Evaluation of therapeutic thoracic medial branch block effectiveness in chronic thoracic pain: a prospective outcome study with minimum 1-year follow up.
BACKGROUND
The prevalence of persistent upper back and mid back pain due to involvement of thoracic facet joints has been described in controlled studies as varying from 43% to 48% based on IASP criteria. Therapeutic intraventions utilized in managing chronic neck pain and low back pain of facet joint origin include intraarticular injections, medial branch nerve blocks, and neurolysis of medial branch nerves by means of radiofrequency. These interventions have not been evaluated in managing chronic thoracic pain of facet joint origin.


OBJECTIVE
To determine the clinical effectiveness of therapeutic thoracic medial branch blocks in managing chronic upper back and mid back pain of facet joint origin.


METHODS
A prospective outcome study.


METHODS
Interventional pain management setting in the United States.


METHODS
Fifty-five consecutive patients meeting the diagnostic criteria of thoracic facet joint pain by means of comparative, controlled diagnostic blocks were included in this evaluation. All medial branch blocks were performed in a sterile operating room under fluoroscopic visualization with mild sedation with midazolam and/or fentanyl. Statistical methods incorporated intent-to-treat analysis.


METHODS
Numeric pain scores, significant pain relief > or = 50%), Oswestry Disability Index, work status and Pain Patient Profile (P-3). Significant pain relief was defined as an average 50% or greater reduction of numeric pain rating scores.


RESULTS
The results showed significant differences in numeric pain scores and significant pain relief (50% or greater) in 71% of the patients at three months and six months, 76% at 12 months, 71% at 24 months, and 69% at 36 months, compared to baseline measurements. Functional improvement was demonstrated at one year, two years, and three years from baseline. There was significant improvement with increase in employment among the patients eligible for employment (employed and unemployed) from baseline to one year, two years, and three years (61% vs 96% to 100%) and improved psychological functioning.


CONCLUSIONS
Therapeutic thoracic medial branch blocks were an effective modality of treatment in managing chronic thoracic pain secondary to facet joint involvement confirmed by controlled, comparative local anesthetic blocks.
Manchikanti
Laxmaiah
L
Pain Management Center of Paducah, Kentucky 42003, USA. drm@apex.net
Manchikanti
Kavita N
KN
Manchukonda
Rajeev
R
Pampati
Vidyasagar
V
Cash
Kim A
KA
D000328:Adult; D001416:Back Pain / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D002908:Chronic Disease; D004185:Disability Evaluation; D004651:Employment; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007270:Injections, Intra-Articular; D008297:Male; D008475:Median Nerve; D008874:Midazolam / Q000627:therapeutic use; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement / Q000379:methods; D011446:Prospective Studies; D012189:Retrospective Studies; D013904:Thoracic Vertebrae / Q000473:pathology; D013997:Time Factors; D021801:Zygapophyseal Joint / Q000473:pathology*
D006993:Hypnotics and Sedatives; D008874:Midazolam; D005283:Fentanyl