Abstract
BackgroundCervical facet block (FB) procedures are often used as a diagnostic precursor to radiofrequency neurotomies (RFN) in the management of chronic whiplash associated disorders (WAD). Some individuals will respond to the FB procedures and others will not respond. Such responders and non-responders provided a sample of convenience to question whether there were differences in their physical and psychological features. This information may inform future predictive studies and ultimately the clinical selection of patients for FB procedures.MethodsThis cross-sectional study involved 58 individuals with chronic WAD who responded to cervical FB procedures (WAD_R); 32 who did not respond (WAD_NR) and 30 Healthy Controls (HC)s. Measures included: quantitative sensory tests (pressure; thermal pain thresholds; brachial plexus provocation test); nociceptive flexion reflex (NFR); motor function (cervical range of movement (ROM); activity of the superficial neck flexors during the cranio-cervical flexion test (CCFT). Self-reported measures were gained from the following questionnaires: neuropathic pain (s-LANSS); psychological distress (General Health Questionnaire-28), post-traumatic stress (PDS) and pain catastrophization (PCS). Individuals with chronic whiplash attended the laboratory once the effects of the blocks had abated and symptoms had returned.ResultsFollowing FB procedures, both WAD groups demonstrated generalized hypersensitivity to all sensory tests, decreased neck ROM and increased superficial muscle activity with the CCFT compared to controls (p < 0.05). There were no significant differences between WAD groups (all p > 0.05). Both WAD groups demonstrated psychological distress (GHQ-28; p < 0.05), moderate post-traumatic stress symptoms and pain catastrophization. The WAD_NR group also demonstrated increased medication intake and elevated PCS scores compared to the WAD_R group (p < 0.05).ConclusionsChronic WAD responders and non-responders to FB procedures demonstrate a similar presentation of sensory disturbance, motor dysfunction and psychological distress. Higher levels of pain catastrophization and greater medication intake were the only factors found to differentiate these groups.
Highlights
Cervical facet block (FB) procedures are often used as a diagnostic precursor to radiofrequency neurotomies (RFN) in the management of chronic whiplash associated disorders (WAD)
A cross-sectional study design was used to compare the clinical manifestations of two WAD groups: 1) WAD participants who responded to cervical facet joint double blockade and subsequently proceeded to, and were awaiting RFN (WAD_Responders); 2) WAD participants who failed to respond to cervical facet joint double blockade (WAD_Non-Responders); and a 3) healthy control group (HC)
Fiftyeight individuals responded to the cervical facet double block procedure (IAB and medial branch blocks (MBB): 18 males, 40 females, mean age 44.9 +/− 11.1 years) and formed the WAD Responder (WAD_R) group
Summary
Cervical facet block (FB) procedures are often used as a diagnostic precursor to radiofrequency neurotomies (RFN) in the management of chronic whiplash associated disorders (WAD). Some individuals will respond to the FB procedures and others will not respond Such responders and non-responders provided a sample of convenience to question whether there were differences in their physical and psychological features. This information may inform future predictive studies and the clinical selection of patients for FB procedures. There is extensive evidence demonstrating marked physical and psychological changes in individuals with chronic WAD. These include sensory disturbances of widespread hypersensitivity [6,7,8] and hyperexcitable spinal cord reflexes [9,10] indicative of augmented central nervous system nociceptive processing (central sensitization). Psychological distress (including affective disturbances, anxiety, depression and posttraumatic stress disorder symptoms) is common in individuals with chronic WAD [14,15,16]
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