Periprocedural Pain and Outcome Difference of Local Anesthetic vs Mechanodesensitization During Lumbar Facet Blocks for Low Back Pain

Pain Medicine ◽  
2020 ◽  
Vol 21 (10) ◽  
pp. 2100-2104
Author(s):  
Bilal Aleem ◽  
Muhammad Muslim Mubashir ◽  
Erin Clark ◽  
Daniel Vardeh
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Local Anesthetic ◽  
Secondary Outcome ◽  
Medial Branch ◽  
Low Back ◽  
Pain Scores ◽  
Global Comparison ◽  
Significant Difference ◽  
Lumbar Facet

Abstract Objective To compare periprocedural pain from mechanodesensitization (MD) with local anesthetic (LA) during medial branch blocks (MBBs), with a secondary outcome to compare diagnostic responses during the five hours postprocedure. Methods Forty-four patients with low back pain underwent three level bilateral MMBs. For the LA technique, 0.5 mL of 1% lidocaine was injected subcutaneously on one side, and for MD the skin was stretched using the index finger and thumb on the other. A 25-gauge 3.5-inch spinal needle was inserted over each target area, and the periprocedural pain was recorded on the numeric rating scale (NRS). After fluoroscopic positioning, the patient’s side preference was recorded. Patients were discharged with a pain diary to record pain scores every 30 minutes for five hours. Results Despite reporting higher pain scores with LA vs MD (P = 0.0462, mean difference ± SEM = 0.4924 ± 0.2459), global comparison favored LA. Pain scores with LA dropped from an average baseline of 6.11 to a mean NRS ± SEM of 2.461 ± 0.615, and with MD from 6.11 to 2.599 ± 0.552 (P ≤ 0.001). While there was no significant difference in area under the curve comparison over five hours (P = 0.3341), there was a trend toward lower pain scores with LA use. Conclusions LA before needle insertion for MBBs appears to be more painful compared with MD. Additionally, subcutaneously administered local anesthetic may have a therapeutic effect on nonspecific low back pain, resulting in a potentially false-positive test in the evaluation of lumbar facet pain.

scholarly journals Lumbar Facet Joint Nerve Blocks in Managing Chronic Facet Joint Pain: One-Year Follow-up of a Randomized, Double-Blind Controlled Trial: Clinical Trial NCT00355914

2008 ◽  
Vol 2;11 (3;2) ◽  
pp. 121-132
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Relief ◽  
Local Anesthetic ◽  
Chronic Low Back Pain ◽  
Facet Joint ◽  
Low Back ◽  
Lumbar Facet Joint ◽  
Nerve Blocks ◽  
Lumbar Facet

Background: Lumbar facet joints have been implicated as the source of chronic pain in 15% to 45% of patients with chronic low back pain. Various therapeutic techniques including intraarticular injections, medial branch blocks, and radiofrequency neurotomy of lumbar facet joint nerves have been described in the alleviation of chronic low back pain of facet joint origin. Objective: The study was conducted to determine the clinical effectiveness of therapeutic local anesthetic lumbar facet joint nerve blocks with or without steroid in managing chronic function-limiting low back pain of facet joint origin. Design: A randomized, double-blind, controlled trial. Setting: An interventional pain management setting in the United States. Methods: This study included 60 patients in Group I with local anesthetic and 60 patients in Group II with local anesthetic and steroid. The inclusion criteria was based on the positive response to the diagnostic controlled comparative local anesthetic lumbar facet joint blocks. Outcome measures: Numeric pain scores, Oswestry Disability Index, opioid intake, and work status. All outcome assessments were performed at baseline, 3 months, 6 months, and 12 months. Results: Significant improvement with significant pain relief (> 50%) and functional improvement (> 40%) were observed in 82% and 85% in Group I, with significant pain relief in over 82% of the patients and improvement in functional status in 78% of the patients. Based on the results of the present study, it appears that patients may experience significant pain relief 44 to 45 weeks of 1 year, requiring approximately 3 to 4 treatments with an average relief of 15 weeks per episode of treatment. Conclusion: Therapeutic lumbar facet joint nerve blocks, with or without steroid, may provide a management option for chronic function-limiting low back pain of facet joint origin. Key words: Chronic low back pain, lumbar facet or zygapophysial joint pain, facet joint nerve or medial branch blocks, comparative controlled local anesthetic blocks, therapeutic lumbar facet joint nerve blocks

Posterior Branches of Lumbar Spinal Nerves – part II: Lumbar Facet Syndrome – Pathomechanism, Symptomatology and Diagnostic Work-up

2017 ◽  
Vol 19 (2) ◽  
pp. 101-109 ◽  
Author(s):  
Katarzyna Kozera ◽  
Bogdan Ciszek ◽  
Paweł Szaro
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Facet Joint ◽  
Medial Branch ◽  
Low Back ◽  
Spinal Nerves ◽  
Lower Lumbar Spine ◽  
Facet Syndrome ◽  
Lumbar Spinal ◽  
Lumbar Facet

Posterior branches of the lumbar spinal nerves are the anatomic substrate of pain in the lower back, sacrum and the gluteal area. Such pain may be associated with various pathologies which cause pain in the posterior branches of the lumbar spinal nerves due to entrapment, mechanical irritation or inflammatory reaction and/or degeneration. The posterior branches are of significant functional importance, which is related to the function of the structures they supply, including facet joints, which are the basic biomechanical units of the spine. Low back pain caused by facet joint pathology may be triggered e.g. by simple activities, such as body rotations, unnatural positions, lifting heavy weights or excessive bending as well as chronic overloading with spinal hyperextension. Pain usually presents at the level of the lumbosacral junction (L 5 -S 1 ) and in the lower lumbar spine (L 4-5 , L 3-4 ). In the absence of specific diagnostic criteria, it is only possible to conclude that patients display tenderness at the level of the affected facet joint and that the pain is triggered by extension. Differential diagnosis for low back pain is difficult, since the pain may originate from various structures. The most reliable method of identifying Lumbar Facet Syndrome has been found to be a positive response to an analgesic procedure in the form of a block of the medial branch or intraarticular injection. There appear to be good grounds for conducting further studies and developing unequivocal diagnostic tests.

scholarly journals To study the effect of Triamcinolone injection for low back pain due to lumbar disc herniation

2018 ◽  
Vol 4 (1) ◽  
pp. 55-59
Author(s):  
Tashi Wangchuk ◽  
Kunzang P. Wangmo ◽  
Thinley Norbu
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Low Back ◽  
Trauma History ◽  
Pain Scores ◽  
Significant Difference ◽  
Epidural Steroid

Introduction: Low back pain is one of the most common complaints in the general population which represents a significant public health problem. Epidural Steroid Injection is being considered as a simple, effective and minimally invasive treatment modality for lumbar disc herniation. However, most studies only find a short-term benefit. In Bhutan, till date, no study has been done in Bhutan on this subject. The objective of our study was to find the effect of epidural steroid injection for low back pain due to lumbar disc herniation. Methods: An observational one-year-period study completed in Jigme Dorji Wangchuck National Referral Hospital. Symptomatic and positive Magnetic Resonance Imaging patients with lumbar disc herniation were included in our study. Pain scores were collected using Numeric Rating Scale at three different points of study. We also included patients’ age, weight and trauma history as some of the independent variables to study their associations with pain scores. The data obtained were analyzed using the Stata software program. One way repeated measures ANOVA was used to assess the significant difference in pain score. Results: Out of 100 participants recruited for the study, 91 of them completed demographic data and only 81 patients completed follow-up till 4 weeks post-treatment for demographic analysis and analytical analysis, respectively. There was a significant difference in pain scores in all three different points of study (p <0.01). No significant difference was observed in the pain scores amongst different age groups, gender, occupation and trauma history (p >0.05) at all three points of study. Conclusion: Our study observed a significant short-term benefit from epidural Triamcinolone injection for symptomatic lumbar disc herniation.

scholarly journals Indications for and benefits of lumbar facet joint block: analysis of 230 consecutive patients

2002 ◽  
Vol 13 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Alan Bani ◽  
Uwe Spetzger ◽  
Joachim M. Gilsbach
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Local Anesthetic ◽  
Joint Pain ◽  
Facet Joint ◽  
Leg Pain ◽  
Low Back ◽  
Lumbar Facet Joint ◽  
Facet Joint Pain ◽  
Lumbar Facet

Object The authors evaluated the effectiveness of using a facet joint block with local anesthetic agents and or steroid medication for the treatment of low-back pain in a medium-sized series of patients. Methods Over a period of 4 years, the authors performed 715 facet joint injections in 230 patients with variable-length histories of low-back pain. The main parameter for the success or failure of this treatment was the relief of the pain. For the first injection—mainly a diagnostic procedure—the authors used a local anesthetic (1 ml bupivacaine 1%). In cases of good response, betamethasone was injected in a second session to achieve a longer-lasting effect. Long-lasting relief of the low-back pain and/or leg pain was reported by 43 patients (18.7%) during a mean follow-up period of 10 months. Thirty-five patients (15.2%) noticed a general improvement in their pain. Twenty-seven patients (11.7%) reported relief of low-back pain but not leg pain. Nine patients (3.9%) suffered no back pain but still leg pain. One hundred sixteen patients (50.4%), however, experienced no improvement of pain at all. In two cases the procedure had to be interrupted because of severe pain. There were no cases of infection or hematoma. Conclusions Lumbar facet joint block is a minimally invasive procedure to differentiate between facet joint pain and other causes of lower-back pain. The procedure seems to be useful for distinguishing between facet joint pain from postoperative pain due to inappropriate neural decompression after lumbar surgery. It can be also recommended as a possible midterm intervention for chronic low-back pain.

scholarly journals Best practice in radiofrequency denervation of the lumbar facet joints: a consensus technique

2019 ◽  
Vol 14 (1) ◽  
pp. 47-56 ◽  
Author(s):  
Sam Eldabe ◽  
Anisah Tariq ◽  
Sherdil Nath ◽  
Ashish Gulve ◽  
Hugh Antrobus ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Best Practice ◽  
Controlled Trial ◽  
Medial Branch ◽  
Low Back ◽  
Facet Joints ◽  
Radiofrequency Denervation ◽  
Lumbar Facet ◽  
Lumbar Facet Joints

Background: Radiofrequency denervation is used to treat selected people with low back pain. Recent trials have been criticised for using a sub-optimal intervention technique. Objectives: To achieve consensus on a best practice technique for administering radiofrequency denervation of the lumbar facet joints to selected people with low back pain. Study design: A consensus of expert professionals in the area of radiofrequency denervation of the lumbar facet joints. Methods: We invited a clinical member from the 30 most active UK departments in radiofrequency pain procedures and two overseas clinicians with specific expertise to a 1 day consensus meeting. Drawing on the known anatomy of the medial branch, the theoretical basis of radiofrequency procedures, a survey of current practice and collective expertise, delegates were facilitated to reach consensus on the best practice technique. Results: The day was attended by 24 UK and international clinical experts. Attendees agreed a best practice technique for the conduct of radiofrequency denervation of the lumbar facet joints. Limitations: This consensus was based on a 1 day meeting of 24 clinical experts who attended and took part in the discussions. The agreed technique has not been subject to input from a wider community of experts. Conclusions: Current best practice for radiofrequency denervation has been agreed for use in a UK trial. Group members intend immediate implementation in their respective trusts. We propose using this in a planned Randomised Controlled Trial (RCT) of radiofrequency denervation for selected people with low back pain.

scholarly journals Quantum Movement Technique versus William Flexion Exercise on Pain and Walking Ability in Patients with Low Back Pain

2020 ◽  
Vol 8 (A) ◽  
pp. 323-325
Author(s):  
Djohan Aras ◽  
Nur Asmi ◽  
Yudi Hardianto ◽  
Rabia Rabia ◽  
Anwar Mallongi
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Primary Outcome ◽  
Rating Scale ◽  
Secondary Outcome ◽  
Walking Ability ◽  
Low Back ◽  
Significant Difference ◽  
Numeric Pain Rating Scale ◽  
Pain Rating Scale

OBJECTIVE: Our study aimed to compare between quantum movement technique (QMT) and William flexion exercise (WFE) in patients with low back pain (LBP) based on pain and walking ability. METHODS: Six-session QMT and WFE were provided for two groups of participants. The frequency of intervention was 6 times/week. Twenty patients (aged 25–65 years) with LBP were randomly assigned into the QMT group (n = 10) or the WFE group (n = 10). The primary outcome of the intervention was pain, measured using the numeric pain rating scale, while the secondary outcome was walking ability, measured using the Oswestry Disability Index. The measurements were conducted at baseline and the end of the intervention. RESULTS: Pain reduction was significantly shown in both groups (p < 0.05). However, QMT was shown more effective in reducing pain compared to WFE (p < 0.05). In addition, we found the significant improvement of walking ability in both groups following the intervention (p < 0.05), but no significant difference was shown between two groups (p > 0.05). CONCLUSIONS: QMT is more effective than WFE for reducing pain in patients with LBP.

scholarly journals Addition of dexmedetomidine and neostigmine to 1.5 % lidocaine and triamcinolone for epidural block to reduce the duration of analgesia in patients suffering from chronic low back pain

2019 ◽  
Vol 12 (3) ◽  
pp. 260-265
Author(s):  
Shima Zargar ◽  
◽  
Ali Nazemi Rafie ◽  
Alireza Sosanabadi ◽  
Alireza Kamali ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Epidural Block ◽  
Low Back ◽  
Double Blind ◽  
Pain Scores ◽  
Interlaminar Approach ◽  
Significant Difference ◽  
Group D

Lower back pain is one of the leading causes of disability in the world. The aim of this study was to evaluate the effect of supplementation of dexmedetomidine and neostigmine with lidocaine 1.5% and triamcinolone for epidural block in increasing the duration of analgesia among patients suffering from chronic low back pain. In this double-blind, randomized clinical trial, 33 patients with chronic low back pain were included in three groups of 11 patients for epidural blockage. Triamcinolone (40 mg/ml) was added to lidocaine 1.5% solution (2 cc/segment) for all three groups. In group N, neostigmine was used at a dose of 1 mg (mg), followed by group D (dexmedetomidine 35 μg [0.5 μg/kg]), and grou [ND (neostigmine 0.5 mg, and 35 μg dexmedetomidine, all of which were added to the triamcinolone and lidocaine solution in each group. Medications were injected into the epidural space using an interlaminar approach. Subsequently, scores of pain and duration of analgesia were recorded in questionnaires and analysed using SPSS version 23. One month after the injections, pain scores recorded in the N group were 7.6±1.4, followed by 5.88±1.2 in group D and 5.42 ±1.1 in group ND. Therefore, the pain scores were significantly higher in the neostigmine group than the other two groups (p = 0.02), but no significant difference was found between the two groups that received dexmedetomidine and a combination of dexmedetomidine + neostigmine. Three months after the injections, there was a significant difference in pain scores between the two groups (P = 0.01). Both neostigmine and dexmedetomidine were capable of reducing the pain of patients with chronic low back pain after epidural block. However, neostigmine’s impact is lower compared to dexmedetomidine. The combination of the two drugs also reduced the pain scores of the patients after the intervention.

scholarly journals Evaluation of Lumbar Facet Joint Nerve Blocks in the Management of Chronic Low Back Pain: Preliminary Report of A Randomized, Double-Blind Controlled Trial: Clinical Trial NCT00355914

2007 ◽  
Vol 3;10 (5;3) ◽  
pp. 425-440
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Facet Joint ◽  
Medial Branch ◽  
Low Back ◽  
Lumbar Facet Joint ◽  
Nerve Blocks ◽  
Steroid Group ◽  
Lumbar Facet

Background: The prevalence of persistent low back pain with the involvement of lumbar facet or zygapophysial joints has been described in controlled studies as varying from 15% to 45% based on the criteria of the International Association for the Study of Pain. Therapeutic interventions utilized in managing chronic low back pain of facet joint origin include intraarticular injections, medial branch nerve blocks, and neurolysis of medial branch nerves. Objective: To determine the clinical effectiveness of therapeutic lumbar facet joint nerve blocks in managing chronic low back pain of facet joint origin. Design: A prospective, randomized, double-blind trial. Setting: An interventional pain management setting in the United States. Methods: In this preliminary analysis, data from a total of 60 patients were included, with 15 patients in each of 4 groups. Thirty patients were in a non-steroid group consisting of Groups I (control, with lumbar facet joint nerve blocks using bupivacaine ) and II (with lumbar facet joint nerve blocks using bupivacaine and Sarapin); another 30 patients were in a steroid group consisting of Groups III (with lumbar facet joint nerve blocks using bupivacaine and steroids) and IV (with lumbar facet joint nerve blocks using bupivacaine, Sarapin, and steroids). All patients met the diagnostic criteria of lumbar facet joint pain by means of comparative, controlled diagnostic blocks. Outcome Measures: Numeric Rating Scale (NRS) pain scale, the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake. Results: Significant improvement in pain and functional status were observed at 3 months, 6 months, and 12 months, compared to baseline measurements. The average number of treatments for 1 year was 3.7 with no significant differences among the groups. Duration of average pain relief with each procedure was 14.8 ± 7.9 weeks in the non-steroid group, and 12.5 ± 3.3 weeks in the steroid group, with no significant differences among the groups. Conclusion: Therapeutic lumbar facet joint nerve blocks with local anesthetic, with or without Sarapin or steroids, may be effective in the treatment of chronic low back pain of facet joint origin. Key words: Chronic back pain, lumbar facet joint pain, lumbar zygapophysial joint pain, medial branch blocks, therapeutic lumbar facet joint nerve blocks, local anesthetic.

scholarly journals Prolongation of Lumbar Facet Joint Nerve Block Duration with 10% Lidocaine Neurolysis: A Retrospective Cohort Study

2018 ◽  
pp. 81-88
Author(s):  
David D. Kim
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Relief ◽  
Facet Joint ◽  
Medial Branch ◽  
Low Back ◽  
Significant Difference ◽  
Dorsal Rami

Background: Neural blockade of the facet medial branch/L5 dorsal rami with local anesthetic with or without corticosteroid has been used to both diagnose and treat low back pain. Higher concentration lidocaine has been shown to be neurolytic in multiple in vivo, in vitro, and some clinical studies. This may make 10% lidocaine a possible neurolytic agent to prolong pain relief from facet blocks. Objective: Compare neurolytic effects of 10% lidocaine to prolong pain relief compared to bupivacaine/ methylprednisolone (BM) in facet medial branch/L5 dorsal rami blocks (MBB). Methods: Retrospective review of 77 patients who received a 10% lidocaine MBB from after short term relief from MBB with BM. Comparison was made in visual analog scale (VAS) and duration of relief using Wilcoxon signed rank matched pairs test. Results: There was no significant difference between baseline median VAS prior to MBB with BM and 10% lidocaine and median days VAS recorded post each MBB ((P = 0.477). Median VAS immediately after BM MBB (17.5 mm) was not significantly different than after 10% Lidocaine MBB) of 18 mm (P = 0.341). Median duration of relief with 10% lidocaine was greater at 14 days versus BM at 3.5 days (P = 0.001). There was no significant correlation between the volume of 10% lidocaine at each level and performance measures: % change VAS post lidocaine MBB (P= 0.529), duration lidocaine MBB (P = 935), VAS pre-RFTC (P = 0.683). Limitation: Retrospective, small study. Conclusion: Ten percent lidocaine was moderately effective neurolytic agent with longer duration than BM. Key words: Lidocaine, facet joint, neurolysis, low back pain

Laser Acupuncture for Chronic Non-Specific Low Back Pain: A Controlled Clinical Trial

2009 ◽  
Vol 27 (3) ◽  
pp. 94-100 ◽  
Author(s):  
Gregory Glazov ◽  
Peter Schattner ◽  
Derrick Lopez ◽  
Kerrie Shandley
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Outcome Measures ◽  
Primary Outcome ◽  
Specific Effect ◽  
Laser Acupuncture ◽  
Secondary Outcome ◽  
Control Group ◽  
Low Back ◽  
Significant Difference

Objective The primary aim was to determine if laser acupuncture (LA) is more effective than sham laser in reducing pain and disability in adults with chronic non-specific low back pain. Methods The design was a double blind, two-group parallel randomised controlled trial. The active intervention was an 830 nm (infrared), 10 mW, Ga-Al-As laser diode laser for acupuncture and a sham control. The primary outcome measures were changes in pain (visual analogue scale) and disability (Oswestry Disability Index) at the end of 5–10 treatment sessions. Secondary outcomes were patient global assessment, psychological distress (Depression Anxiety Stress Scale) and subjective wellbeing (Personal Wellbeing Index). Follow up was performed at 6 weeks and 6 months after completion of treatment. Results 100 participants were enrolled and treated in a general practice setting. Per protocol analysis of the primary outcome measures using ANOVA suggested that although there was a significant overall improvement in pain and disability after the course of treatments (p<0.01), there was no significant difference between the intervention and control group in both the primary and most secondary outcome measures. Conclusion This study did not show a specific effect for LA using infrared laser at 0.2 Joules per point for chronic low back pain. The overall intervention appeared effective because of placebo and other factors. As there was some concern about baseline inequality between the groups further research using tighter inclusion criteria should attempt to replicate the result and examine if a dose response may exist.

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