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+).
Showing posts with label cervical pain. Show all posts
Showing posts with label cervical pain. Show all posts
Wednesday, March 17, 2010
Wednesday, February 24, 2010
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
5. Cervical Facet Pain
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+).
Published Online: 23 Feb 2010
EVIDENCE-BASED MEDICINE
Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
5. Cervical Facet Pain
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+).
Thursday, January 7, 2010
Cervical Radicular Pain
Pain Practice
Volume 10 Issue 1, Pages 1 - 17
Jan Van Zundert, MD, PhD, FIPP* † ; Marc Huntoon, MD ‡ ; Jacob Patijn, MD, PhD † ; Arno Lataster, MSc § ; Nagy Mekhail, MD, PhD, FIPP ¶ ; Maarten van Kleef, MD, PhD, FIPP †
*Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium; † Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, the Netherlands; § Department of Anatomy and Embryology, Maastricht University, Maastricht, the Netherlands; ‡ Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A.; ¶ Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Correspondence to Jan Van Zundert, MD, PhD, FIPP, Ziekenhuis Oost-Limburg, Genk, Multidisciplinary Pain Centre, Stalenstraat, 2, 3600 Genk, Belgium. E-mail: jan.van.zundert@zol.be.
ABSTRACT
Cervical radicular pain is defined as pain perceived as arising in the arm caused by irritation of a cervical spinal nerve or its roots.
Approximately 1 person in 1,000 suffers from cervical radicular pain. In the absence of a gold standard, the diagnosis is based on a combination of history, clinical examination, and (potentially) complementary examination. Medical imaging may show abnormalities, but those findings may not correlate with the patient's pain. Electrophysiologic testing may be requested when nerve damage is suspected but will not provide quantitative/qualitative information about the pain. The presumed causative level may be confirmed by means of selective diagnostic blocks.
Conservative treatment typically consists of medication and physical therapy. There are no studies assessing the effectiveness of different types of medication specifically in patients suffering cervical radicular pain. Cochrane reviews did not find sufficient proof of efficacy for either education or cervical traction.
When conservative treatment fails, interventional treatment may be considered.
For subacute cervical radicular pain, the available evidence on efficacy and safety supports a recommendation (2B+) of interlaminar cervical epidural corticosteroid administration. A recent negative randomized controlled trial of transforaminal cervical epidural corticosteroid administration, coupled with an increasing number of reports of serious adverse events, warrants a negative recommendation (2B−). Pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion is a recommended treatment for chronic cervical radicular pain (1B+). When its effect is insufficient or of short duration, conventional radiofrequency treatment is recommended (2B+).
In selected patients with cervical radicular pain, refractory to other treatment options, spinal cord stimulation may be considered. This treatment should be performed in specialized centers, preferentially study related.
Volume 10 Issue 1, Pages 1 - 17
Jan Van Zundert, MD, PhD, FIPP* † ; Marc Huntoon, MD ‡ ; Jacob Patijn, MD, PhD † ; Arno Lataster, MSc § ; Nagy Mekhail, MD, PhD, FIPP ¶ ; Maarten van Kleef, MD, PhD, FIPP †
*Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium; † Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, the Netherlands; § Department of Anatomy and Embryology, Maastricht University, Maastricht, the Netherlands; ‡ Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A.; ¶ Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Correspondence to Jan Van Zundert, MD, PhD, FIPP, Ziekenhuis Oost-Limburg, Genk, Multidisciplinary Pain Centre, Stalenstraat, 2, 3600 Genk, Belgium. E-mail: jan.van.zundert@zol.be.
ABSTRACT
Cervical radicular pain is defined as pain perceived as arising in the arm caused by irritation of a cervical spinal nerve or its roots.
Approximately 1 person in 1,000 suffers from cervical radicular pain. In the absence of a gold standard, the diagnosis is based on a combination of history, clinical examination, and (potentially) complementary examination. Medical imaging may show abnormalities, but those findings may not correlate with the patient's pain. Electrophysiologic testing may be requested when nerve damage is suspected but will not provide quantitative/qualitative information about the pain. The presumed causative level may be confirmed by means of selective diagnostic blocks.
Conservative treatment typically consists of medication and physical therapy. There are no studies assessing the effectiveness of different types of medication specifically in patients suffering cervical radicular pain. Cochrane reviews did not find sufficient proof of efficacy for either education or cervical traction.
When conservative treatment fails, interventional treatment may be considered.
For subacute cervical radicular pain, the available evidence on efficacy and safety supports a recommendation (2B+) of interlaminar cervical epidural corticosteroid administration. A recent negative randomized controlled trial of transforaminal cervical epidural corticosteroid administration, coupled with an increasing number of reports of serious adverse events, warrants a negative recommendation (2B−). Pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion is a recommended treatment for chronic cervical radicular pain (1B+). When its effect is insufficient or of short duration, conventional radiofrequency treatment is recommended (2B+).
In selected patients with cervical radicular pain, refractory to other treatment options, spinal cord stimulation may be considered. This treatment should be performed in specialized centers, preferentially study related.
Wednesday, October 7, 2009
Cervical Radicular Pain
EVIDENCE BASED MEDICINE
Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
4. Cervical Radicular Pain
Jan Van Zundert, MD, PhD, FIPP*†; Marc Huntoon, MD ‡ ; Jacob Patijn, MD, PhD † ; Arno Lataster, MSc § ; Nagy Mekhail, MD, PhD, FIPP ¶ ; Maarten van Kleef, MD, PhD, FIPP †
*Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium; † Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, the Netherlands; § Department of Anatomy and Embryology, Maastricht University, Maastricht, the Netherlands; ‡ Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A.; ¶ Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Correspondence to Jan Van Zundert, MD, PhD, FIPP, Ziekenhuis Oost-Limburg, Genk, Multidisciplinary Pain Centre, Stalenstraat, 2, 3600 Genk, Belgium. E-mail: jan.van.zundert@zol.be.
Pain Practice
Published Online: 5 Oct 2009
Journal compilation © 2009 World Institute of Pain
ABSTRACT
Cervical radicular pain is defined as pain perceived as arising in the arm caused by irritation of a cervical spinal nerve or its roots. Approximately 1 person in 1,000 suffers from cervical radicular pain. In the absence of a gold standard, the diagnosis is based on a combination of history, clinical examination, and (potentially) complementary examination. Medical imaging may show abnormalities, but those findings may not correlate with the patient's pain. Electrophysiologic testing may be requested when nerve damage is suspected but will not provide quantitative/qualitative information about the pain. The presumed causative level may be confirmed by means of selective diagnostic blocks. Conservative treatment typically consists of medication and physical therapy. There are no studies assessing the effectiveness of different types of medication specifically in patients suffering cervical radicular pain. Cochrane reviews did not find sufficient proof of efficacy for either education or cervical traction. When conservative treatment fails, interventional treatment may be considered. For subacute cervical radicular pain, the available evidence on efficacy and safety supports a recommendation (2B+) of interlaminar cervical epidural corticosteroid administration. A recent negative randomized controlled trial of transforaminal cervical epidural corticosteroid administration, coupled with an increasing number of reports of serious adverse events, warrants a negative recommendation (2B−). Pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion is a recommended treatment for chronic cervical radicular pain (1B+). When its effect is insufficient or of short duration, conventional radiofrequency treatment is recommended (2B+). In selected patients with cervical radicular pain, refractory to other treatment options, spinal cord stimulation may be considered. This treatment should be performed in specialized centers, preferentially study related.
Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
4. Cervical Radicular Pain
Jan Van Zundert, MD, PhD, FIPP*†; Marc Huntoon, MD ‡ ; Jacob Patijn, MD, PhD † ; Arno Lataster, MSc § ; Nagy Mekhail, MD, PhD, FIPP ¶ ; Maarten van Kleef, MD, PhD, FIPP †
*Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium; † Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, the Netherlands; § Department of Anatomy and Embryology, Maastricht University, Maastricht, the Netherlands; ‡ Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A.; ¶ Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Correspondence to Jan Van Zundert, MD, PhD, FIPP, Ziekenhuis Oost-Limburg, Genk, Multidisciplinary Pain Centre, Stalenstraat, 2, 3600 Genk, Belgium. E-mail: jan.van.zundert@zol.be.
Pain Practice
Published Online: 5 Oct 2009
Journal compilation © 2009 World Institute of Pain
ABSTRACT
Cervical radicular pain is defined as pain perceived as arising in the arm caused by irritation of a cervical spinal nerve or its roots. Approximately 1 person in 1,000 suffers from cervical radicular pain. In the absence of a gold standard, the diagnosis is based on a combination of history, clinical examination, and (potentially) complementary examination. Medical imaging may show abnormalities, but those findings may not correlate with the patient's pain. Electrophysiologic testing may be requested when nerve damage is suspected but will not provide quantitative/qualitative information about the pain. The presumed causative level may be confirmed by means of selective diagnostic blocks. Conservative treatment typically consists of medication and physical therapy. There are no studies assessing the effectiveness of different types of medication specifically in patients suffering cervical radicular pain. Cochrane reviews did not find sufficient proof of efficacy for either education or cervical traction. When conservative treatment fails, interventional treatment may be considered. For subacute cervical radicular pain, the available evidence on efficacy and safety supports a recommendation (2B+) of interlaminar cervical epidural corticosteroid administration. A recent negative randomized controlled trial of transforaminal cervical epidural corticosteroid administration, coupled with an increasing number of reports of serious adverse events, warrants a negative recommendation (2B−). Pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion is a recommended treatment for chronic cervical radicular pain (1B+). When its effect is insufficient or of short duration, conventional radiofrequency treatment is recommended (2B+). In selected patients with cervical radicular pain, refractory to other treatment options, spinal cord stimulation may be considered. This treatment should be performed in specialized centers, preferentially study related.
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