A multidisciplinary group of doctors and researchers has released new guidelines on how to treat cervical spine facet joint pain. Below is a summary of their combined recommendations.

The American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine formed a group of scientists, researchers, and doctors called the Cervical Joint Working Group. They asked this group of about 20 experts to develop guidelines for neck pain treatment. In this article we break down some of their recommendations.

What Is Cervical Spine Facet Joint Pain?

The cervical spine is the region of the spine from the upper back to the base of the skull, effectively in the neck area. (To learn more read our anatomy of the spine series.)

Facet joint pain is pain caused by issues in the facet joints. A facet joint is an area where one vertebrae of the spine moves in relation to another vertebrae, ie: a joint between two vertebrae of the spine. In particular, facet joints are joints in which the irregularly shaped portion of the vertebrae move in relation to one another. (Read more on vertebrae anatomy and facet joint pain.)

Recommendations for Treatment of Cervical Facet Joint Pain

Based on the Cervical Joint Working Group’s review, they make the following recommendations with regard to treatment of cervical facet joint pain. In their summary article, they carefully note that these are only recommendations and not strict standards. Cases, as always, can vary.

The types of treatments they reviewed are:

• Intra-Articular Joint Injections (IA) – an injection directly into a joint to treat pain which can consist of corticosteroids, anesthetics, or other medications
• Medial Branch Blocks (MBB) – a more specific type of injection associated with the facet joint
• Radio Frequency Ablation (RFA) – a pain treatment method in which heat is used to destroy a small amount of tissue on a nerve in an attempt to restrict its ability to send pain signals to the brain

Some of their recommendations, with respect to the treatments above, include:

• Patient history and a physical examination alone cannot reliably identify the exact joint and location of the problem area.
• Sedation is not recommended when performing diagnostic tests.
• There is currently no reliable method for predicting the effectiveness of a facet joint injection for chronic neck pain.
• Conservative treatment is recommended before a facet joint injection is utilized.
• When facet joint injections are performed, utilizing imaging equipment to guide the injection location is preferred.
• A few recommendations are made with respect to how facet joint injections should be made (ie: from which direction, at which angle the needle should be inserted). These approaches vary depending on the specific joint being treated.
• In addition, the type and amount of medication and/or anesthetic injected is outlined.
• In most cases, ablation should not be utilized as treatment unless injection(s) have proven unsuccessful in treating the pain.

Source

researchgate.net