Cervical Facet Pain

Pain Practice Volume 10 Issue 2, Pages 113 - 123 Published Online: 23 Feb 2010

EVIDENCE-BASED MEDICINE
Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
Maarten van Eerd, MD, FIPP*†; Jacob Patijn, MD, PhD*; Arno Lataster, MSc ‡ ; Richard W. Rosenquist, MD § ; Maarten van Kleef, MD, PhD, FIPP*; Nagy Mekhail, MD, PhD, FIPP ¶ ; Jan Van Zundert, MD, PhD, FIPP*,**
*Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands; † Department of Anesthesiology and Pain Management, Amphia Ziekenhuis, Breda, The Netherlands; ‡ Department of Anatomy and Embryology, Maastricht University, Maastricht, The Netherlands; § Department of Anesthesia, Pain Medicine Division, University of Iowa, Iowa City, Iowa, USA; ¶ Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A.; **Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium
Correspondence to M. van Eerd, MD, Maastricht University Medical Centre, Department of Anesthesiology and Pain Management, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: m.eerd@wxs.nl. 

ABSTRACT

More than 50% of patients presenting to a pain clinic with neck pain may suffer from facet-related pain. The most common symptom is unilateral pain without radiation to the arm. Rotation and retroflexion are frequently painful or limited. The history should exclude risk factors for serious underlying pathology (red flags). Radiculopathy may be excluded with neurologic testing. Direct correlation between degenerative changes observed with plain radiography, computerized tomography, and magnetic resonance imaging and pain has not been proven.

Conservative treatment options for cervical facet pain such as physiotherapy, manipulation, and mobilization, although supported by little evidence, are frequently applied before considering interventional treatments.

Interventional pain management techniques, including intra-articular steroid injections, medial branch blocks, and radiofrequency treatment, may be considered (0).

At present, there is no evidence to support cervical intra-articular corticosteroid injection. When applied, this should be done in the context of a study.

Therapeutic repetitive medial branch blocks, with or without corticosteroid added to the local anesthetic, result in a comparable short-term pain relief (2 B+).

Radiofrequency treatment of the ramus medialis of the cervical ramus dorsalis (facet) may be considered. The evidence to support its use in the management of degenerative cervical facet joint pain is derived from observational studies (2 C+).