On diagnostic blocks for lumbar zygapophysial joint pain

Diagnostic blocks are used to identify patients with back pain stemming from their lumbar zygapophysial joints. Single, diagnostic blocks have an unacceptably high false positive rate. As well, comparative local anaesthetic blocks lack validity because the prevalence of the condition is low. Relying on 50% relief following single-diagnostic blocks does not provide a valid diagnosis. Placebo-controlled blocks are the only available valid means of establishing a diagnosis of lumbar zygapophysial joint pain

Is spinal surgery effective for back pain?

There have only been a few randomized controlled trials of surgical treatment of chronic low back pain caused by degenerative disc disease. Fusion surgery has been compared primarily with nonoperative treatment, whereas disc arthroplasty has been compared with fusion surgery. The results for either of the two surgical procedures are modest in terms of pain relief and improved function

Response to “Branch Blockade of the Dorsal Sacral Rami”

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78675/1/j.1526-4637.2009.00779.x.pd

Advice or exercise for chronic whiplash disorders? Design of a randomized controlled trial

BACKGROUND: Whiplash-associated disorder (or "whiplash") is a common condition incurring considerable expense in social and economic terms. A lack of research on effective therapy for patients with chronic whiplash associated disorders prompted the design of the current study. The primary aim of this randomised controlled trial is to determine the effects of a physical activity program for people with chronic (symptoms of > 3 months duration) whiplash. A secondary aim is to determine if pain severity, level of disability and fear of movement/(re)injury predict response to a physical activity program. METHODS / DESIGN: This paper presents the rationale and design of a randomised controlled trial examining the effects of advice and individualized sub-maximal exercise programs in the treatment of whiplash associated disorders. DISCUSSION: This paper highlights the design, methods and operational aspects of a significant clinical trial in the area of whiplash and chronic pain

Neck pain and whiplash

The foremost message that any pain physician should take from a chapter on neck pain is that neck pain and cervical radicular pain are not synonymous. The causes, mechanisms, investigations, and treatment of radicular pain differ from those of neck pain, and the two conditions have a different evidence base. Most emphatically, when a patient presents with just neck pain there is no justification for investigating and treating them as if they had radicular pain. Confusion in this regard has led to inappropriate investigations and therapeutic misadventure in the past and continues to do so. The topic of cervical radicular pain is covered elsewhere. The present chapter deals exclusively with neck pain

On the rational use of diagnostic blocks for spinal pain

Diagnostic blocks can be a powerful tool for the investigation of spinal pain. However, for their use to be rational, blocks must have diagnostic or therapeutic utility, proven validity, and their use should be efficient. Of the 6 diagnostic blocks available for spinal pain, only some have been fully validated. Others still require particular validation studies

On cervical zygapophysial joint pain after whiplash

Study Design: Narrative review. Objective: To summarize the evidence that implicates the cervical zygapophysial joints as the leading source of chronic neck pain after whiplash. Summary of Background Data: Reputedly a patho-anatomic basis for neck pain after whiplash has been elusive. However, studies conducted in a variety of disparate disciplines indicate that this is not necessarily the case. Methods: Data were retrieved from studies that addressed the postmortem features and biomechanics of injury to the cervical zygapophysial joints, and from clinical studies of the diagnosis and treatment of zygapophysial joint pain, to illustrate convergent validity. Results: Postmortem studies show that a spectrum of injuries can befall the zygapophysial joints in motor vehicle accidents. Biomechanics studies of normal volunteers and of cadavers reveal the mechanisms by which such injuries can be sustained. Studies in cadavers and in laboratory animals have produced these injuries. Clinical studies have shown that zygapophysial joint pain is very common among patients with chronic neck pain after whiplash, and that this pain can be successfully eliminated by radiofrequency neurotomy. Conclusion: The fact that multiple lines of evidence, using independent techniques, consistently implicate the cervical zygapophysial joints as a site of injury and source of pain, strongly implicates injury to these joints as a common basis for chronic neck pain after whiplash

Diagnostic procedures in chronic pain

Investigations for chronic pain are limited by what particular tests can and cannot show, and by the nature of conditions that cause chronic pain. Responsible and efficient practice in pain medicine requires understanding of what investigations can and cannot show, and when they should and should not be used. This needs to be complemented by understanding the conditions that cause chronic pain, which investigations are inappropriate, and which are likely to be informative.2nd ed