Capacity of the Clinical Picture to Characterize Low Back Pain Relieved by Facet Joint Anesthesia

Revel, Michel; Poiraudeau, Serge; Auleley, Guy Robert; Payán, C.; Denke, Afiwa; Nguyen, Mylan T.; Chevrot, A.; Fermanian, Jacques

doi:10.1097/00007632-199809150-00011

Cited by 240 publications

(166 citation statements)

References 16 publications

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“…The presence of five of these characteristics, including pain on recumbency, correctly identified 92% of responders and 80% of non-responders. 30 Others, however, were unable to replicate their findings. 31 Subsequent reviews suggest that 62% of those with these clinical features of facet joint pain obtained immediate relief from FJIs; one-third of these were false positives.…”

Section: Clinical Features Of Facet Joint Painmentioning

confidence: 98%

Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial

Ellard

Underwood

Achana

et al. 2017

Health Technol Assess

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BackgroundThe National Institute for Health and Care Excellence (NICE) 2009 guidelines for persistent low back pain (LBP) do not recommend the injection of therapeutic substances into the back as a treatment for LBP because of the absence of evidence for their effectiveness. This feasibility study aimed to provide a stable platform that could be used to evaluate a randomised controlled trial (RCT) on the clinical effectiveness and cost-effectiveness of intra-articular facet joint injections (FJIs) when added to normal care.ObjectivesTo explore the feasibility of running a RCT to test the hypothesis that, for people with suspected facet joint back pain, adding the option of intra-articular FJIs (local anaesthetic and corticosteroids) to best usual non-invasive care is clinically effective and cost-effective.DesignThe trial was a mixed design. The RCT pilot protocol development involved literature reviews and a consensus conference followed by a randomised pilot study with an embedded mixed-methods process evaluation.SettingFive NHS acute trusts in England.ParticipantsParticipants were patients aged ≥ 18 years with moderately troublesome LBP present (> 6 months), who had failed previous conservative treatment and who had suspected facet joint pain. The study aimed to recruit 150 participants (approximately 30 per site). Participants were randomised sequentially by a remote service to FJIs combined with ‘best usual care’ (BUC) or BUC alone.InterventionsAll participants were to receive six sessions of a bespoke BUC rehabilitation package. Those randomised into the intervention arm were, in addition, given FJIs with local anaesthetic and steroids (at up to six injection sites). Randomisation occurred at the end of the first BUC session.Main outcome measuresProcess and clinical outcomes. Clinical outcomes included a measurement of level of pain on a scale from 0 to 10, which was collected daily and then weekly via text messaging (or through a written diary). Questionnaire follow-up was at 3 months.ResultsFifty-two stakeholders attended the consensus meeting. Agreement informed several statistical questions and three design considerations: diagnosis, the process of FJI and the BUC package and informing the design for the randomised pilot study. Recruitment started on 26 June 2015 and was terminated by the funder (as a result of poor recruitment) on 11 December 2015. In total, 26 participants were randomised. Process data illuminate some of the reasons for recruitment problems but also show that trial processes after enrolment ran smoothly. No between-group analysis was carried out. All pain-related outcomes show the expected improvement between baseline and follow-up. The mean total cost of the overall treatment package (injection £419.22 and BUC £264.00) was estimated at £683.22 per participant. This is similar to a NHS tariff cost for a course of FJIs of £686.84.LimitationsPoor recruitment was a limiting factor.ConclusionsThis feasibility study achieved consensus on the main challenges in a trial of FJIs for people with persistent non-specific low back pain.Future workFurther work is needed to test recruitment from alternative clinical situations.Trial registrationEudraCT 2014-000682-50 and Current Controlled Trials ISRCTN93184143.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 30. See the NIHR Journals Library website for further project information.

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Section: Clinical Features Of Facet Joint Painmentioning

confidence: 98%

Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial

Ellard

Underwood

Achana

et al. 2017

Health Technol Assess

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“…One study reported that the factors found to be predictive of a response to facet joint anaesthesia (defined as 75% decrease in pain severity), which can be viewed as a gold standard diagnostic test for facet joint syndrome, were different from the criteria generally used for the clinical diagnosis of this condition (Revel et al 1998).…”

Section: Commentsmentioning

confidence: 99%

Chapter 4 European guidelines for the management of chronic nonspecific low back pain

Airaksinen¹,

Brox²,

Cedraschi³

et al. 2006

Eur Spine J

2,176

1,623

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“…Criteria include pain not exacerbated by coughing, pain increased by recumbence, relieved by walking, deep achy nature, no parasthesia or no root tension sings, pain provocation by pushing hips forward while standing, morning stiffness with stooped posture, no radiation below knee, well localized paraspinal tenderness, pain in the back with straight leg raising test, pain with extension and rotation toward the symptomatic side. 19 Facet joint block has a major diagnostic value. No matter what the symptoms, signs or imaging features are, a characteristic feature of facet syndrome is relief of pain from injection of local anaesthetic.…”

Section: 7mentioning

confidence: 99%

Comparison between Computed Tomography & Fluoroscopy Guided Facet Joint Block in Lumbar Spine

Al-Shatoury

Alghandour

2013

Egyptian Spine Journal

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Background Data: Facet joint disorders are main source of chronic low back pain with a prevalence of 16.7%. Facet joint block is performed for diagnostic or therapeutic purposes and generally is carried out under computed tomography (CT) or fluoroscopy. Facet joint block is the gold standard in diagnosis of facet joint syndrome. It can also relief pain for up to 6 months. Purpose: To identify which imaging modality (CT or fluoroscopy) is more suitable to guide the procedure of lumbar facet joint block, and results in better relieve of symptoms. Study Design: Prospective analytic clinical case study. Patients and Methods: Sixty eight lumbar facet joints representing 24 patients were injected in the radiology department, Suez Canal University Hospital, Ismailia, Egypt from 1/2005 to 12/2010. All cases were suspected of having facet joint disorders based on clinical and radiological data. After clinical examination and reviewing lumbar images to identify target facets, every patient underwent facet joint block under either CT or fluoroscopy. Visual Analogue Scale was used to assess improvement of symptoms. Results: Fluoroscopy was more successful in guiding the injections (success rate 77.7% compared with 31.25% in CT guidance). It is also faster (6:37 minutes per joint compared with 10:54 minutes for CT guidance). Less number of trials were required (1.7 trial compared with 6.6 trials with CT guidance). Fluoroscopy exposed the patients and the radiologist to much irradiation (21.3 rad compared to 0.3 rad in CT guidance). Decreased bone density and laminectomy impair fluoroscopy guidance. CT guidance is difficult in patient with marked arthropathy and coronally oriented joints (8 trials compared with 5.6 for normally appearing joints). Both groups showed significant improvement of symptoms. Conclusion: Fluoroscopy should be the primary choice for guiding lumbar facet joint block. It is more successful and faster. Its disadvantages include much irradiation to patients and radiologists, and difficulty in patients with laminectomy and decreased bone density. CT can then be used to guide the block. Both techniques are effective in pain reduction. (2012ESJ035)

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Capacity of the Clinical Picture to Characterize Low Back Pain Relieved by Facet Joint Anesthesia

Cited by 240 publications

References 16 publications

Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial

Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial

Chapter 4 European guidelines for the management of chronic nonspecific low back pain

Comparison between Computed Tomography & Fluoroscopy Guided Facet Joint Block in Lumbar Spine

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