Intra-articular Steroids vs Saline for Lumbar Z-Joint Pain: A Prospective, Randomized, Double-Blind Placebo-Controlled Trial

Kennedy, David J.; Fraiser, Ryan; Zheng, Patricia; Huynh, Lisa; Levin, Josh; Smuck, Matthew; Schneider, Byron J.

doi:10.1093/pm/pny225

Cited by 13 publications

(8 citation statements)

References 20 publications

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“…The facet joint is a true synovial joint with a capsule that has a reported capacity of 1.0–2.0 mL of fluid. 177 Yet in RCTs examining the efficacy and prognostic value of lumbar facet IA injections, a wide range of volumes have been used including 0.25–0.50 mL, 84 0.3 mL, 178 0.5 mL, 18 0.7 mL, 61 1.0 mL, 179 180 1.5 mL, 53 138 139 3.0 mL 66 and 8.0 mL. 41 Whereas high volumes may result in rupture of the joint capsule and inadvertent spread to other potential pain generators, thereby undermining specificity, using an insufficient volume may conversely fail to anesthetize the joint, resulting in a false-negative block.…”

Section: Question 8: What Is the Ideal Volume For Prognostic Facet Inmentioning

confidence: 99%

Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group

Cohen

Bhaskar

Bhatia

et al. 2020

Reg Anesth Pain Med

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216

215

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BackgroundThe past two decades have witnessed a surge in the use of lumbar facet blocks and radiofrequency ablation (RFA) to treat low back pain (LBP), yet nearly all aspects of the procedures remain controversial.MethodsAfter approval by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, letters were sent to a dozen pain societies, as well as representatives from the US Departments of Veterans Affairs and Defense. A steering committee was convened to select preliminary questions, which were revised by the full committee. Questions were assigned to 4–5 person modules, who worked with the Subcommittee Lead and Committee Chair on preliminary versions, which were sent to the full committee. We used a modified Delphi method, whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chair, who incorporated the comments and sent out revised versions until consensus was reached.Results17 questions were selected for guideline development, with 100% consensus achieved by committee members on all topics. All societies except for one approved every recommendation, with one society dissenting on two questions (number of blocks and cut-off for a positive block before RFA), but approving the document. Specific questions that were addressed included the value of history and physical examination in selecting patients for blocks, the value of imaging in patient selection, whether conservative treatment should be used before injections, whether imaging is necessary for block performance, the diagnostic and prognostic value of medial branch blocks (MBB) and intra-articular (IA) injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for a prognostic block, how many blocks should be performed before RFA, how electrodes should be oriented, the evidence for larger lesions, whether stimulation should be used before RFA, ways to mitigate complications, if different standards should be applied to clinical practice and clinical trials and the evidence for repeating RFA (see table 12 for summary).ConclusionsLumbar medial branch RFA may provide benefit to well-selected individuals, with MBB being more predictive than IA injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of more false-negatives. Clinical trials should be tailored based on objectives, and selection criteria for some may be more stringent than what is ideal in clinical practice.

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Section: Question 8: What Is the Ideal Volume For Prognostic Facet Inmentioning

confidence: 99%

Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group

Cohen

Bhaskar

Bhatia

et al. 2020

Reg Anesth Pain Med

Self Cite

216

215

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“…Thus, IA PRF is a useful therapeutic option for the management of LFJ pain. Kennedy et al 70 Randomized, double blind, placebo-controlled study 56 Time to RFA, need for RFA Intra-articular corticosteroids were not effective in reducing the need for or the time to a radiofrequency ablation of the medial branches in those with dual MBB-confirmed lumbar z-joint pain. Joo et al 69 Prospective RCT 126 Vascular uptake A Quincke needle was related to positive IV injection at a 1.898-fold higher rate than was use of a Whitacre needle.…”

Section: Injection Therapymentioning

confidence: 99%

The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain

Sayed¹,

Grider²,

Strand³

et al. 2022

JPR

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Introduction Painful lumbar spinal disorders represent a leading cause of disability in the US and worldwide. Interventional treatments for lumbar disorders are an effective treatment for the pain and disability from low back pain. Although many established and emerging interventional procedures are currently available, there exists a need for a defined guideline for their appropriateness, effectiveness, and safety. Objective The ASPN Back Guideline was developed to provide clinicians the most comprehensive review of interventional treatments for lower back disorders. Clinicians should utilize the ASPN Back Guideline to evaluate the quality of the literature, safety, and efficacy of interventional treatments for lower back disorders. Methods The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations. Experts from the fields of Anesthesiology, Physiatry, Neurology, Neurosurgery, Radiology, and Pain Psychology developed the ASPN Back Guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Scopus, and meeting abstracts to identify and compile the evidence (per section) for back-related pain. Search words were selected based upon the section represented. Identified peer-reviewed literature was critiqued using United States Preventive Services Task Force (USPSTF) criteria and consensus points are presented. Results After a comprehensive review and analysis of the available evidence, the ASPN Back Guideline group was able to rate the literature and provide therapy grades to each of the most commonly available interventional treatments for low back pain. Conclusion The ASPN Back Guideline represents the first comprehensive analysis and grading of the existing and emerging interventional treatments available for low back pain. This will be a living document which will be periodically updated to the current standard of care based on the available evidence within peer-reviewed literature.

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“…showed some benefits of RFA treatment to the lumbar medial branch [ 4 ], the results of other studies are consistent with clinical trials and systematic reviews that have shown negative evidence for the therapeutic value of facet blocks [ 30 , 31 ]. If the treated FJs are the source of the pain, the patient may begin to notice longer-lasting pain relief from denervation 2–5 days after the injection [ 32 ]. In our study, a minimal increase in VAS scores was observed at the end of the first year.…”

Section: Discussionmentioning

confidence: 99%

Effect of radiofrequency denervation on pain severity among patients with cervical, thoracic or lumbar spinal pain: A clinical retrospective study

Akgül

Akgün

2022

Heliyon

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Intra-articular Steroids vs Saline for Lumbar Z-Joint Pain: A Prospective, Randomized, Double-Blind Placebo-Controlled Trial

Cited by 13 publications

References 20 publications

Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group

Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group

The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain

Effect of radiofrequency denervation on pain severity among patients with cervical, thoracic or lumbar spinal pain: A clinical retrospective study

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