OBJECTIVE: To determine the relationship between pain provocation and the analgesic response in lumbar zygapophyseal joint blocks. DESIGN: Consecutive patients undergoing intraarticular zygapophyseal joint blocks for the investigation of low back pain were included in this prospective study. SETTING: The referred sample was from the metropolitan areas of New Orleans and San Francisco. PATIENTS: Ninety patients with low back pain of > 3 months' duration and no history of lumbar surgery. INTERVENTIONS: All patients underwent one or more intraarticular injections of radiographic contrast followed by lignocaine (lidocaine) 2% into zygapophyseal joints between L2-3 and L5-S1. Those with definite responses at one or more levels underwent confirmatory blocks using 0.5% bupivacaine. OUTCOME MEASURES: Provocation of familiar pain and relief of pain after the injection of local anesthetic. Patients were assessed by an independent observer. RESULTS: A total of 203 joints were studied. Adopting liberal criteria, either exact or similar reproduction of pain on the one hand correlated with either definite or complete relief of pain after a single, analgesic block on the other (p < 0.0001). However, when more stringent criteria were adopted, such as response to a confirmatory block using bupivacaine, there was no significant association. CONCLUSIONS: This study calls into question the validity of pain provocation alone as a criterion standard in patients undergoing diagnostic lumbar zygapophyseal joint blocks.
OBJECTIVE: To determine the relationship between pain provocation and the analgesic response in lumbar zygapophyseal joint blocks. DESIGN: Consecutive patients undergoing intraarticular zygapophyseal joint blocks for the investigation of low back pain were included in this prospective study. SETTING: The referred sample was from the metropolitan areas of New Orleans and San Francisco. PATIENTS: Ninety patients with low back pain of > 3 months' duration and no history of lumbar surgery. INTERVENTIONS: All patients underwent one or more intraarticular injections of radiographic contrast followed by lignocaine (lidocaine) 2% into zygapophyseal joints between L2-3 and L5-S1. Those with definite responses at one or more levels underwent confirmatory blocks using 0.5% bupivacaine. OUTCOME MEASURES: Provocation of familiar pain and relief of pain after the injection of local anesthetic. Patients were assessed by an independent observer. RESULTS: A total of 203 joints were studied. Adopting liberal criteria, either exact or similar reproduction of pain on the one hand correlated with either definite or complete relief of pain after a single, analgesic block on the other (p < 0.0001). However, when more stringent criteria were adopted, such as response to a confirmatory block using bupivacaine, there was no significant association. CONCLUSIONS: This study calls into question the validity of pain provocation alone as a criterion standard in patients undergoing diagnostic lumbar zygapophyseal joint blocks.
Authors: Eric L Schiffman; Richard Ohrbach; Edmond L Truelove; Feng Tai; Gary C Anderson; Wei Pan; Yoly M Gonzalez; Mike T John; Earl Sommers; Thomas List; Ana M Velly; Wenjun Kang; John O Look Journal: J Orofac Pain Date: 2010
Authors: Eric Schiffman; Richard Ohrbach; Edmond Truelove; John Look; Gary Anderson; Jean-Paul Goulet; Thomas List; Peter Svensson; Yoly Gonzalez; Frank Lobbezoo; Ambra Michelotti; Sharon L Brooks; Werner Ceusters; Mark Drangsholt; Dominik Ettlin; Charly Gaul; Louis J Goldberg; Jennifer A Haythornthwaite; Lars Hollender; Rigmor Jensen; Mike T John; Antoon De Laat; Reny de Leeuw; William Maixner; Marylee van der Meulen; Greg M Murray; Donald R Nixdorf; Sandro Palla; Arne Petersson; Paul Pionchon; Barry Smith; Corine M Visscher; Joanna Zakrzewska; Samuel F Dworkin Journal: J Oral Facial Pain Headache Date: 2014
Authors: Eric L Schiffman; Edmond L Truelove; Richard Ohrbach; Gary C Anderson; Mike T John; Thomas List; John O Look Journal: J Orofac Pain Date: 2010
Authors: Edmond Truelove; Wei Pan; John O Look; Lloyd A Mancl; Richard K Ohrbach; Ana M Velly; Kimberly H Huggins; Patricia Lenton; Eric L Shiffman Journal: J Orofac Pain Date: 2010
Authors: Eric Schiffman; Richard Ohrbach; Thomas List; Gary Anderson; Rigmor Jensen; Mike T John; Donald Nixdorf; Jean-Paul Goulet; Wenjun Kang; Ed Truelove; Al Clavel; James Fricton; John Look Journal: Cephalalgia Date: 2012-07 Impact factor: 6.292
Authors: Laxmaiah Manchikanti; Mark V Boswell; Vijay Singh; Vidyasagar Pampati; Kim S Damron; Carla D Beyer Journal: BMC Musculoskelet Disord Date: 2004-05-28 Impact factor: 2.362