Affiliation:
1. Pain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY
Abstract
Background: Thoracic facet joints have been implicated as the source of chronic pain in the mid
back or upper back in 34% to 42% of patients when the modified criteria of the International
Association for the Study of Pain (IASP) is utilized. Various therapeutic techniques utilized in
managing chronic thoracic pain of facet joint origin include intraarticular injections, medial branch
blocks, and radiofrequency neurotomy of thoracic medial branch nerves.
Study Design: A randomized, double-blind, active controlled trial.
Setting: A private practice, interventional pain management setting, and a specialty referral
center setting in the United States.
Objective: To determine the clinical effectiveness of therapeutic local anesthetic medial branch
blocks with or without steroid in managing chronic function-limiting mid back or upper back pain
of facet joint origin.
Methods: The study was performed in an interventional pain management private practice, a
tertiary referral center, in the United States. A total of 100 participants were included, with 50
participants in each of the local anesthetic and steroid groups. All of the participants met the
diagnostic criteria of thoracic facet joint pain by means of comparative, controlled diagnostic
blocks and the inclusion criteria. Group I participants received thoracic medial branch blocks with
bupivacaine, whereas Group II participants received thoracic medial branch blocks with bupivacaine
and non-particulate betamethasone.
Outcomes Assessment: Outcomes measures included numeric rating scores (NRS), Oswestry
Disability Index (ODI), opioid intake, and return to work status at baseline, 3 months, 6 months,
and 12 months. Significant pain relief was defined as ≥ 50% pain relief and/or a positive change
in ODI scores.
Results: In Group I and Group II 90% of participants showed significant pain relief and functional
improvement at 12 months.
The majority of the participants experienced significant pain relief of 47.2 ± 10.1 weeks in Group I
and 46.3 ± 8.4 weeks in Group II, requiring approximately 3.5 treatments per year with an average
relief of 15.8 ± 10.5 in Group I and 13.6 ± 3.6 weeks in Group II per episode of treatment.
Limitations: Study limitations include the lack of a placebo group.
Conclusions: Therapeutic thoracic medial branch blocks, with or without steroid, may provide a
management option for chronic function-limiting mid back or upper back pain of facet joint origin.
Clinical Trial: NCT00355706
Key words: Chronic spinal pain, thoracic pain, thoracic facet or zygapophysial joint pain, facet
joint nerve or medial branch blocks, comparative controlled local anesthetic blocks, therapeutic
thoracic medial branch blocks.
Publisher
American Society of Interventional Pain Physicians
Subject
Anesthesiology and Pain Medicine
Cited by
13 articles.
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