Health Problem: Chronic pain is defined as persistent or episodic pain of a duration > 6 months of an intensity that adversely affects the function or well-being of an individual. Back and neck pain are very common conditions in the United States. Low back pain was the leading cause contributing to the most years lived with disability in 2010, both in the United States and globally. Although it may be less common than low back or neck pain, chronic persistent thoracic spinal pain can be disabling. One study estimated the prevalence of all spinal pain in the general population as 66%, including 15% thoracic pain, 44% cervical pain, and 56% low back pain. Chronic neck pain with or without sprain or injury is a common occurrence in the general population and may cause serious disability.

Technology Description: A medial branch nerve block (MBNB) involves injection of local anesthetic with or without a corticosteroid into the vicinity of the medial branch nerves of the dorsal rami, which innervate the facet joints of the spine. Facet joints are pairs of joints that provide stability to the spine and enhance motion; they are located near the bony spine but not near the spinal cord. MBNBs are performed, usually in an outpatient setting, for treatment of pain of the lumbar, thoracic, or cervical spine. Using imaging guidance and local anesthetic of the skin over the injection site, the physician injects local anesthetic with or without corticosteroid into the area of the medial branch nerve associated with the facet joint identified as the probable source of pain. After a brief recovery, the patient is discharged on the same day.

Controversy: Major controversies in the use of MBNBs to treat chronic, nonresponsive spine pain of facet joint origin include the durability of response and the optimization of the treatment schedule. Appropriate patient selection criteria have not been defined beyond the presence of chronic, nonresponsive pain of facet joint origin. However, defining the pain as facet joint in origin has been controversial due to questions of the accuracy of diagnostic MBNBs to localize the involved facet joint level(s) for therapy.

Key Questions: Key questions regarding the use of MBNB injections for management of chronic nonmalignant spinal pain of facet joint origin include:

  • Do MBNB injections provide effective and sustained relief for chronic nonmalignant spinal pain of facet joint origin?
  • Are MBNB injections safe?
  • Have definitive patient selection criteria been established for the use of medial nerve block injections to manage chronic nonmalignant spinal pain of facet joint origin?

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