An Effective Option for
Chronic Neck Pain & Chronic Whiplash

Patients with acute neck pain develop chronic neck pain in 15% to 40% of cases.¹ After a whiplash injury, the cervical facet joint becomes the most common source of chronic neck pain, and some patients experience pain from both the facet joint and the disk.^2,3 Initial treatment options include medication, rest, physical therapy, and chiropractic. For thousands of patients, a significant portion of chronic whiplash pain remains refractory to these treatments. When your patients suffer with chronic pain, please refer them to my private practice, Neal S. Taub MD, Physiatrist.

One treatment option for chronic neck pain is the medial branch nerve block. A growing body of evidence now supports the efficacy of medial branch nerve blocks for both short-term and long-term (over six weeks) pain relief. A systematic review published in Pain Physician in 2007 concluded that there is now “moderate” evidence supporting medial branch blocks as a pain relief treatment.⁴

Chronic neck pain often proves life altering and debilitating. For instance, Manchikanti, MD and colleagues provided medial branch blocks to 100 consecutive patients meeting the diagnostic criteria of facet joint pain by means of comparative, controlled diagnostic blocks.⁵ They not only measured pain at baseline, but they also measured depression, anxiety, and employment. Significant pain relief (50% or greater on numeric scales) occurred in 92% of patients at 3 months. They used P-3® psychological evaluation where scores of 55+ indicate a depression diagnosis and scores of 56+ indicate a diagnosis for anxiety. At baseline, the patient group averaged a score of 52 for depression and 53 for anxiety. Those scores fell to 45 and 46 respectively at 12 months. At baseline, 30% of the group were unemployed. At 12 months, the unemployment rate in the group fell to only 10%.

Pain relief from a single treatment lasts an average of 12-13 weeks, and many patients experience relief lasting well past three months.^5,6 In 2006, Manchikanti and colleagues reported a trend toward longer lasting relief (by 2.5 weeks) when the blocks included anesthesia plus steroids, but steroids are associated with unnecessary side effects. At my private, referral-based practice in Charlotte, I find that blocks performed with small amounts of phenol provide low-risk, long-lasting pain relief. All studies of medial branch blocks also find that the pain relief effect outlasts the pharmocological effect of the drug. Many experts propose that the local anesthetics interrupt the pain-spasm cycle and reverberating nociceptor transmissions.⁵ This may be a mechanism by which medial branch blocks can help your patients overcome chronic pain and become more responsive to other therapies.

Call Neal S. Taub, MD, Physiatrist for
pain management & rehabilitation.

References

1. Schofferman J, Bogduk N, Slosar P. Chronic whiplash and whiplash associated disorders: an evidence-based approach.

2. Barnsley L, Lord SM, Wallis BJ, Bogduk N. The prevalence of chronic cervical zygapophysial joint pain after whiplash. Spine 1995 Jan 1; 20(1): 20-5.

3. Lord SM, Barnsley L, Wallis BJ, Bogduk N. Chronic cervical zygapophysial joint pain after whiplash. A placebo-controlled prevalence study. Spine 1996 Aug 1; 21(15): 1737-44.

4. Boswell M, Colson J, Sehgal N, et al. A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician. 2007 Jan; 10(1): 229-53.

5. Manchikanti L, Manchikanti K, Damron K, et al. Effectiveness of cervical medial branch blocks in chronic neck pain: a prospective outcome study. Pain Physician. 2004; 7: 195-201.

6. Manchikanti L, Damron K, Cash K. Therapeutic cervical medial branch blocks in managing chronic neck pain: a preliminary report of a randomized, double-blind, controlled trial: clinical trial NCT0033272. Pain Physician. 2006; 9(4):336-46.