Comparison of cervical medial branch nerve block versus trigger point injection in patients with chronic neck pain

Abstract

Background: Annual prevalence of chronic neck pain in general population averages between 30%-50%. Among various causes of chronic neck pain cervical facet joint involvement accounts for about 54% to 67%. Interventional procedures such as medial branch nerve block, trigger point injections and dry needling have been described for management of chronic neck pain. Objectives: To determine the clinical effectiveness of cervical medial branch block and trigger point injections in the management chronic neck pain. Design: Randomized, double blinded, prospective study conducted at two different centers in India, Pain Clinic, Department of Anaesthesiology, J.N. Medical College hospital, Aligarh Muslim University, Aligarh, Delhi Pain management centre, New Delhi, India. Methods: Data analysis was done from a total of 60 patients with 30 patients in each group. Group CMB received cervical medial branch block and group TP received trigger point injection with levobupivacaine (0.25%) and triamcinolone (20mg) at two different levels. There was no sham group. Outcome Measure: Numeric rating scale (NRS), Neck Pain Disability Index (NDI), weekly analgesic requirement and subjective evaluation of patients was done at 1st week, 3rd week, 6th week and 12th week of follow up and compared with the pre-procedure value. Results: Significant pain relief was observed in both the groups of study, at 1st week of study, compared to baseline. Further follow up showed significantly better pain relief in patients receiving medial branch nerve block than patient receiving tender point injections at 3rd, 6th week and 12th week. NDI score in-group CMB was significantly better as compared to group TP at 3rd, 6th and 12th week follow up. Subjective evaluation of pain showed significantly greater proportion of patient with good to excellent pain relief in group receiving medial branch block. Analgesic requirement was significantly less in group CMB compared to group TP during follow up. Conclusion: Cervical medial branch block with local anaesthetic and steroid may provide long-term relief in patients with chronic neck pain than trigger point injection with no major incidence of complications in either group.