Persson Mats, Sörensen Jan, Gerdle Björn
*Clinical Department of Operation and Intensive Care, Pain Unit, County Hospital Ryhov, Jönköping, Sweden
Division of Community Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Sweden & Pain and Rehabilitation Centre, Anaesthetics, Operations and Specialty Surgery Centre, Region Östergötland, Linköping, Sweden.
Pain Med. 2016 Dec;17(12):2162-2175. doi: 10.1093/pm/pnw036. Epub 2016 Mar 27.
This study explores the prevalence of facet joint pain in chronic Whiplash Associated Disorder (WAD).
Forty-seven patients with chronic WAD were scheduled for medial branch blocks of the cervical spine.
The patient's localization of the pain together with established pain maps guided to the first level of zygapophyseal joint to be tested. The joint was anesthetized by injecting bupivacaine (0.5 ml; 5 mg/ml) to the medial branches of the cervical dorsal rami above and below the joint. If a positive response was noted, the schedule continued with a double-blinded sequence with a placebo (saline) and bupivacaine. If a negative response was noted, other joint levels were anesthetized until all joints from C2 to C7 were tested. The responses were assessed using a visual analog scale (VAS) in a predefined protocol.The study was carried through with a definition of a positive response to a diagnostic block as a VAS decrease ≥50% compared with baseline during a minimum of 3 hours after the block. All other responses were regarded as negative. The data were also analyzed using a definition of a positive response as a VAS decrease ≥80%, and figures from this analysis are presented as the main result of the study.
The study yielded 29% true positive responders, 60% non-responders, and 11% placebo responders.
A substantial amount of patients with chronic WAD have their persistent pain emanating from cervical zygapophyseal joints.
本研究探讨慢性挥鞭样损伤相关疾病（WAD）中 facet 关节疼痛的患病率。
47 例慢性 WAD 患者计划接受颈椎内侧支阻滞。
根据患者疼痛定位及已建立的疼痛图谱确定要测试的第一级关节突关节。通过向关节上方和下方的颈背神经内侧支注射布比卡因（0.5 ml；5 mg/ml）对关节进行麻醉。若出现阳性反应，则按双盲顺序继续使用安慰剂（生理盐水）和布比卡因。若出现阴性反应，则对其他关节水平进行麻醉，直至对 C2 至 C7 的所有关节进行测试。使用视觉模拟量表（VAS）按照预定义方案评估反应。本研究将诊断性阻滞的阳性反应定义为与基线相比，阻滞后至少 3 小时 VAS 降低≥50%。所有其他反应均视为阴性。数据还使用阳性反应定义为 VAS降低≥80%进行分析，该分析结果作为研究的主要结果呈现。
该研究产生了 29%的真阳性反应者、60%的无反应者和 11%的安慰剂反应者。
相当数量的慢性 WAD 患者其持续性疼痛源于颈椎关节突关节。
