title: Cervical zygapophysial (facet) joint pain: effectiveness of interventional management strategies.
abstract: Diagnostic facet joint nerve blocks have been utilized in the diagnosis of cervical facet joint pain in patients without disk herniation or radicular pain due to a lack of reliable noninvasive diagnostic measures. Therapeutic interventions include intra-articular injections, facet joint nerve blocks and radiofrequency neurotomy. The diagnostic accuracy and effectiveness of facet joint interventions have been assessed in multiple diagnostic accuracy studies, randomized controlled trials (RCTs), and systematic reviews in managing chronic neck pain. This assessment shows there is Level II evidence based on a total of 11 controlled diagnostic accuracy studies for diagnosing cervical facet joint pain in patients without disk herniation or radicular pain utilizing controlled diagnostic blocks. Due to significant variability and internal inconsistency regarding prevalence in a heterogenous population; despite 11 studies, evidence is determined as Level II. Prevalence ranged from 36% to 67% with at least 80% pain relief as the criterion standard with a false-positive rate ranging from 27% to 63%. The evidence is Level II for the long-term effectiveness of radiofrequency neurotomy and facet joint nerve blocks in managing cervical facet joint pain. There is Level III evidence for cervical intra-articular injections.
authors.affiliation: a Pain Management Center of Paducah , Paducah , KY , USA.|b Department of Anesthesiology and Perioperative Medicine , University of Louisville , Louisville , KY , USA.
authors.forename: Laxmaiah
authors.initials: L
authors.lastname: Manchikanti
authors.affiliation: c Neuroendovascular Program , Massachusetts General Hospital , Boston , MA , USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Hirsch
authors.affiliation: d Department of Anesthesia , LSU Health Science Center , New Orleans , LA , USA.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Kaye
authors.affiliation: b Department of Anesthesiology and Perioperative Medicine , University of Louisville , Louisville , KY , USA.
authors.forename: Mark V
authors.initials: MV
authors.lastname: Boswell
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D018771:Arthralgia / Q000175:diagnosis / Q000628:therapy*; D017115:Catheter Ablation; D059350:Chronic Pain / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007270:Injections, Intra-Articular; D019547:Neck Pain / Q000175:diagnosis / Q000628:therapy*; D009407:Nerve Block; D021801:Zygapophyseal Joint
chemical_list: D000700:Analgesics
keywords: Cervical facet joint; Cervical facet joint nerve blocks; Cervical facet joint pain; Cervical facet joint radiofrequency neurotomy; Cervical intra-articular injections; Controlled diagnostic blocks