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Nerve blocks may, or may not, help chronic neck pain

PainSci » bibliography » Manchikanti et al 2008
Tags: treatment, neck, injections, neuropathy, head/neck, spine, medicine, pain, pain problems

Three pages on PainSci cite Manchikanti 2008: 1. The Complete Guide to Low Back Pain2. The Complete Guide to Neck Pain & Cricks3. Do Nerve Blocks Work for Neck Pain and Low Back Pain?

PainSci commentary on Manchikanti 2008: ?This page is one of thousands in the 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 wherever possible.

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.

~ Paul Ingraham

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.

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