title: Does therapist's attitude affect clinical outcome of lumbar facet joint injections?
abstract: OBJECTIVE
  To investigate if the clinical outcome of intra-articular lumbar facet joint injections is affected by the therapist's attitude.
  
  
  METHODS
  A total of 40 patients with facet joint-associated chronic low back pain were randomly divided into two groups. All patients received computed tomography-guided, monosegmental intra-articular facet joint injections. Following the therapeutic procedure, the patients of the experimental group (EG) held a conversation with the radiologist in a comfortable atmosphere. During the dialog, the patients were encouraged to ask questions and were shown four images. The patients of the control group (CG) left the clinic without any further contact with the radiologist. Outcome was assessed using a pain-based Verbal Numeric Scale at baseline, at 1 wk and at 1, 3, and 6 mo after first treatment.
  
  
  RESULTS
  The patient demographics showed no differences between the groups. The patients of the EG received 57 interventional procedures in total, while the patients of the CG received 70 interventional procedures. In both groups, the pain scores decreased significantly over the entire observation period. Compared to the CG, the EG showed a statistically significant reduction of pain at 1 wk and 1 mo post-treatment, while at 3 and 6 mo after treatment, there were no significant differences between both groups.
  
  
  CONCLUSIONS
  Our results show a significant effect on pain relief during the early post-interventional period in the EG as compared to the CG. The basic principle behind the higher efficacy might be the phenomenon of hetero-suggestion.
authors.affiliation: Marcus Middendorp, Department of Nuclear Medicine, Goethe University, 60590 Frankfurt, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Middendorp
authors.affiliation: Marcus Middendorp, Department of Nuclear Medicine, Goethe University, 60590 Frankfurt, Germany.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kollias
authors.affiliation: Marcus Middendorp, Department of Nuclear Medicine, Goethe University, 60590 Frankfurt, Germany.
authors.forename: Hanns
authors.initials: H
authors.lastname: Ackermann
authors.affiliation: Marcus Middendorp, Department of Nuclear Medicine, Goethe University, 60590 Frankfurt, Germany.
authors.forename: Annina
authors.initials: A
authors.lastname: Splettstößer
authors.affiliation: Marcus Middendorp, Department of Nuclear Medicine, Goethe University, 60590 Frankfurt, Germany.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Vogl
authors.affiliation: Marcus Middendorp, Department of Nuclear Medicine, Goethe University, 60590 Frankfurt, Germany.
authors.forename: M Fawad
authors.initials: MF
authors.lastname: Khan
authors.affiliation: Marcus Middendorp, Department of Nuclear Medicine, Goethe University, 60590 Frankfurt, Germany.
authors.forename: Adel
authors.initials: A
authors.lastname: Maataoui
keywords: Facet joint injection; Facet joint osteoarthritis; Hetero-suggestion; Low back pain; Lumbar spine; Magnetic resonance imaging