评估诊断性颈椎内侧支阻滞对颈椎小关节突疼痛的患病率：基于慢性疼痛模型的分析。

Assessment of Prevalence of Cervical Facet Joint Pain with Diagnostic Cervical Medial Branch Blocks: Analysis Based on Chronic Pain Model.

机构信息

Pain Management Centers of America, Paducah, KY and Evansville, IN; LSU Health Science Center, New Orleans, LA.

Pain Management Centers of America, Paducah, KY.

出版信息

Pain Physician. 2020 Nov;23(6):531-540.

PMID:33185369

Abstract

BACKGROUND

Research into cervical spinal pain syndromes has indicated that the cervical facet joints can be a potent source of neck pain, headache, and referred pain into the upper extremities. There have been multiple diagnostic accuracy studies, most commonly utilizing diagnostic facet joint nerve blocks and an acute pain model, as Bogduk has proposed. Subsequently, Manchikanti has focused on the importance of the chronic pain model and longer lasting relief with diagnostic blocks.

OBJECTIVE

To assess diagnostic accuracy of cervical facet joint nerve blocks with controlled comparative local anesthetic blocks, with updated assessment of prevalence, false-positive rate, and a description of philosophical paradigm shift from acute to chronic pain model, with concordant pain relief.

STUDY DESIGN

This diagnostic accuracy study was performed with retrospective assessment of data to assess prevalence and false-positive rates.

SETTING

The study was performed in a non-university-based, multidisciplinary, interventional pain management, private practice in the United States.

METHODS

Cervical medial branch blocks were performed utilizing lidocaine 1% followed by bupivacaine 0.25% when appropriate response was obtained in an operating room under fluoroscopic guidance with 0.5 mL of lidocaine or bupivacaine from C3-C6 medial branches (levels blocked on joints involved). If a patient failed to respond to lidocaine with appropriate >= 80% pain relief, that patient was considered as negative for facet joint pain. If the response was positive with lidocaine block, a bupivacaine block was performed.

RESULTS

The chronic cervical facet joint pain was diagnosed with cervical facet joint nerve blocks at a prevalence of 49.3% (95% CI, 43.6%, 55.0%) and with a false-positive rate of 25.6% (95% CI, 19.5%, 32.8%). This study also showed a single block prevalence rate of 66.3% (95% CI, 71.7%, 60.9%). Assessment of the duration of relief with each block showed greater than 80% for 6 days with lidocaine block and total relief of >= 50% of 31 days. In contrast, with bupivacaine, average duration of pain relief of >= 80% was 12 days with a total relief of >= 50% lasting for 55 days.

CONCLUSION

Based on this investigation, utilizing a chronic pain model, there was significant difference in the relief patterns. This assessment showed prevalence and false-positive rates of 49.3% and 25.6% in chronic neck pain. Duration of relief >= 80% pain relief was 6 days with lidocaine and 12 days with bupivacaine, with total relief of >= 50% of 31 days with 55 days respectively.

摘要

背景

对颈椎脊柱疼痛综合征的研究表明，颈椎关节突关节可能是颈部疼痛、头痛和上肢牵涉痛的一个潜在来源。博德克（Bogduk）提出，已经有多项诊断准确性研究，最常用的是诊断性关节突关节神经阻滞和急性疼痛模型。随后，曼奇卡蒂（Manchikanti）专注于慢性疼痛模型的重要性和诊断性阻滞带来的更持久的缓解。

目的

利用对照性局部麻醉阻滞评估颈椎关节突关节神经阻滞的诊断准确性，同时更新对流行程度、假阳性率的评估，并描述从急性疼痛模型向慢性疼痛模型的哲学范式转变，同时伴有一致的疼痛缓解。

研究设计

本诊断准确性研究通过回顾性评估数据来评估流行程度和假阳性率。

设置

该研究在美国一所非大学、多学科、介入性疼痛管理、私人执业的机构中进行。

方法

在手术室中，在透视引导下，用 1%利多卡因和 0.25%布比卡因进行颈椎内侧支阻滞，如果在 C3-C6 内侧支（涉及关节的阻滞水平）获得适当的反应，每支 0.5 毫升利多卡因或布比卡因。如果患者对利多卡因无反应或缓解不足 80%，则认为该患者关节突关节疼痛为阴性。如果利多卡因阻滞有阳性反应，再进行布比卡因阻滞。

结果

慢性颈椎关节突关节疼痛的诊断率为 49.3%（95%可信区间，43.6%，55.0%），假阳性率为 25.6%（95%可信区间，19.5%，32.8%）。本研究还显示单次阻滞的流行率为 66.3%（95%可信区间，71.7%，60.9%）。对每次阻滞的缓解持续时间进行评估显示，利多卡因阻滞的缓解时间大于 80%，持续 6 天，布比卡因阻滞的缓解时间大于 50%，持续 31 天。相比之下，布比卡因的平均缓解时间大于 80%为 12 天，缓解时间大于 50%持续 55 天。