesthetic with or without steroids were administered. Main outcome measures included numeric pain scores, Neck Disability Index (NDI), opioid intake, and work status evaluated at baseline, 6, 12, 18, and 24 months. The one-year results of outcomes were published in 2008. This manuscript describes the 2-year results. Significant improvement was defined as at least 50% improvement in pain relief and/or functional status improvement.
Patient outcomes were measured at baseline, 3, 6, 12, 18, and 24 months post-treatment with the Numeric Rating Scale (NRS), the Neck Disability Index (NDI), employment status, and opioid intake. Decrease of ≥ 50% of NRS scores and Oswestry scores were considered significant.
Eighty-five percent of patients in Group I and 93% of patients in Group II showed significant pain relief (≥ 50%) at 2 years. The average number of treatments for 2 years was 5.7. The duration of average pain relief with each procedure was 17-19 weeks on average in both groups. Significant improvement of pain and function was demonstrated for 83 to 89 weeks over a period of 2 years.
The study limitations include the lack of a placebo group.
In this study, therapeutic cervical medial branch blocks instituted after the diagnosis, with controlled comparative local anesthetic blocks with 80% concordant pain relief, repeated approximately 6 times over a period of 2 years, provided significant improvement over a period of 2 years.
NCT00332722.
颈椎关节突关节内关节注射、治疗性内侧支阻滞和射频神经切断术已应用于治疗颈椎关节突关节源性慢性颈痛。然而，这些方法的有效性仍存在争议。本研究的目的是确定治疗性颈椎内侧支阻滞联合或不联合类固醇的临床效果。
随机、双盲、对照试验。
美国介入性疼痛管理实践、专科转诊中心、私人执业环境。
评估在管理源自小关节的慢性颈痛时，局部麻醉剂联合或不联合类固醇的治疗性颈椎内侧支阻滞的临床效果。
共纳入符合纳入标准的 120 例患者。所有患者均通过对照性、控制性诊断阻滞符合颈椎小关节痛的诊断标准，至少有 80%的缓解率。第 I 组为单纯布比卡因颈椎内侧支阻滞，第 II 组为布比卡因加类固醇颈椎内侧支阻滞。进行治疗性颈椎内侧支阻滞，使用局部麻醉剂联合或不联合类固醇。主要观察指标包括数字疼痛评分、颈部残疾指数（NDI）、阿片类药物摄入量以及治疗前、6、12、18 和 24 个月的工作状态。2008 年发表了 1 年的结果。本文描述了 2 年的结果。显著改善定义为疼痛缓解和/或功能状态改善至少 50%。
第 I 组 85%的患者和第 II 组 93%的患者在 2 年时疼痛缓解（≥50%）显著。治疗后 3、6、12、18 和 24 个月，患者采用数字评分量表（NRS）、颈部残疾指数（NDI）、就业状况和阿片类药物摄入量来评估患者的预后。NRS 评分和 Oswestry 评分下降≥50%被认为有显著意义。
在这项研究中，在诊断后进行治疗性颈椎内侧支阻滞，采用控制性局部麻醉剂阻滞，有 80%的疼痛缓解率，在 2 年内重复约 6 次，在 2 年内提供了显著的改善。
NCT00332722。
