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Int J Med Sci 2010; 7(3):124-135. doi:10.7150/ijms.7.124 This issue Cite

Research Paper

Evaluation of Lumbar Facet Joint Nerve Blocks in Managing Chronic Low Back Pain: A Randomized, Double-Blind, Controlled Trial with a 2-Year Follow-Up

Laxmaiah Manchikanti^1✉, Vijay Singh², Frank J.E. Falco³, Kimberly A. Cash⁴, Vidyasagar Pampati⁵

1. Medical Director of the Pain Management Center of Paducah, Paducah, KY and Associate Clinical Professor, Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA
2. Medical Director, Pain Diagnostics Associates, Niagara, WI, USA
3. Medical Director of the Mid Atlantic Spine & Pain Physicians of Newark, DE; Director, Pain Medicine Fellowship, Temple University Hospital, Philadelphia, PA, Associate Professor, Department of PM&R, Temple University Medical School, Philadelphia, PA, USA
4. Research Coordinator at the Pain Management Center of Paducah, Paducah, KY, USA
5. Statistician at the Pain Management Center of Paducah, Paducah, KY, USA

✉ Corresponding author: Laxmaiah Manchikanti, MD, 2831 Lone Oak Road, Paducah, Kentucky 42003. Phone: 270-554-8373; Fax: 270-554-8987; E-mail: drlmcom

Abstract

Study Design: A randomized, double-blind, controlled trial.

Objective: To determine the clinical effectiveness of therapeutic lumbar facet joint nerve blocks with or without steroids in managing chronic low back pain of facet joint origin.

Summary of Background Data: Lumbar facet joints have been shown as the source of chronic pain in 21% to 41% of low back patients with an average prevalence of 31% utilizing controlled comparative local anesthetic blocks. Intraarticular injections, medial branch blocks, and radiofrequency neurotomy of lumbar facet joint nerves have been described in the alleviation of chronic low back pain of facet joint origin.

Methods: The study included 120 patients with 60 patients in each group with local anesthetic alone or local anesthetic and steroids. The inclusion criteria was based upon a positive response to diagnostic controlled, comparative local anesthetic lumbar facet joint blocks.

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 of ≥ 50% and functional improvement of ≥ 40% were observed in 85% in Group 1, and 90% in Group II, at 2-year follow-up.

The patients in the study experienced significant pain relief for 82 to 84 weeks of 104 weeks, requiring approximately 5 to 6 treatments with an average relief of 19 weeks per episode of treatment.

Conclusions: Therapeutic lumbar facet joint nerve blocks, with or without steroids, may provide a management option for chronic function-limiting low back pain of facet joint origin.

Keywords: Chronic low back pain, lumbar facet or zygapophysial joint pain, facet joint nerve or medial branch blocks, comparative controlled local anesthetic blocks, therapeutic lumbar facet joint nerve blocks

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