Cervical Epidural Injections in Chronic Discogenic Neck Pain Without Disc Herniation or Radiculitis: Preliminary Results of a Randomized, Double-Blind, Controlled Trial

Pain Physician July/August 2010 - Vol 13 Issue 4
2010;13;E265-E278.


Randomized Trial
Laxmaiah Manchikanti, MD, Kimberly A. Cash, RT, Vidyasagar Pampati, MSc, Bradley W. Wargo, DO, and Yogesh Malla, MD

BACKGROUND: Chronic neck pain is a common problem in the adult population with a typical 12-month prevalence of 30% to 50%. However, there is a lack of consensus regarding the causes and treatments of chronic neck pain.

Despite limited evidence, cervical epidural injections are one of the commonly performed non-surgical interventions in the management of chronic neck pain.

STUDY DESIGN: A randomized, double-blind, active control trial.
SETTING: An interventional pain management practice, a specialty referral center, a private practice setting in the United States.
OBJECTIVES: To evaluate the effectiveness of cervical interlaminar epidural injections with local anesthetic with or without steroids in the management of chronic neck pain with or without upper extremity pain in patients without disc herniation or radiculitis or facet joint pain.
METHODS: Patients without disc herniation or radiculitis and negative for facet joint pain by means of controlled diagnostic medial branch blocks were randomly assigned to one of 2 groups: injection of local anesthetic only or local anesthetic mixed with non-particulate betamethasone. Seventy patients were included in this analysis. Randomization was performed by computer-generated random allocation sequence by simple randomization.

OUTCOMES ASSESSMENT: Multiple outcome measures were utilized including the Numeric Rating Scale (NRS), the Neck Disability Index (NDI), employment status, and opioid intake with assessment at 3, 6, and 12 months post-treatment.

Significant pain relief or functional status was defined as a 50% or more reduction.
RESULTS: Significant pain relief (≥ 50%) was demonstrated in 80% of patients in both groups and functional status improvement (> 50%) in 69% of Group I and 80% of Group II. The overall average procedures per year were 3.9 ± 1.01 in Group I and 3.9 ± 0.8 in Group II with an average total relief per year of 40.3 ± 14.1 weeks in Group I and 42.1 ± 9.9 weeks in Group II over a period of 52 weeks in the successful group.

LIMITATIONS: The results of this study are limited by the lack of a placebo group and a preliminary report of 70 patients, with 35 patients in each group.

CONCLUSION: Cervical interlaminar epidural injections with local anesthetic with or without steroids may be effective in patients with chronic function-limiting discogenic.