Abstract
Study Design. A randomized, double-blind, active-control trial. Objective. To determine the clinical effectiveness of therapeutic thoracic facet joint nerve blocks with or without steroids in managing chronic mid back and upper back pain. Summary of Background Data. The prevalence of thoracic facet joint pain has been established as 34% to 42%. Multiple therapeutic techniques utilized in managing chronic thoracic pain of facet joint origin include medial branch blocks, radiofrequency neurotomy, and intraarticular injections. Methods. This randomized double-blind active controlled trial was performed in 100 patients with 50 patients in each group who received medial branch blocks with local anesthetic alone or local anesthetic and steroids. Outcome measures included the numeric rating scale (NRS), Oswestry Disability Index (ODI), opioid intake, and work status, at baseline, 3, 6, 12, 18, and 24 months. Results. Significant improvement with significant pain relief and functional status improvement of 50% or more were observed in 80% of the patients in Group I and 84% of the patients in Group II at 2-year followup. Conclusions. Therapeutic medial branch blocks of thoracic facets with or without steroids may provide a management option for chronic function-limiting thoracic pain of facet joint origin.
Highlights
Leboeuf-Yde et al [1] showed the prevalence of thoracic pain to be 13% of the general population, in contrast to 43% with low back pain and 32% with neck pain during the past year
Significant improvement with significant pain relief and functional status improvement of 50% or more were observed in 80% of the patients in Group I and 84% of the patients in Group II at 2-year followup
There have been 3 publications evaluating the effectiveness of thoracic facet joint nerve blocks [22,23,24], which is much less than publications for the management of cervical and lumbar facet joint pain [19, 25, 26]
Summary
Leboeuf-Yde et al [1] showed the prevalence of thoracic pain to be 13% of the general population, in contrast to 43% with low back pain and 32% with neck pain during the past year. Studies of the lumbar spine have shown the value of controlled comparative local anesthetic blocks having 80% concordant pain relief with long-term relief of up to 2 years [40,41,42,43]. This study was sought to evaluate the effectiveness of medial branch blocks on a long-term basis of at least a 2-year followup in patients with a confirmed diagnosis of thoracic facet joint pain by means of comparative, controlled, local anesthetic blocks based on the modified International Association of the Study of Pain (IASP) criteria of 80% pain relief, and the ability to perform previously painful movements [6, 7]
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