The effectiveness of corticosteroid injection into cervical facet joint for managing whiplash-related neck pain.

BACKGROUND

Cervical facet joint (CFJ) pain is commonly seen after whiplash trauma, and is frequently refractory to physical therapy and oral medication. Previous studies have shown positive pain-reducing outcomes after intra-articular (IA) corticosteroid injection in patients with CFJ pain unrelated to injury. We evaluated the effectiveness of IA corticosteroid injection for managing whiplash-related CFJ pain.

METHODS

We prospectively recruited 32 patients with chronic and persistent CFJ pain after whiplash trauma [≥3 on the Numeric Rating Scale (NRS)] despite physical therapy and oral medication. Under fluoroscopy guidance, we injected 10 mg (0.25 mL) of triamcinolone acetonide, mixed with 0.25 mL of 0.125% bupivacaine and 0.5 mL of normal saline. At 1 and 2 months after the injection, pain intensity was reassessed using the NRS.

RESULTS

Thirty patients completed the study. The mean pretreatment NRS score was 5.4±1.7, while the mean NRS scores at 1 and 2 months after treatment were 3.9±1.7 and 4.0±1.6, respectively. The NRS scores at both follow-ups were significantly decreased compared to pretreatment scores (pretreatment vs. 1 month, P=0.002; pretreatment vs. 2 months, P=0.004). Furthermore, 8 patients (26.7%) reported pain relief of ≥50% 2 months after the treatment.

CONCLUSIONS

In clinical practice, whiplash-induced CFJ pain is often refractory to physical therapy and oral medication, and clinicians have limited options to alleviate pain. We think that IA corticosteroid injection may serve as a management option for whiplash-related CFJ pain.