scholarly journals A Shortened Radiofrequency Denervation Method for Cervical Zygapophysial Joint Pain Based on Ultrasound Localization of the Nerves

Pain Medicine ◽  
2011 ◽  
Vol 12 (12) ◽  
pp. 1703-1709 ◽  
Author(s):  
Andreas Siegenthaler ◽  
Urs Eichenberger ◽  
Michele Curatolo
Keyword(s):  
Joint Pain ◽  
Ultrasound Localization ◽  
Zygapophysial Joint ◽  
Radiofrequency Denervation

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.

Pathogenesis, Diagnosis, and Treatment of Lumbar Zygapophysial (Facet) Joint Pain

2007 ◽  
Vol 106 (3) ◽  
pp. 591-614 ◽  
Author(s):  
Steven P. Cohen ◽  
Srinivasa N. Raja
Keyword(s):  
Joint Pain ◽  
Facet Joint ◽  
Diagnosis And Treatment ◽  
Treatment Modalities ◽  
Medial Branch ◽  
Systematic Analysis ◽  
Zygapophysial Joint ◽  
Radiofrequency Denervation ◽  
Facet Joint Pain ◽  
Lumbar Facet

Lumbar zygapophysial joint arthropathy is a challenging condition affecting up to 15% of patients with chronic low back pain. The onset of lumbar facet joint pain is usually insidious, with predisposing factors including spondylolisthesis, degenerative disc pathology, and old age. Despite previous reports of a "facet syndrome," the existing literature does not support the use of historic or physical examination findings to diagnose lumbar zygapophysial joint pain. The most accepted method for diagnosing pain arising from the lumbar facet joints is with low-volume intraarticular or medial branch blocks, both of which are associated with high false-positive rates. Standard treatment modalities for lumbar zygapophysial joint pain include intraarticular steroid injections and radiofrequency denervation of the medial branches innervating the joints, but the evidence supporting both of these is conflicting. In this article, the authors provide a comprehensive review of the anatomy, biomechanics, and function of the lumbar zygapophysial joints, along with a systematic analysis of the diagnosis and treatment of facet joint pain.

scholarly journals Radiofrequency Denervation of the Lumbar Zygapophysial Joints: 10-Year Prospective Clinical Audit

2007 ◽  
Vol 2;10 (3;2) ◽  
pp. 291-299
Author(s):  
Michael Gofeld
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Relief ◽  
Patient Selection ◽  
Clinical Audit ◽  
Low Back ◽  
Zygapophysial Joint ◽  
Radiofrequency Neurotomy ◽  
Radiofrequency Denervation

Background: Evidence for the efficacy of zygapophysial joint nerve radiofrequency neurotomy has remained controversial. Two randomized controlled trials showed positive results, but two others demonstrated no benefit. One carefully performed prospective trial confirmed high efficacy and lasting pain relief after the procedure; however, selection criteria for this study were superfluous, which resulted in a small number of patients available for follow up. Objectives: A large clinical audit with routine patient selection and use of appropriate technique was undertaken to determine the effect of radiofrequency neurotomy of the lumbar facet joints for relief of chronic low back pain. Design: Prospective clinical audit for quality was conducted in the pain clinic affiliated with a tertiary care teaching hospital. Setting: An interventional pain management setting in Canada. Methods: All patients with low back pain of more than 6 months’ duration, with or without non-radicular radiation to the buttock, hip, and leg were included. From January 1991 to December 2000, eligible patients underwent standardized diagnostic work-up, which included a self-reported pain questionnaire, physical examination, review of imaging studies, and diagnostic blockades. Those with an appropriate response to comparative double diagnostic blocks underwent standardized radiofrequency denervation of the lumbar zygapophysial joints. Patients were asked to estimate total perceived pain reduction (on a scale from 0% to 100%) at 6 weeks and at 6, 12, and 24 months after the procedure. Results: Of the 209 patients, 174 completed the study, and 35 were lost to follow-up or did not provide complete data for assessment. Of the 174 patients with complete data, 55 (31.6%) experienced no benefit from the procedure. One hundred and nineteen patients (68.4%) had good (> 50%) to excellent (> 80%) pain relief lasting from 6 to 24 months. Conclusion: This large, prospective clinical audit indicates that proper patient selection and anatomically correct radiofrequency denervation of the lumbar zygapophysial joints provide long-term pain relief in a routine clinical setting. Key words: low back pain, lumbar zygapophysial joint, radiofrequency denervation, clinical audit

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

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

scholarly journals Radiofrequency Denervation for Management of Chronic Sacroiliac Joint Pain

2019 ◽  
Vol 30 (1) ◽  
pp. 41-47
Author(s):  
khaled Ebrahim ◽  
Ahmed Abdel Bar Salem ◽  
sherif morad
Keyword(s):  
Sacroiliac Joint ◽  
Joint Pain ◽  
Sacroiliac Joint Pain ◽  
Radiofrequency Denervation
Sign in / Sign up

Export Citation Format

Share Document