Long-term Follow-up of Cervical Facet Medial Branch Radiofrequency Treatment With the Single Posterior-lateral Approach: An Exploratory Study

Pain Practice

1. Maarten van Eerd MD, FIPP^1,2, 
2. Nelleke de Meij MSc^1,*, 
3. Erik Dortangs MD¹, 
4. Alfons Kessels MD, MSc³, 
5. Jan van Zundert MD, PhD, FIPP¹, 
6. Arno Lataster MSc⁴, 
7. Jacob Patijn MD, PhD¹, 
8. Maarten van Kleef MD, PhD, FIPP¹

Article first published online: 18 MAR 2013

DOI: 10.1111/papr.12043

Background

Over 50% of patients presenting to pain clinic with neck pain have the cervical facet joints as the source of pain. Radiofrequency (RF) treatment of the medial branch, innervating the facet joint, is a therapeutic option. The objectives of this study were to evaluate the therapeutic effect and its duration of RF treatment, using the single posterior-lateral approach in patients suffering from facet joint degeneration and to identify predictors for a long-term effect.

Methods

Of the 130 consecutive patients with axial neck pain referred to the University Pain Center Maastricht, 67 fulfilled the inclusion criteria. The therapeutic effect was measured using the Patients’ Global Impression of Change (PGIC) scale. Retrospective data were made complete using newly collected PGIC follow-up data. A Kaplan–Meier curve evaluated the long-term therapeutic effect. Possible predictors of outcome were evaluated.

Results

Two patients refused to participate and in the remaining 65 patients, overall pain relief was reported in 55.4% at 2-month follow-up. Moderately, important change of improvement and substantial change of improvement were seen in 50.8% of patients. At 3-year follow-up, 30% still reported pain reduction. Spinal treatment level was the only predictor found.

Conclusions

Radiofrequency treatment of the cervical facet joints using a single posterior-lateral approach is a promising technique in patients with chronic neck pain due to facet degeneration. The short-term and long-term therapeutic effects of this intervention justify a randomized controlled trial to estimate the efficacy of cervical facet joint RF treatment in a chronic neck pain population.

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.

Cluster Headache

Pain Practice

Volume 9 Issue 6, Pages 435 - 442

Published Online: 27 Oct 2009

© 2009 by World Institute of Pain

EVIDENCE-BASED MEDICINE Evidence-Based Interventional Pain Medicine according to Clinical Diagnoses

Maarten van Kleef, MD, PhD, FIPP*; Arno Lataster, MSc ^† ; Samer Narouze, MD, MSc, FIPP ^‡ ; Nagy Mekhail, MD, PhD, FIPP ^‡ ; José W.Geurts, MSc*; Jan van Zundert, MD, PhD, FIPP*^§

*Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands; ^†Department of Anatomy and Embryology, Maastricht University, Maastricht, The Netherlands; ^‡ Pain Management Department, Cleveland Clinic, Cleveland, Anesthesiology Institute, Ohio, U.S.A.; ^§ Department of Anesthesiology and Pain Management, Ziekenhuis Oost Limburg, Genk, Belgium

Correspondence to Maarten van Kleef, MD, PhD, FIPP, Maastricht University Medical Centre, Department of Anesthesiology and Pain Management, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: maarten.van.kleef@mumc.nl.

ABSTRACT

Cluster headache is a strictly unilateral headache that is associated with ipsilateral cranial autonomic symptoms and usually has a circadian and circannual pattern. Prevalence is estimated at 0.5 to 1.0/1,000. The diagnosis of cluster headache is made based on the patient's case history. There are two main clinical patterns of cluster headache: the episodic and the chronic. Episodic is the most common pattern of cluster headache. It occurs in periods lasting 7 days to 1 year and is separated by at least a 1-month pain-free interval. The attacks in the chronic form occur for more than 1 year without remission periods or with remission periods lasting less than 1 month.

Conservative therapy consists of abortive and preventative remedies. Ergotamines and sumatriptan injections, sublingual ergotamine tartrate administration, and oxygen inhalation are effective abortive therapies. Verapamil is an effective and the safest prophylactic remedy. When pharmacological and oxygen therapies fail, interventional pain treatment may be considered. The effectiveness of radiofrequency treatment of the ganglion pterygopalatinum and of occipital nerve stimulation is only evaluated in observational studies, resulting in a 2 C+ recommendation.

In conclusion, the primary treatment is medication. Radiofrequency treatment of the ganglion pterygopalatinum should be considered in patients who are resistant to conservative pain therapy. In patients with cluster headache refractory to all other treatments, occipital nerve stimulation may be considered, preferably within the context of a clinical study.

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.