scholarly journals Cervical Zygapophysial Joint Pain Maps

Pain Medicine ◽  
2007 ◽  
Vol 8 (4) ◽  
pp. 344-353 ◽  
Author(s):  
Grant Cooper ◽  
Beverly Bailey ◽  
Nikolai Bogduk
Keyword(s):  
Joint Pain ◽  
Zygapophysial Joint

Diagnostic blocks for chronic pain

2010 ◽  
Vol 1 (4) ◽  
pp. 186-192 ◽  
Author(s):  
Michele Curatolo ◽  
Nikolai Bogduk
Keyword(s):  
Chronic Pain ◽  
False Positive ◽  
Joint Pain ◽  
Prognostic Value ◽  
False Positive Rate ◽  
High Rate ◽  
Discogenic Pain ◽  
Nerve Blocks ◽  
Zygapophysial Joint ◽  
Radiofrequency Denervation

AbstractMany conditions associated with chronic pain have no detectable morphological correlate. Consequently, the source of pain cannot be established by clinical examination or medical imaging. However, for some such conditions, the source of pain can be established using diagnostic blocks. The aim of this paper is to review the available evidence concerning the validity and utility of diagnostic blocks, and to identify areas where research is needed.Diagnostic blocks for cervical and lumbar zygapophysial joint pain have been extensively studied. Single blocks are associated with about 30% false-positive responses. Patients can report relief of pain for reasons other than the effect of a local anaesthetic injected during a diagnostic block, e.g. as the result of placebo effect. Therefore, in order to be valid, diagnostic blocks must be controlled in each patient. Many practitioners find limitations in the clinical applicability of placebo-controlled blocks. Comparative blocks (comparison lidocaine-bupivacaine for each block within each patient) have been investigated as alternatives to placebo-controlled blocks. A positive response requires short-lasting relief when lidocaine is used, and long-lasting relief when bupivacaine is used. The validity of comparative blocks is high when the disease under investigation is common. This is the case for zygapophysial joint pain after whiplash injury. However, the validity of comparative blocks strongly decreases with decreasing prevalence of the condition. This is the case for lumbar zygapophysial joint pain in young subjects: in these patients, the expected false-positive rate with comparative blocks is unacceptably high. Diagnostic blocks for cervical and lumbar zygapophysial joint have therapeutic utility. When positive, radiofrequency denervation is expected to produce substantial pain relief in 60-80% of patients.For all other types of blocks, very little research has been conducted. The few studies that have been published did not use controlled blocks. This may have produced a high rate of false-positive responses. Some data on spinal nerve root blocks suggest that these procedures may be valid for the diagnosis of radicular pain and are perhaps predictive for the success of surgery. The validity of diagnostic sympathetic blocks and their prognostic value in relation to outcomes of sympathectomy are unclear. There is lack of data on the validity of diagnostic intra-articular blocks. Discogenic pain is typically diagnosed by provocative discography, but this procedure remains controversial. Intradiscal and sinuvertebral nerve blocks with local anaesthetics are possible alternatives to provocation discography. At present, the sparse data available on these procedures do not allow an estimation of their validity.In conclusion, nerve blocks have an important potential role in the management of chronic pain. These procedures are not suitable to identify the pathology that is the cause of the pain (e.g. inflammatory, neuropathic, etc.). However, they can reveal the anatomical source of pain, thereby allowing the development of targeted treatments. Unfortunately, there is currently very little research on the validity and prognostic value of blocks. The potential usefulness of this practice remains therefore largely unexplored.

Differences in sensory processing between chronic cervical zygapophysial joint pain patients with and without cervicogenic headache

Cephalalgia ◽  
2011 ◽  
Vol 31 (8) ◽  
pp. 953-963 ◽  
Author(s):  
Nicholas H L Chua ◽  
Hans A van Suijlekom ◽  
Kris C Vissers ◽  
Lars Arendt-Nielsen ◽  
Oliver H Wilder-Smith
Keyword(s):  
Joint Pain ◽  
Pain Threshold ◽  
Detection Threshold ◽  
Pressure Pain Threshold ◽  
Cervicogenic Headache ◽  
Pain Modulation ◽  
Zygapophysial Joint ◽  
Testing And Measurement ◽  
Threshold Testing ◽  
Pain Patients

Background: It is not known why some patients with underlying chronic nociceptive sources in the neck develop cervicogenic headache (CEH) and why others do not. This quantitative sensory testing (QST) study systematically explores the differences in sensory pain processing in 17 CEH patients with underlying chronic cervical zygapophysial joint pain compared to 10 patients with chronic cervical zygapophysial joint pain but without CEH. Methods: The QST protocol comprises pressure pain threshold testing, thermal detection threshold testing, electrical pain threshold testing and measurement of descending inhibitory modulation using the conditioned pain modulation (CPM) paradigm. Results: The main difference between patients with or without CEH was the lateralization of pressure hyperalgesia to the painful side of the head of CEH patients, accompanied by cold as well as warm relative hyperesthesia on the painful side of the head and neck. Discussion: From this hypothesis-generating study, our results suggest that rostral neuraxial spread of central sensitization, probably to the trigeminal spinal nucleus, plays a major role in the development of CEH.

Percutaneous Radiofrequency Neurotomy in the Treatment of Cervical Zygapophysial Joint Pain

Neurosurgery ◽  
1995 ◽  
Vol 36 (4) ◽  
pp. 732???739 ◽  
Author(s):  
Susan M. Lord ◽  
Leslie Barnsley ◽  
Nikolai Bogduk
Keyword(s):  
Joint Pain ◽  
Zygapophysial Joint ◽  
Radiofrequency Neurotomy

Zygapophysial Joint Pain

2011 ◽  
pp. 357-389 ◽  
Author(s):  
Wade King ◽  
James MackIntosh Borowczyk
Keyword(s):  
Joint Pain ◽  
Zygapophysial Joint

scholarly journals Endoscopic rhizotomy for chronic lumbar zygapophysial joint pain

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yuntao Xue ◽  
Tao Ding ◽  
Dajie Wang ◽  
Jianli Zhao ◽  
Huilin Yang ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Radiofrequency Ablation ◽  
Chronic Low Back Pain ◽  
Joint Pain ◽  
Control Group ◽  
Low Back ◽  
Percutaneous Radiofrequency Ablation ◽  
Time Points ◽  
Zygapophysial Joint

Abstract Background Chronic lumbar zygapophysial joint pain is a common cause of chronic low back pain. Percutaneous radiofrequency ablation (RFA) is one of the effective management options; however, the results from the traditional RFA need to be improved in certain cases. The aim of this study is to investigate the effect of percutaneous radiofrequency ablation under endoscopic guidance (ERFA) for chronic low back pain secondary to facet joint arthritis. Methods This is a prospective study enrolled 60 patients. The cases were randomized into two groups: 30 patients in the control group underwent traditional percutaneous radiofrequency ablation, others underwent ERFA. The lumbar visual analog scale (VAS), MacNab score, and postoperative complications were used to evaluate the outcomes. All outcome assessments were performed at postoperative 1 day, 1 month, 3 months, 6 months, and 12 months. Results There was no difference between the two groups in preoperative VAS (P > 0.05). VAS scores, except the postoperative first day, in all other postoperative time points were significantly lower than preoperative values each in both groups (P < 0.05). There was no significant difference between the two groups in VAS at 1 day, 1 month, and 3 months after surgery (P > 0.05). However, the EFRA demonstrated significant benefits at the time points of 3 months and 6 months (P > 0.05). The MacNab scores of 1-year follow-up in the ERFA group were higher than that in the control group (P < 0.05). The incidence of complications in the ERFA group was significantly less than that in the control group (P < 0.05). Conclusions ERFA may achieve more accurate and definite denervation on the nerves, which leads to longer lasting pain relief.

On Cervical Zygapophysial Joint Pain After Whiplash

Spine ◽  
2011 ◽  
Vol 36 ◽  
pp. S194-S199 ◽  
Author(s):  
Nikolai Bogduk
Keyword(s):  
Joint Pain ◽  
Zygapophysial Joint
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