The Ability of Computed Tomography to Identify a Painful Zygapophysial Joint in Patients With Chronic Low Back Pain

Association between Magnetic Resonance Imaging and the Result of Medial Branch Blocks

“…A large population study using plain radiography [20] and a smaller one using computed tomography (CT) [21] found osteoarthrosis to be equally prevalent in individuals with no pain as in patients with back pain. Similar negative results can be found in a previous CT study [8] and in a radiographic study [22]. Neither used an asymptomatic control group, and intra-articular injections were performed instead of medial branch blocks.…”

“…Though pain is the most common reason why patients undergo imaging of the spine [4], the evidence in the literature does not support the routine use of radiological imaging to diagnose zygapophysial joint pain [5]- [10]. The identification of a painful joint seems difficult, because the literature does not report any correlation between the clinical symptoms of low back pain and degenerative spinal changes on radiological imaging studies [11], including radiographs, magnetic resonance imaging (MRI), and computed tomography [8] [9]. Specifically, the association between degenerative changes in the lumbar facet joints and symptomatic low back pain remains unclear and is a subject of ongoing debate [5] [6] [7] [8].…”

“…The identification of a painful joint seems difficult, because the literature does not report any correlation between the clinical symptoms of low back pain and degenerative spinal changes on radiological imaging studies [11], including radiographs, magnetic resonance imaging (MRI), and computed tomography [8] [9]. Specifically, the association between degenerative changes in the lumbar facet joints and symptomatic low back pain remains unclear and is a subject of ongoing debate [5] [6] [7] [8]. The prevalence of abnormal zygapophysial joint changes in radiological imaging depends on the age of the study population, the imaging modality used, and the threshold of abnormality used.…”

Interventional pain medicine: retreat from the biopsychosocial model of pain

“…IPM relies heavily on findings from imaging studies to identify potential targets of intervention despite evidence for the poor association between radiographic imaging and pain [32,33,36]. Moreover, pain relief alone may not facilitate improvements in the suffering and disability common to chronic pain given evidence for the absent relationship between pain severity and both pain-related functional disability and mood [122,123].…”

“…Numerous critical reviews have failed to find evidenced-based support for the routine use of IPM [10,[21][22][23] as well as for specific procedures such as epidural steroid injections [24][25][26][27] and facet blocks [28,29] for the management of chronic spinal pain. Routine administration of nerve blocks for chronic pain is further challenged by studies of healthy and clinical populations that find little association between abnormalities on magnetic resonance imaging or computerized tomography, upon which much of the decisionmaking for IPM relies, and pain experience [30][31][32][33]. Despite the enormous upward trajectory of IPM, its clinical utility does not appear to be supported empirically by a paralleled improvement in patient outcomes or disability rates for chronic pain [34].…”