Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions.
BACKGROUND
Facet joints are a clinically important source of chronic cervical, thoracic, and lumbar spine pain. The purpose of this study was to systematically evaluate the prevalence of facet joint pain by spinal region in patients with chronic spine pain referred to an interventional pain management practice.


METHODS
Five hundred consecutive patients with chronic, non-specific spine pain were evaluated. The prevalence of facet joint pain was determined using controlled comparative local anesthetic blocks (1% lidocaine or 1% lidocaine followed by 0.25% bupivacaine), in accordance with the criteria established by the International Association for the Study of Pain (IASP). The study was performed in the United States in a non-university based ambulatory interventional pain management setting.


RESULTS
The prevalence of facet joint pain in patients with chronic cervical spine pain was 55% 5(95% CI, 49%-61%), with thoracic spine pain was 42% (95% CI, 30%-53%), and in with lumbar spine pain was 31% (95% CI, 27%-36%). The false-positive rate with single blocks with lidocaine was 63% (95% CI, 54%-72%) in the cervical spine, 55% (95% CI, 39%-78%) in the thoracic spine, and 27% (95% CI, 22%-32%) in the lumbar spine.


CONCLUSIONS
This study demonstrated that in an interventional pain management setting, facet joints are clinically important spinal pain generators in a significant proportion of patients with chronic spinal pain. Because these patients typically have failed conservative management, including physical therapy, chiropractic treatment and analgesics, they may benefit from specific interventions designed to manage facet joint pain.
Manchikanti
Laxmaiah
L
Pain Management Center of Paducah, 2831 Lone Oak Road, Paducah, Kentucky, USA. drm@apex.net
Boswell
Mark V
MV
Singh
Vijay
V
Pampati
Vidyasagar
V
Damron
Kim S
KS
Beyer
Carla D
CD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D001416:Back Pain / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D002574:Cervical Vertebrae; D002908:Chronic Disease; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use; D017116:Low Back Pain / Q000188:drug therapy / Q000453:epidemiology*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D015995:Prevalence; D011446:Prospective Studies; D013904:Thoracic Vertebrae; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000503:physiopathology*
D000779:Anesthetics, Local; D008012:Lidocaine; D002045:Bupivacaine