Lord S M, Barnsley L, Wallis B J, Bogduk N
Cervical Spine Research Unit, University of Newcastle, Callaghan, Australia.
Spine (Phila Pa 1976). 1996 Aug 1;21(15):1737-44; discussion 1744-5. doi: 10.1097/00007632-199608010-00005.
The authors developed a diagnostic double-blindfolded survey using placebo-controlled local anesthetic blocks.
To determine the prevalence of cervical zygapophysial joint pain among patients with chronic neck pain (more than 3 months' duration) after whiplash injury.
The prevalence of cervical zygapophysial joint pain after whiplash has been studied by means of comparative local anesthetic blocks. The concern is that such blocks may be compromised by placebo responses and that prevalence estimates based on such blocks may exaggerate the importance of this condition.
Sixty-eight consecutive patients referred for chronic neck pain after whiplash were studied. Patients with dominant headache were first screened with the use of comparative blocks of the C2-C3 zygapophysial joint. Patients who had positive responses concluded investigations. Those who did not experience pain relief together with the patients with dominant neck pain proceeded to undergo placebo-controlled local anesthetic blocks. Two different local anesthetics and a placebo injection of normal saline were administered in random order and under double-blindfolded conditions. A positive diagnosis was made if the patient's pain was completely and reproducibly relieved by each local anesthetic but not by the placebo injection.
Among patients with dominant headache, comparative blocks revealed that the prevalence of C2-C3 zygapophysial joint pain was 50%. Among those without C2-C3 zygapophysial joint pain, placebo-controlled blocks revealed the prevalence of lower cervical zygapophysial joint pain to be 49%. Overall, the prevalence of cervical zygapophysial joint pain (C2-C3 or below) was 60% (95% confidence interval, 46%, 73%).
Cervical zygapophysial joint pain is common among patients with chronic neck pain after whiplash. This nosologic entity has survived challenge with placebo-controlled, diagnostic investigations and has proven to be of major clinical importance.
作者通过使用安慰剂对照的局部麻醉阻滞开发了一种诊断性双盲调查。
确定挥鞭伤后慢性颈部疼痛（持续时间超过3个月）患者中颈椎关节突关节疼痛的患病率。
已通过比较性局部麻醉阻滞研究了挥鞭伤后颈椎关节突关节疼痛的患病率。令人担忧的是，此类阻滞可能会受到安慰剂反应的影响，并且基于此类阻滞的患病率估计可能会夸大这种情况的重要性。
对68例因挥鞭伤后慢性颈部疼痛前来就诊的连续患者进行了研究。首先使用C2-C3关节突关节的比较性阻滞对以头痛为主的患者进行筛查。有阳性反应的患者完成检查。那些未经历疼痛缓解的患者与以颈部疼痛为主的患者一起接受安慰剂对照的局部麻醉阻滞。在双盲条件下随机顺序给予两种不同的局部麻醉剂和一次安慰剂注射生理盐水。如果患者的疼痛通过每种局部麻醉剂完全且可重复地缓解，但未通过安慰剂注射缓解，则做出阳性诊断。
在以头痛为主的患者中，比较性阻滞显示C2-C3关节突关节疼痛的患病率为50%。在没有C2-C3关节突关节疼痛的患者中，安慰剂对照阻滞显示下颈椎关节突关节疼痛的患病率为49%。总体而言，颈椎关节突关节疼痛（C2-C3或更低）的患病率为60%（95%置信区间，46%，73%）。
颈椎关节突关节疼痛在挥鞭伤后慢性颈部疼痛患者中很常见。这种疾病实体在安慰剂对照的诊断性研究中经受住了考验，并已证明具有重要的临床意义。
