PainSci summary of Manchikanti 2008?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★★☆4-star ratings are for bigger/better studies and reviews published in more prestigious journals, with only quibbles. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
This test of needles for neck pain — specifically, nerve blocks with either steroids or anaesthetic — has been used to justify quite a bit of enthusiasm about the technique. The evidence is only of moderate quality, however, and there are numerous caveats: although many patients undoubtedly did improve, they didn’t necessarily improve a lot, some did not improve at all, benefits last only 2–6 months, patients received 2-5 treatments over a year, and it is an invasive strategy (minimally invasive, but injected meds are never risk-free). In short, despite improvements, most patients continued to have some degree of erratic symptoms … much like untreated patients.
Nerve blocks for neck pain may be well worth considering — they “may provide relief,” the study concludes — but they are no miracle cure.
original abstract†Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
STUDY DESIGN: A double-blind, randomized, controlled trial.
OBJECTIVE: To determine the clinical effectiveness of therapeutic local anesthetic cervical medial branch blocks with or without steroid in managing chronic neck pain of facet joint origin.
SUMMARY OF BACKGROUND DATA: The prevalence of persistent neck pain, secondary to involvement of cervical facet or zygapophysial joints, has been described in controlled studies as varying from 39% to 67%. Intra-articular injections, medial branch nerve blocks, and neurolysis of medial branch nerves have been described in managing chronic neck pain of facet joint origin.
METHODS: A total of 120 patients were included, with 60 patients in each of the local anesthetic and steroid groups. All the patients met the diagnostic criteria of cervical facet joint pain by means of comparative, controlled diagnostic blocks, and the inclusion criteria. Group I consisted of medial branch blocks with bupivacaine. Group II consisted of cervical medial branch blocks with bupivacaine and steroid. Numerical pain scores, Neck Disability Index, opioid intake, and work status were evaluated at baseline, 3 months, 6 months, and 12 months.
RESULTS: Significant pain relief (>or=50%) and functional status improvement was observed at 3 months, 6 months, and 12 months in over 83% of patients. The average number of treatments for 1 year was 3.5 +/- 1.0 in the nonsteroid group and 3.4 +/- 0.9 in the steroid group. Duration of average pain relief with each procedure was 14 +/- 6.9 weeks in the nonsteroid group, and it was 16 +/- 7.9 weeks in the steroid group. Significant relief and functional improvement was reported for 46 to 48 weeks in a year.
CONCLUSION: Therapeutic cervical medial branch nerve blocks, with or without steroids, may provide effective management for chronic neck pain of facet joint origin.
- “Systematic review of diagnostic utility and therapeutic effectiveness of thoracic facet joint interventions,” Sairam Atluri, Sukdeb Datta, Frank J E Falco, and Marion Lee, Pain Physician, 2008.
- “Injection therapy for subacute and chronic low back pain: an updated Cochrane review,” J Bart Staal, Rob A de Bie, Henrica C W de Vet, Jan Hildebrandt, and Patty Nelemans, Spine, 2009.
- “Systematic assessment of diagnostic accuracy and therapeutic utility of lumbar facet joint interventions,” Sukdeb Datta, Marion Lee, Frank J E Falco, David A Bryce, and Salim M Hayek, Pain Physician, 2009.
- “Systematic review of the therapeutic effectiveness of cervical facet joint interventions: an update,” Frank J E Falco, Laxmaiah Manchikanti, Sukdeb Datta, Bradley W Wargo, Stephanie Geffert, David A Bryce, Sairam Atluri, Vijay Singh, Ramsin M Benyamin, Nalini Sehgal, Stephen P Ward, 2nd Helm, Sanjeeva Gupta, and Mark V Boswell, Pain Physician, 2012.
- “An update of evaluation of therapeutic thoracic facet joint interventions,” Kavita N Manchikanti, Sairam Atluri, Vijay Singh, Stephanie Geffert, Nalini Sehgal, and Frank J E Falco, Pain Physician, 2012.
These three articles on PainScience.com cite Manchikanti 2008 as a source:
- PS Save Yourself from Low Back Pain! — Low back pain myths debunked and all your treatment options reviewed
- PS Save Yourself from Neck Pain! — A complete guide to chronic neck pain and the disturbing sensation of a “crick”
- PS Do Nerve Blocks Work for Neck Pain and Low Back Pain? — Analysis of the science of stopping the pain of facet joint syndrome with nerve blocks, joint injections, and nerve ablation
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Effectiveness of customised foot orthoses for Achilles tendinopathy: a randomised controlled trial. Munteanu 2015 Br J Sports Med.
- A Bayesian model-averaged meta-analysis of the power pose effect with informed and default priors: the case of felt power. Gronau 2017 Comprehensive Results in Social Psychology.
- The neck and headaches. Bogduk 2014 Neurol Clin.
- Agreement of self-reported items and clinically assessed nerve root involvement (or sciatica) in a primary care setting. Konstantinou 2012 Eur Spine J.
- Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis. Morelli 2017 Am J Sports Med.