Abstract
BackgroundFacet joints are a clinically important source of chronic cervical, thoracic, and lumbar spine pain. The purpose of this study was to systematically evaluate the prevalence of facet joint pain by spinal region in patients with chronic spine pain referred to an interventional pain management practice.MethodsFive hundred consecutive patients with chronic, non-specific spine pain were evaluated. The prevalence of facet joint pain was determined using controlled comparative local anesthetic blocks (1% lidocaine or 1% lidocaine followed by 0.25% bupivacaine), in accordance with the criteria established by the International Association for the Study of Pain (IASP). The study was performed in the United States in a non-university based ambulatory interventional pain management setting.ResultsThe prevalence of facet joint pain in patients with chronic cervical spine pain was 55% 5(95% CI, 49% – 61%), with thoracic spine pain was 42% (95% CI, 30% – 53%), and in with lumbar spine pain was 31% (95% CI, 27% – 36%). The false-positive rate with single blocks with lidocaine was 63% (95% CI, 54% – 72%) in the cervical spine, 55% (95% CI, 39% – 78%) in the thoracic spine, and 27% (95% CI, 22% – 32%) in the lumbar spine.ConclusionThis study demonstrated that in an interventional pain management setting, facet joints are clinically important spinal pain generators in a significant proportion of patients with chronic spinal pain. Because these patients typically have failed conservative management, including physical therapy, chiropractic treatment and analgesics, they may benefit from specific interventions designed to manage facet joint pain.
Highlights
Facet joints are a clinically important source of chronic cervical, thoracic, and lumbar spine pain
Two hundred twelve of 255 patients with pain in the cervical spine reported a definite response to initial lidocaine blocks, 53 of 72 patients with thoracic spine pain after lidocaine blocks and 198 of 397 patients with lumbar spine pain after lidocaine blocks
The double local anesthetic block group provided a prevalence rate of facet joint pain in patients with chronic cervical spine pain of 55%; 42% with thoracic pain; and 31% with lumbar pain
Summary
Facet joints are a clinically important source of chronic cervical, thoracic, and lumbar spine pain. The purpose of this study was to systematically evaluate the prevalence of facet joint pain by spinal region in patients with chronic spine pain referred to an interventional pain management practice. Linton et al [3] estimated the prevalence of spinal pain in the general population as 66%, with 44% of patients reporting pain in the cervical region, 56% in the lumbar region, and 15% in the thoracic region. Bogduk [10] identified four factors necessary for any structure to be deemed a cause of back pain: a nerve supply to the structure; the ability of the structure to cause pain similar to that seen clinically in normal volunteers; the structure's susceptibility to painful diseases or injuries; and demonstration that the structure can be a source of pain in patients using diagnostic techniques of known reliability and validity
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