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Medial branch nerve blocks have
been shown to progress patients not responding to chiropractic at
first. Ultrasound for Evaluation of the Wrist How to Improve the Efficacy of Shoulder Injections A Local Resource for Neurodiagnostic Testing |
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A Letter Released
to Chiropractic Physicians on May 9, 2008 Multidisciplinary Management of 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 People
suffering from chronic neck pain after an injury would do well to find their
way to a chiropractic physician.
Research shows that manual therapy including spinal manipulation and
joint mobilization helps cases of facet joint pain / cervical facet syndrome.4-10 Therapeutic exercise also helps.8,10 Gross et al found manipulation combined
with therapeutic exercise to be more effective than either alone.11 However, none of the research suggests that
any of these treatment options are effective 100% of the time. Lawrence
Wyatt, DC, DACBR writes that chiropractors should consider referral for
medial branch blocks when patients are not progressing with chiropractic
treatment alone.12 Numerous studies now support the efficacy of treating chronic neck
pain with blocks of the medial branch nerves.13 Medial branch blocks even create
significant pain relief when pain has proved refractory to other conservative
approaches (i.e. chiropractic adjustments, physical therapy, rest, drug
therapy, exercise).14 Pain
relief from a single treatment lasts an average of 12-13 weeks, and many
patients experience relief lasting well past three months.14,15 Manchikanti and
colleagues found 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 his private practice in 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.14 In the smaller percentage of cases
that do not respond to chiropractic for unknown reasons, it also stands to
reason that using a block to interrupt the pain-spasm cycle might make a
patient’s body more responsive to future manual therapies. Doctors of
chiropractic may also consider using Dr. Taub’s
medial branch blocks for diagnostic purposes.
Medial branch blocks are prone to false positives when diagnosing
facet joint pain of the cervical or lumbar spine. However, when scans are not positive,
medial branch blocks can be very informative.
They are also safer and easier to perform than facet joint
blocks. Please refer to Neal S. Taub, MD, Physiatrist for pain management &
rehabilitation. |
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References 1.
Schofferman J, Bogduk N, Slosar P. Chronic
whiplash and whiplash associated disorders: an evidence-based approach. 2.
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. Hurwitz
EL, Aker PD, Adams AH, Meeker WC, Shekelle PG.
Manipulation and mobilization of the cervical spine. A
systematic review of the literature. Spine.
1996 Aug 1; 21(15):1746-59;1759-60. 5. Hurwitz
EL, Morgenstern H, Harber P, Kominski
GF, Yu F, Adams AH. A randomized trial of chiropractic manipulation and
mobilization for patients with neck pain: clinical outcomes from the UCLA
neck-pain study. Am J Public Health. 2002 Oct;92(10):1634-41. 6. Wood
TG, Colloca CJ, Matthews R. A pilot randomized
clinical trial on the relative effect of instrumental (MFMA) versus manual
(HVLA) manipulation in the treatment of cervical spine dysfunction. J Manipulative Physiol Ther. 2001 May;24(4):260-71. 7. Giles L, Muller R. Chronic spinal pain syndromes: A clinical pilot trial
comparing acupuncture, a nonsteroidal
anti-inflammatory drug, and spinal manipulation. J Manipulative Physiol Ther. 1999 July/Aug;22(6):376-381. 8. Evans
R, Bronfort G, Nelson B, Goldsmith CH. Two-year
follow-up of a randomized clinical trial of spinal manipulation and two types
of exercise for patients with chronic neck pain. Spine.
2002 Nov 1;27(21):2383-9. 9. Korthals-de Bos IB,
Moving JL, van Tulder MW, Rutten-van
Molken MP, Ader HJ, de
Vet HC, Koes BW, Vondeling
H, Bouter LM. Cost effectiveness of physiotherapy,
manual therapy, and general practitioner care for neck pain: economic
evaluation alongside a randomised controlled trial.
BMJ. 2003 Apr 26;326(7395):911. 10. Sarig-Bahat H. Evidence for exercise therapy in mechanical neck disorders. Man Ther. 2003 Feb;8(1):10-20. 11.
Gross AR, Kay
T, Hondras M, Goldsmith C, Haines T, Peloso P, Kennedy C, Hoving J.
Manual therapy for mechanical neck disorders: a systematic review. Man Ther. 2002 Aug;7(3):131-49. 12.
Wyatt L. Facet syndrome in the cervical spine. J Amer Chiropr Assoc 2004
Mar;41(3):32-37 13.
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. 14.
Manchikanit 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. 15.
Manchikani 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. |
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Home Stroke Rehabilitation About Neal Taub, MD What is a Physiatrist |
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