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

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.

Transforaminal injection of corticosteroids for lumbar radiculopathy: systematic review and meta-analysis

“…Thus, it is suggested that corticosteroids may be unnecessary for nerve root blocks. This concept has been reinforced by numerous randomized and observational studies [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]. A recent systematic review has found that there was no significant difference between transforaminal and caudal epidural injection [39].…”

Post–Vertebral Augmentation Back Pain: Evaluation and Management

“…20 The above-mentioned studies assessed the efficacy of facet joint injection in participants who had subacute or chronic back pain with various causes, and the results may not be applicable to our patients. [18][19][20] To the best of our knowledge, there is no study available in the literature that evaluates the efficacy of facet and/or SIJ injection in patients with persistent or recurrent back pain after vertebral augmentation.…”

“…Review of the literature showed different results in pain relief after facet injection. [18][19][20] A randomized double-blind controlled trial with a 2-year follow-up showed a very high rate of significant pain relief in 85%-90% of patients with chronic back pain after lumbar facet injection. 18 However, another systematic review by Boswell et al 19 showed that the evidence for short-and long-term pain relief is moderate for lumbar facet joint injection.…”

“…[18][19][20] A randomized double-blind controlled trial with a 2-year follow-up showed a very high rate of significant pain relief in 85%-90% of patients with chronic back pain after lumbar facet injection. 18 However, another systematic review by Boswell et al 19 showed that the evidence for short-and long-term pain relief is moderate for lumbar facet joint injection. Another systematic review of randomized controlled trials by Staal et al 20 showed that there is insufficient evidence for or against facet joint injection and that specific subgroups of patients may benefit from treatment.…”

The Role of Peripheral Nerve Blocks in the Interdisciplinary Care of Children with Chronic Pain: A Case Series and Review of the Literature

“…The literature is comprised of case reports and small case series, along with a few randomized, placebo-controlled trials (RCTs). For example, therapeutic lumbar facet joint nerve blocks can provide effective pain relief and functional improvement (Manchikanti et al, 2010). However, epidural corticosteroid injections for sciatica appear to offer only transient benefit (Arden et al, 2005).…”