1. 2006;9;333-346Therapeutic cervical medial branch blocks in managing chronic neck pain: A preliminary report of a randomized, double-blind, controlled trial: Clinical Trial NCT0033272
   A Randomized Trial
   Laxmaiah Manchikanti, MD, Kim Damron, RN, Kim Cash, RT, Rajeev Manchukonda, BDS, and Vidyasagar Pampati, MSc.

Background: Based on the criteria established by the International Association for the Study of Pain, the prevalence of persistent neck pain, secondary to involvement of cervical facet or zygapophysial joints has been described in controlled studies as varying from 54% to 67%. Intraarticular injections, medial branch nerve blocks and neurolysis of medial branch nerves have been described in managing chronic neck pain of facet joint origin. Objectives: To determine the clinical effectiveness of therapeutic cervical medial branch blocks in managing chronic neck pain of facet joint origin and to evaluate the effectiveness of the addition of Sarapin and steroids to local anesthetics. Design: A double-blind, randomized, controlled trial. Setting: An interventional pain management setting in the United States. Methods: In this preliminary analysis, data from a total of 60 patients were included, with 15 patients in each of the 4 groups. Thirty patients were in a non-steroid group (combined Group I and II); and 30 patients were in a steroid group (combined Group III and IV). All of the patients met the diagnostic criteria of cervical facet joint pain by means of comparative, controlled diagnostic blocks. Four types of interventions were included. Group I served as control, receiving medial branch blocks using bupivacaine. Group II consisted of cervical medial branch blocks with bupivacaine and Sarapin. Group III consisted of cervical medial branch blocks with bupivacaine and betamethasone. Group IV consisted of cervical medial branch blocks with bupivacaine, Sarapin and betamethasone. Outcome Measures: Numeric pain scores, Neck Pain Disability Index, opioid intake, and work status were evaluated at baseline, 3 months, 6 months and 12 months. Results: Significant pain relief (≥50%), and functional status improvement was observed at 3 months, 6 months and 12 months. The average number of treatments for 1 year was 3.8 ± 0.7 in the non-steroid group and 3.4 ± 1.0 in the steroid group with no significant difference among the groups. Duration of average pain relief with each procedure was 13.4 ± 3.5 weeks in the nonsteroid group, and it was 15.9 ± 8.0 weeks in the steroid group with no significant difference among the groups. Conclusion: Therapeutic cervical medial branch nerve blocks, with or without Sarapin or steroids, may provide effective management for chronic neck pain of facet joint origin.