Cervical Epidural Injections in Chronic Discogenic Neck Pain Without Disc Herniation or Radiculitis: Preliminary Results of a Randomized, Double-Blind, Controlled Trial

Background: Chronic neck pain is a common problem in the adult population with a typical 12-month prevalence of 30% to 50%. However, there is a lack of consensus regarding the causes andtreatments of chronic neck pain.Despite limited evidence, cervical epidural injections are one of the commonly performed nonsurgical interventions in the management of chronic neck pain.Study Design: A randomized, double-blind, active control trial.Setting: An interventional pain management practice, a specialty referral center, a private practicesetting in the United States.Objectives: To evaluate the effectiveness of cervical interlaminar epidural injections with localanesthetic with or without steroids in the management of chronic neck pain with or without upperextremity pain in patients without disc herniation or radiculitis or facet joint pain.Methods: Patients without disc herniation or radiculitis and negative for facet joint pain by meansof controlled diagnostic medial branch blocks were randomly assigned to one of 2 groups: injectionof local anesthetic only or local anesthetic mixed with non-particulate betamethasone. Seventypatients were included in this analysis. Randomization was performed by computer-generatedrandom allocation sequence by simple randomization.Outcomes Assessment: Multiple outcome measures were utilized including the Numeric RatingScale (NRS), the Neck Disability Index (NDI), employment status, and opioid intake with assessmentat 3, 6, and 12 months post-treatment.Significant pain relief or functional status was defined as a 50% or more reduction.Results: Significant pain relief (≥ 50%) was demonstrated in 80% of patients in both groups andfunctional status improvement (> 50%) in 69% of Group I and 80% of Group II. The overall averageprocedures per year were 3.9 ± 1.01 in Group I and 3.9 ± 0.8 in Group II with an average totalrelief per year of 40.3 ± 14.1 weeks in Group I and 42.1 ± 9.9 weeks in Group II over a period of52 weeks in the successful group.Limitations: The results of this study are limited by the lack of a placebo group and that it is apreliminary report of 70 patients, with 35 patients in each group.Conclusion: Cervical interlaminar epidural injections with local anesthetic with or without steroidsmay be effective in patients with chronic function-limiting discogenic.Key words: Chronic neck pain, cervical disc herniation, cervical discogenic pain, cervical epiduralinjections, epidural steroids, local anesthetics