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Research shows Medial Branch Nerve Blocks providing significant pain relief for 92% of patients. Knee Pain, Shoulder Pain & the Suprascapular
Nerve |
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A
Letter Released to Medical Professionals on July 10, 2008 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. |
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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. |
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Home Stroke Rehabilitation About Neal Taub, MD What is a Physiatrist |
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