Open AccessComparative Effectiveness of a One-Year Follow-Up of Thoracic Medial Branch Blocks in Management of Chronic Thoracic Pain: A Randomized, Double-Blind Active Controlled Trial
Author(s) -
Laxmaiah Manchikanti,
Vijay Singh,
Frank J E Falco,
Kimberly A Cash,
Vidyasagar Pampati,
Bert Fellows
Publication year - 2010
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2010/13/535
Subject(s) - medicine , oswestry disability index , interventional pain management , facet joint , physical therapy , local anesthetic , chronic pain , anesthesia , randomized controlled trial , back pain , neurotomy , low back pain , thoracic vertebrae , surgery , lumbar , lumbar vertebrae , alternative medicine , pathology
Background: Thoracic facet joints have been implicated as the source of chronic pain in the midback or upper back in 34% to 42% of patients when the modified criteria of the InternationalAssociation for the Study of Pain (IASP) is utilized. Various therapeutic techniques utilized inmanaging chronic thoracic pain of facet joint origin include intraarticular injections, medial branchblocks, 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 referralcenter setting in the United States.Objective: To determine the clinical effectiveness of therapeutic local anesthetic medial branchblocks with or without steroid in managing chronic function-limiting mid back or upper back painof facet joint origin.Methods: The study was performed in an interventional pain management private practice, atertiary referral center, in the United States. A total of 100 participants were included, with 50participants in each of the local anesthetic and steroid groups. All of the participants met thediagnostic criteria of thoracic facet joint pain by means of comparative, controlled diagnosticblocks and the inclusion criteria. Group I participants received thoracic medial branch blocks withbupivacaine, whereas Group II participants received thoracic medial branch blocks with bupivacaineand non-particulate betamethasone.Outcomes Assessment: Outcomes measures included numeric rating scores (NRS), OswestryDisability 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 changein ODI scores.Results: In Group I and Group II 90% of participants showed significant pain relief and functionalimprovement at 12 months.The majority of the participants experienced significant pain relief of 47.2 ± 10.1 weeks in Group Iand 46.3 ± 8.4 weeks in Group II, requiring approximately 3.5 treatments per year with an averagerelief 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 amanagement option for chronic function-limiting mid back or upper back pain of facet joint origin.Clinical Trial: NCT00355706Key words: Chronic spinal pain, thoracic pain, thoracic facet or zygapophysial joint pain, facetjoint nerve or medial branch blocks, comparative controlled local anesthetic blocks, therapeuticthoracic medial branch blocks.