Hellinga M D, van Eerd M, Stojanovic M P, Cohen S P, de Andrès Ares J, Kallewaard J W, Van Boxem K, Van Zundert J, Niesters M
Department of Anesthesiology and Pain Management, Leiden University Medical Center, Leiden, The Netherlands.
Department of Anesthesiology and Pain Management, Amphia Hospital, Breda, The Netherlands.
Pain Pract. 2025 Feb;25(2):e70005. doi: 10.1111/papr.70005.
Pain from the cervical facet joints, either due to degenerative conditions or due to whiplash-related trauma, is very common in the general population. Here, we provide an overview of the literature on the diagnosis and treatment of cervical facet-related pain with special emphasis on interventional treatment techniques.
A literature search on the diagnosis and treatment of cervical facet joint pain and whiplash-associated disorders (WAD) was performed using PubMed, Cochrane, and Embase databases. All relevant literature was retrieved and summarized.
Facet-related pain is typically diagnosed based on history and physical examination of the patients, combined with a diagnostic block (eg, with local anesthetic) of the medial branches innervating the joints. There is no additive value for imaging techniques to diagnose cervical facet pain, but imaging may be used for procedure planning. First-line therapy for pain treatment includes focused exercise, graded activity, and range-of-motion training. Pharmacological treatment may be considered for acute facet joint pain; however, for chronic facet joint pain, evidence for pharmacological treatment is lacking. Considering the lack of evidence for treatment with botulinum toxin, intra-articular steroid injections, or surgery, these interventions are not recommended. Diagnostic blocks are not considered a viable treatment option, though some patients may experience a prolonged analgesic effect. Long-term analgesia (>6 months) has been observed for radiofrequency treatment of the medial branches.
Cervical facet pain is diagnosed based on history, physical examination, and a diagnostic block of the medial branches innervating the painful joints. Conservative management, including exercise therapy, is the first line of treatment. When conservative management does not result in adequate improvement of pain, radiofrequency treatment of the medial branches should be considered, which often results in adequate pain relief.
颈椎小关节疼痛，无论是由于退行性病变还是与挥鞭样损伤相关的创伤，在普通人群中都非常常见。在此，我们概述了有关颈椎小关节相关疼痛诊断和治疗的文献，特别强调介入治疗技术。
使用PubMed、Cochrane和Embase数据库对颈椎小关节疼痛和挥鞭样损伤相关疾病（WAD）的诊断和治疗进行文献检索。检索并总结了所有相关文献。
小关节相关疼痛通常根据患者的病史和体格检查，结合对支配关节的内侧支进行诊断性阻滞（如使用局部麻醉剂）来诊断。成像技术对诊断颈椎小关节疼痛没有附加价值，但成像可用于手术规划。疼痛治疗的一线疗法包括针对性锻炼、分级活动和活动范围训练。急性小关节疼痛可考虑药物治疗；然而，对于慢性小关节疼痛，缺乏药物治疗的证据。考虑到肉毒杆菌毒素、关节内注射类固醇或手术治疗缺乏证据，不推荐这些干预措施。诊断性阻滞不被视为可行的治疗选择，尽管一些患者可能会有延长的镇痛效果。内侧支射频治疗已观察到长期镇痛（>6个月）。
颈椎小关节疼痛根据病史、体格检查以及对支配疼痛关节的内侧支进行诊断性阻滞来诊断。保守治疗，包括运动疗法，是一线治疗方法。当保守治疗不能充分改善疼痛时，应考虑对内侧支进行射频治疗，这通常能充分缓解疼痛。
