scholarly journals Making Sense of the Accuracy of Diagnostic Lumbar Facet Joint Nerve Blocks: An Assessment of the Implications of 50% Relief, 80% Relief, Single Block, or Controlled Diagnostic Blocks

2010 ◽  
Vol 2;13 (1;2) ◽  
pp. 133-143
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Pain Relief ◽  
Joint Pain ◽  
Facet Joint ◽  
Lumbar Facet Joint ◽  
Nerve Blocks ◽  
Single Block ◽  
Facet Joint Pain ◽  
One Year ◽  
Lumbar Facet

Background: The presence of lumbar facet joint pain has been overwhelmingly supported and the accuracy of controlled diagnostic blocks has been demonstrated in multiple studies and confirmed in systematic reviews. However, controversy surrounds the following related issues: placebo control, the amount of relief (50% versus 80%), single block versus double block, and placebo or comparative control. Study Design: An observational report of an outcome study to establish the diagnostic accuracy of controlled lumbar facet joint nerve blocks. Setting: An interventional pain management practice setting in the United States. Objective: To determine the accuracy of controlled diagnostic blocks in managing lumbar facet joint pain at the end of 2 years, with 2 different criteria (50% or 80% relief) and single block versus double block. Methods: A previous study of 152 patients showed an 89.5% of sustained diagnosis of lumbar facet joint pain at the end of a 2-year follow-up period when the diagnosis was made with double blocks and at least 80% relief. The present evaluation includes comparison of the above results with a study of 110 patients undergoing lumbar facet joint nerve blocks with positive criteria of at least 50% relief and follow-up of 2 years. The inclusion criteria in both studies was based on a positive response to diagnostic controlled comparative local anesthetic lumbar facet joint blocks, with either 50% or 80% relief and the ability to perform previously painful movements. The treatment in both groups included therapeutic lumbar facet joint interventions either with facet joint nerve blocks or radiofrequency neurotomy. Outcome Measures: The sustained diagnosis of lumbar facet joint pain at the end of one year and 2 years based on pain relief and functional status improvement. Results: At the end of one year, the diagnosis was confirmed in 75% of the group with 50% relief, whereas it was 93% in the group with 80% relief. At the end of the 2-year follow-up, the diagnosis of lumbar facet joint pain was sustained in 51% of the patients in the group with 50% relief, whereas it was sustained in 89.5% of the patients with 80% relief. The results differed between 50% relief and 80% relief with prevalence of 61% facet joint pain with dual blocks with 50% relief, and 31% with dual blocks with 80% relief; whereas with only a single block, the prevalence was 73% with 50% relief and 53% in the 80% relief group. Limitations: The study is limited by its observational nature. Conclusion: Controlled diagnostic lumbar facet joint nerve blocks are valid utilizing the criteria of 80% pain relief and the ability to perform previously painful movements, with a sustained diagnosis of lumbar facet joint pain in at least 89.5% of the patients at the end of a 2-year follow-up. In contrast, the diagnosis was sustained in 51% of the patients with 50% relief at the end of 2 years. Thus, inappropriate diagnostic criteria will increase the prevalence of facet joint pain substantially, leading to inappropriate and unnecessary treatment. Key words: Chronic low back pain, lumbar facet or zygapophysial joint pain, facet joint nerve or medial branch blocks, controlled local anesthetic blocks, construct validity, diagnostic studies, diagnostic accuracy

scholarly journals Accuracy of Diagnostic Lumbar Facet Joint Nerve Blocks: A 2-Year Follow-Up of 152 Patients Diagnosed with Controlled Diagnostic Blocks

2009 ◽  
Vol 5;12 (5;9) ◽  
pp. 855-866 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Low Back Pain ◽  
Joint Pain ◽  
Facet Joint ◽  
Low Back ◽  
Lumbar Facet Joint ◽  
Nerve Blocks ◽  
Facet Joint Pain ◽  
One Year ◽  
Lumbar Facet

Background: Lumbar facet joint pain is diagnosed by controlled diagnostic blocks. The accuracy of controlled diagnostic blocks has been demonstrated in multiple studies and confirmed in systematic reviews. Controlled diagnostic studies have shown an overall prevalence of lumbar facet joint pain in 31% of the patients with chronic low back pain without disc displacement or radiculitis, with an overall false-positive rate of 30% using a single diagnostic block. Study Design: An observational report of outcomes assessment. Setting: An interventional pain management practice setting in the United States. Objective: To determine the accuracy of controlled diagnostic blocks in managing lumbar facet joint pain at the end of 2 years. Methods: This study included 152 patients diagnosed with lumbar facet joint pain using controlled diagnostic blocks. The inclusion criteria was based on a positive response to diagnostic controlled comparative local anesthetic lumbar facet joint blocks. The treatment included therapeutic lumbar facet joint nerve blocks. Outcome Measures: The sustained diagnosis of lumbar facet joint pain at the end of one year and 2 years based on pain relief and functional status improvement. Results: At the end of one year 93% of the patients and at the end of 2 years 89.5% of the patients were considered to have lumbar facet joint pain. Limitations: The study is limited by its observational nature. Conclusion: Controlled diagnostic lumbar facet joint nerve blocks are valid utilizing the criteria of 80% pain relief and the ability to perform previously painful movements, with sustained diagnosis of lumbar facet joint pain in at least 89.5% of the patients at the end of a 2-year follow-up period. Key words: Chronic low back pain, lumbar facet or zygapophysial joint pain, facet joint nerve or medial branch blocks, controlled local anesthetic blocks, construct validity, diagnostic studies, diagnostic accuracy

scholarly journals Controlled medial branch anesthetic block in the diagnosis of chronic lumbar facet joint pain: the value of a three-month follow-up

Clinics ◽  
2014 ◽  
Vol 69 (8) ◽  
pp. 529-534 ◽  
Author(s):  
ID Rocha ◽  
AF Cristante ◽  
RM Marcon ◽  
RP Oliveira ◽  
OB Letaif ◽  
...  
Keyword(s):  
Joint Pain ◽  
Facet Joint ◽  
Medial Branch ◽  
Lumbar Facet Joint ◽  
Facet Joint Pain ◽  
Lumbar Facet

scholarly journals Pulsed radiofrequency therapy might be not inferior to thermal neurotomy in lumbar facet joint pain: a commentary

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Haiko Sprott ◽  
Norina Bergamin ◽  
Armin Aeschbach
Keyword(s):  
Pain Relief ◽  
Joint Pain ◽  
Facet Joint ◽  
Medial Branch ◽  
Pulsed Radiofrequency ◽  
Lumbar Facet Joint ◽  
Pulsed Radiofrequency Treatment ◽  
Radiofrequency Therapy ◽  
Facet Joint Pain ◽  
Lumbar Facet

The effects of pulsed radiofrequency treatment in low back pain was evaluated in a routine clinical setting and compared with thermal neurotomy of nerve structures of the facet joint. The treatment of 19 patients with lumbar facet joint pain was prospectively evaluated. Follow-ups were recorded at 6 weeks and 6 months after intervention. Patients with ≥50% pain relief following controlled diagnostic local anesthetic block underwent medial branch neurotomy with thermal continuous radiofrequency (CRF, n=16) or pulsed radiofrequency (PRF, n=3). Experiences between the two radiofrequency modes in the treatment of facet joint pain were recorded. In the overall population, a facet joint pain reduction of 23% at 6 weeks, 20% at 6 months and an improvement in various clinical scores was achieved. CRF and PRF appeared to be similarly effective in the treatment of facet joint pain, providing pain relief for at least 6 months. These observations should encourage pain researcher to design meaningful studies to further address this concept.

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

scholarly journals An Update of the Systematic Assessment of the Diagnostic Accuracy of Lumbar Facet Joint Nerve Blocks

2012 ◽  
Vol 6;15 (6;12) ◽  
pp. E869-E907
Author(s):  
Frank J.E. Falco
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Relief ◽  
Diagnostic Accuracy ◽  
Chronic Low Back Pain ◽  
Facet Joint ◽  
Low Back ◽  
Lumbar Facet Joint ◽  
Nerve Blocks ◽  
Lumbar Facet

Background: Lumbar facet joints are a well recognized source of low back pain and referred pain in the lower extremity in patients with chronic low back pain. Conventional clinical features and other non-invasive diagnostic modalities are unreliable in diagnosing lumbar zygapophysial joint pain. Controlled diagnostic studies with at least 80% pain relief as the criterion standard have shown the prevalence of lumbar facet joint pain to be 16% to 41% of patients with chronic low back pain without disc displacement or radiculitis, with a false-positive rate of 17% to 49% with a single diagnostic block. Study Design: A systematic review of the diagnostic accuracy of lumbar facet joint nerve blocks. Objective: To determine and update the diagnostic accuracy of lumbar facet joint nerve blocks in the assessment of chronic low back pain. Methods: A methodological quality assessment of included studies was performed using Quality Appraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. Studies scoring less than 50% are presented descriptively and analyzed critically. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to June 2012, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: Studies must have been performed utilizing controlled local anesthetic blocks. Pain relief was categorized as at least 50% pain relief from baseline pain and the ability to perform previously painful movements. Results: A total of 25 diagnostic accuracy studies were included. Of these, one study evaluated 50% to 74% relief as criterion standard with a single block with prevalence of 48%, 4 studies evaluated 75% to 100% relief as the criterion standard with a single block with a prevalence of 31% to 61%, 5 studies evaluated 50% to 74% relief as the criterion standard with controlled blocks with a prevalence of 15% to 61%, and 13 studies evaluated 75% to 100% relief as the criterion standard with controlled blocks with a prevalence of 25% to 45% in heterogenous populations. False-positive rates ranged from 17% to 66% in the 50% to 74% pain relief group and 27% to 49% with at least 75% relief as the criterion standard. Based on this evaluation, the evidence showed that there is good evidence for diagnostic facet joint nerve blocks with 75% to 100% pain relief as the criterion standard with dual blocks and fair evidence with 50% to 74% pain relief as the criterion standard with controlled diagnostic blocks; however, the evidence is poor with single diagnostic blocks of 50% to 74%, and limited for 75% or more pain relief as the criterion standard. Limitations: The shortcomings of this systematic review of the accuracy of diagnostic lumbar facet joint nerve blocks include a paucity of literature and continued debate on an appropriate gold standard. Conclusion: There is good evidence for diagnostic facet joint nerve blocks with 75% to 100% pain relief as the criterion standard with dual blocks, with fair evidence with 50% to 74% pain relief. Key words: Chronic low back pain, lumbar facet or zygapophysial joint pain, facet joint nerve blocks, medial branch blocks, controlled comparative local anesthetic blocks

scholarly journals Randomized prospective trial of cooled versus traditional radiofrequency ablation of the medial branch nerves for the treatment of lumbar facet joint pain

2019 ◽  
Vol 44 (3) ◽  
pp. 389-397 ◽  
Author(s):  
Zachary L McCormick ◽  
Heejung Choi ◽  
Rajiv Reddy ◽  
Raafay H Syed ◽  
Meghan Bhave ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Success Rate ◽  
Joint Pain ◽  
Rating Scale ◽  
Facet Joint ◽  
Prospective Trial ◽  
Medial Branch ◽  
Lumbar Facet Joint ◽  
Facet Joint Pain ◽  
Lumbar Facet

Background and objectivesNo previous study has assessed the outcomes of cooled radiofrequency ablation (C-RFA) of the medial branch nerves (MBN) for the treatment of lumbar facet joint pain nor compared its effectiveness with traditional RFA (T-RFA). This study evaluated 6-month outcomes for pain, function, psychometrics, and medication usage in patients who underwent MBN C-RFA versus T-RFA for lumbar Z-joint pain.MethodsIn this blinded, prospective trial, patients with positive diagnostic MBN blocks (>75% relief) were randomized to MBN C-RFA or T-RFA. The primary outcome was the proportion of ‘responders’ (≥50% Numeric Rating Scale (NRS) reduction) at 6 months. Secondary outcomes included NRS, Oswestry Disability Index (ODI), and Patient Global Impression of Change.ResultsForty-three participants were randomized to MBN C-RFA (n=21) or T-RFA (n=22). There were no significant differences in demographic variables (p>0.05). A ≥50% NRS reduction was observed in 52% (95% CI 31% to 74%) and 44% (95% CI 22% to 69%) of participants in the C-RFA and T-RFA groups, respectively (p=0.75). A ≥15-point or ≥30% reduction in ODI score was observed in 62% (95% CI 38% to 82%) and 44% (95% CI 22% to 69%) of participants in the C-RFA and T-RFA groups, respectively (p=0.21).ConclusionsWhen using a single diagnostic block paradigm with a threshold of >75% pain reduction, both treatment with both C-RFA and T-RFA resulted in a success rate of approximately 50% when defined by both improvement in pain and physical function at 6-month follow-up. While the success rate was higher in the C-RFA group, this difference was not statistically significant.Trial registration numberNCT02478437.

Sign in / Sign up

Export Citation Format

Share Document