Effectiveness of cervical medial branch blocks in chronic neck pain: a prospective outcome study.

ABSTRACT

BACKGROUND: The high prevalence of persistent neck pain due to involvement of cervical facet joints has been described in controlled studies. Therapeutic interventions utilized in managing chronic neck pain of facet joint origin include intraarticular injections, medial branch nerve blocks, and neurolysis of medial branch nerves by means of radiofrequency. OBJECTIVE: The objective of this prospective evaluation was to determine the clinical effectiveness of cervical medial branch blocks for therapeutic purposes. DESIGN: A prospective, non-randomized, outcome study. METHODS: One hundred consecutive patients meeting the diagnostic criteria of facet joint pain by means of comparative, controlled diagnostic blocks were included in this evaluation. All medial branch blocks were performed in a sterile operating room under fluoroscopic visualization with mild sedation with midazolam and/or fentanyl. Statistical methods incorporated intent-to-treat analysis. OUTCOME MEASURES: Numeric pain scores, Oswestry Disability Index, work status, and Pain Patient Profile (P-3(R)). Significant pain relief was defined as average relief of 50% or greater. RESULTS: The results showed significant differences in numeric pain scores and significant pain relief (50% or greater) at 3 months, 6 months, and 12 months, compared to baseline measurements. Functional improvement was demonstrated at 12 months from baseline. There was significant improvement with increase in employment among the patients eligible for employment (employed and unemployed) from baseline to 12 months, and improved psychological functioning. CONCLUSION: Cervical medial branch blocks were an effective modality of treatment in managing chronic neck pain secondary to facet joint involvement confirmed by controlled, comparative local anesthetic blocks.