Comparative Outcomes of a 2-Year Follow-Up of Cervical Medial Branch Blocks in Management of Chronic Neck Pain: A Randomized, Double-Blind Controlled Trial

Background: Cervical therapeutic intraarticular facet joint injections, therapeutic medial branchblocks, and radiofrequency neurotomy have been applied in managing chronic neck pain of cervicalfacet joint origin. However, the effectiveness of these modalities continues to be debated.The purpose of this study was to determine the clinical effectiveness of therapeutic cervical medialbranch blocks with or without steroids.Study Design: A randomized, double-blind, controlled trial.Setting: An interventional pain management practice, a specialty referral center, a private practicesetting in the United States.Objective: To evaluate the clinical outcomes of therapeutic cervical medial branch blocks with localanesthetic with or without steroids in managing chronic neck pain of facet joint origin.Methods: A total of 120 patients meeting inclusion criteria were included. All of the patients met thediagnostic criteria of cervical facet joint pain by means of comparative, controlled diagnostic blocks,with at least 80% relief. Group I consisted of cervical medial branch blocks with bupivacaine only andGroup II consisted of cervical medial branch blocks with bupivacaine and steroid.Therapeutic cervical medial branch blocks with local anesthetic with or without steroids wereadministered. Main outcome measures included numeric pain scores, Neck Disability Index (NDI), opioidintake, and work status evaluated at baseline, 6, 12, 18, and 24 months. The one-year results ofoutcomes were published in 2008. This manuscript describes the 2-year results.Significant improvement was defined as at least 50% improvement in pain relief and/or functionalstatus improvement.Outcomes Assessment: Patient outcomes were measured at baseline, 3, 6, 12, 18, and 24 monthspost-treatment with the Numeric Rating Scale (NRS), the Neck Disability Index (NDI), employment status,and opioid intake. Decrease of ≥ 50% of NRS scores and Oswestry scores were considered significant.Results: Eighty-five percent of patients in Group I and 93% of patients in Group II showed significantpain relief (≥ 50%) at 2 years. The average number of treatments for 2 years was 5.7. The durationof average pain relief with each procedure was 17-19 weeks on average in both groups. Significantimprovement of pain and function was demonstrated for 83 to 89 weeks over a period of 2 years.Limitations: The study limitations include the lack of a placebo group.Conclusions: In this study, therapeutic cervical medial branch blocks instituted after the diagnosis, withcontrolled comparative local anesthetic blocks with 80% concordant pain relief, repeated approximately 6times over a period of 2 years, provided significant improvement over a period of 2 years.Key words: Chronic neck pain, cervical facet or zygapophysial joint pain, facet joint nerve or medial branchblocks, comparative controlled local anesthetic blocks, therapeutic cervical facet joint nerve blocks