Open AccessDiagnostic Accuracy of Thoracic Facet Joint Nerve Blocks: An Update of the Assessment of Evidence
Author(s) -
Sairam Atluri
Publication year - 2012
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.2012/15/e483
Subject(s) - medicine , facet joint , facet (psychology) , local anesthetic , evidence based medicine , physical therapy , back pain , systematic review , nerve block , medline , surgery , alternative medicine , pathology , psychology , social psychology , lumbar spine , personality , political science , law , big five personality traits
Background: Chronic mid back and upper back pain caused by thoracic facet jointshas been reported in 34% to 48% of the patients based on their responses to controlleddiagnostic blocks. Systematic reviews have established moderate evidence for controlledcomparative local anesthetic blocks of thoracic facet joints in the diagnosis of mid back andupper back pain.Objective: To determine the diagnostic accuracy of thoracic facet joint nerve blocks in theassessment of chronic upper back and mid back pain.Study Design: Systematic review of the diagnostic accuracy of thoracic facet joint nerveblocks.Methods: A methodological quality assessment of included studies was performed usingQuality Appraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting atleast 50% of the designated inclusion criteria were utilized for analysis. Studies scoring lessthan 50% are presented descriptively and critically analyzed.The level of evidence was classified as good, fair, and limited (or poor) based on the qualityof evidence developed by the United States Preventive Services Task Force (USPSTF).Data sources included relevant literature identified through searches of PubMed and EMBASEfrom 1966 to March 2012, and manual searches of the bibliographies of known primary andreview articles.Outcome Measures: Controlled placebo or local anesthetic blocks were utilized using atleast 50% pain relief as the reference standard.Results: Three studies were identified utilizing controlled comparative local anestheticblocks, with ≥50% pain relief as the criterion standard. The evidence is good for the diagnosisof thoracic pain of facet joint origin with controlled diagnostic blocks.Limitations: The limitations of this systematic review include a paucity of literature forthe diagnosis of thoracic facet joint pain, with all included manuscripts originating from onegroup of authors.Conclusions: Based on this systematic review, the evidence for the diagnostic accuracy ofthoracic facet joint injections is good.Key words: Chronic thoracic pain, mid back or upper back pain, thoracic facet orzygapophysial joint pain, facet joint nerve blocks, medial branch blocks, controlledcomparative local anesthetic blocks