Critical appraisal of facet joints injections for chronic whiplash.
Whiplash has been defined as an injury mechanism, an injury, a medicolegal and social dilemma, and a complex chronic pain syndrome. The chronic whiplash syndrome has long been a source of controversy, in large part because most patients do not have any readily identifiable injury in either the acute or chronic stage. Many sites of pathology have been postulated over the years, but all have thus far been unsubstantiated by objective research evidence or have been shown in controlled studies to be no more prevalent in injured than in uninjured subjects. Recent promise has been afforded to the possibility of acute facet joint injury in the cervical spine and chronic pain arising from the facet joint. Despite the great appeal of this notion, however, there are considerable methodological and epidemiological barriers to its acceptance, and there remains a paucity of research to date to advance this theory. In this review, we examine the clinical studies which have identified facet joint pain in whiplash patients and have examined the diagnosis of the same via facet joint blocks and treatment via radiofrequency neurotomy. We conclude that this therapy should not be used until more credible and scientific evidence arises from further study.
Kwan
Oliver
O
Private Practice, Edmonton, Alberta, Canada. okwan@shaw.ca
Fiel
Jon
J
D000779:Anesthetics, Local / Q000008:administration & dosage*; D002574:Cervical Vertebrae / Q000293:injuries*; D006801:Humans; D007270:Injections, Intra-Articular; D007346:Insurance, Accident; D019547:Neck Pain / Q000601:surgery / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D019051:Rhizotomy; D014911:Whiplash Injuries / Q000601:surgery / Q000628:therapy*; D021801:Zygapophyseal Joint / Q000293:injuries*
D000779:Anesthetics, Local